As global attention and political will to address the rising tide of antibiotic resistance has increased over the last years, and a wider range of actors starting to become involved in the field, the urgency of developing global governance of antimicrobial resistance (AMR) is growing.
Discussions of what a more elaborate and permanent and global governance system should look like and what it should address are therefore beginning to emerge. Ensuring that low- and middle-income countries are able to influence the discussions in the policy fora that are formulating rules, principles and structures that will govern the global response to antimicrobial resistance will be important in order to develop sustainable solutions that work in all countries.
Early governance structures have already emerged with the adoption of the Global Action Plan and the UNGA Political declaration on AMR down to the national level where national actions plans are being developed. The UN General Assembly took another step in 2016 with the establishment of an ad-hoc UN Inter-Agency Coordination Group (IACG). Its time-limited mandate, set out in the Political declaration on AMR, tasked it to “provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance’ while also providing recommendations “on options to improve coordination”.
The IACG has since been divided into several subgroup, which will all develop recommendations on a range of issues, including on global governance. The final report from the IACG will be submitted to the UN General Secretary by September 2019, who will subsequently present his recommendations to the Member States for their consideration during the 73rd session of the UN General Assembly.
However, the discussions on global governance including what form it should take are also getting increasing attention in academic journals and it will likely only increase in the coming years.
Strong scientific base
The body of academic research in antimicrobial resistance and its drivers is growing and it is becoming increasingly difficult to keep track of the most recent scientific findings. A more elaborate global governance system should however be based on a strong scientific base and be able to ensure the soundness of its evidence base. This would ensure that a global response is continuously informed by the growing level of local and country level data being generated and the most recent breakthroughs on the scientific side.
Ensure broader action
Antibiotic resistance is caused and driven by a wide range of factors, including overuse and misuse of antibiotics in humans and animals; lack of access to infection prevention measures like vaccines and basic health care, poor quality water, sanitation and hygiene to name a few. The tripartite consisting of the WHO, OIE and FAO are able to cover a wide range of human and animal health issues, but the responsibility to tackle antibiotic resistance stretches far beyond those three UN agencies. A global governance system will need to enable ta broader remit of action and be able to influence a wider set of relevant policy agendas including (but not exclusively) those on sustainable development and poverty reduction.
Ensure coordination and needs-driven response
The field of antimicrobial resistance is becoming increasingly crowded and the coordination of actions more challenging, which in turn increases the risk for wasteful duplication of efforts. A global governance structure should be designed to have sufficient overview of what work that is being done across sectors and agencies including where funding is made available in order to be able to identify gaps. Moreover it will be important that a strong link to countries and to civil society is established to ensure that responses are driven by the actual needs on the ground – in particular those in low- and middle-income countries.
Transparency for accountability
Importantly any new global governance structure will need to work in a transparent and inclusive manner making it possible for civil society to engage in monitoring and evaluation activities to hold actors accountable to their commitments. Without effective monitoring and data transparency, the accountability and responsiveness by governments to the particular challenges and concerns of the most vulnerable in low- and-middle-income countries will likely fall short.
Ensuring sufficient financing
Finally funding sources for tackling antimicrobial resistance continue to be few and far between. Many low-and middle-income countries struggle to be able to fund the implementation of their national action plans, and so far there are not obvious places for them to turn to for support. Both the Global Action Plan and the UNGA Political Declaration on AMR were silent on funding mechanisms and it remains a deep concern that a continued lack of resources will severely limit the world’s ability to effectively respond to antimicrobial resistance. A global governance structure should therefore be able to mobilize sustainable financing – in the very first instance to support low- and middle-income in implementing their national action plans.