5 years after the UN Political Declaration on AMR – where are we now?

2021-09-30

On September 21, 2016, prompted by calls from academia, civil society organizations and the World Health Assembly, the United Nations General Assembly (UNGA) convened a high-level meeting on antimicrobial resistance - which agreed on a political declaration on antimicrobial resistance (AMR).

Despite the many commitments made by UN Member States in the declaration the individual and societal consequences of antibiotic resistance continue to spiral upwards.

Professor Otto Cars, former member of the UN Interagency Coordination Group on AMR, gives his view on the status quo five years after the adoption of the political declaration. ReAct staff from across the ReAct network also give their perspectives on the impact of the political declaration in the African region, in Latin America and in India.

In Financial Times earlier this week, Otto Cars, former UN Interagency Coordination Group on AMR and founder of ReAct, was quoted saying:

“Comparing the many commitments made in the UN declaration with how governance and financial initiatives for AMR has developed in reality, progress – and particularly the pace – has been truly disappointing.”

We continued the discussion with Professor Otto Cars, a long-time advocate for action on antibiotic resistance.

What are your thoughts about global progress this far?

– This slow pace has been detrimental. In the political declaration UN members states committed to many initiatives which has not been delivered on. Three of the most important steps for the UN, the UN agencies, governments, development banks and civil society and other actors need to deliver on are:

– One: There is an urgent need to mobilize adequate, predictable and sustainable funding to support human resources and costs related to adaptation of systems. National, bilateral and multilateral channels all need to come together to support the development and implementation of national action plans.

– Two: The research and development system for new antibiotics, diagnostics, vaccines and other technologies relevant for antibiotic resistance needs to be revamped and revitalized. We also need strengthened collaborative research infrastructure and innovative financing mechanisms. We need a system that is needs-driven and builds on the principle of ensuring a public return on public investment. It should be based on the principle of delinking the cost of research and development from the price and volume of sales of the end-product, which all the UN Member States supported in the political declaration.

– Three: There is an urgent need to ensure that national action plans include the development and strengthening of: effective surveillance, monitoring and regulatory frameworks on the preservation – use – and sale – of antimicrobial medicines for humans and animals. Simultaneously, governments need to secure affordable access to effective antibiotics for all in need. The national response to manage antibiotic resistance should take a systems approach, and address it as a development issue, where infrastructure and capacity building will be needed within the health and food production.

What are the responsibilities of high income countries in relation to the UN Declaration of AMR and use of antibiotics?

– High income countries should lead by example, however, unnecessary use of antibiotics remains high in most of these countries. Wealthy countries have been able to kick the can down the road by switching to new and more expensive antibiotics to treat resistant infections. This is both an unsustainable strategy as the development of new antibiotics isn’t keeping up with resistance development, and it is also a strategy that only few countries can afford.

– Already-fragile health systems in low-income countries will be stretched beyond breaking point as the switch from first-line antibiotics can add a median overall cost of $700 per infection.

Antibiotic resistance is not like COVID-19 – it is not an unpredictable pandemic

– Governments need to initiate, increase and sustain awareness and knowledge-raising activities on antibiotic resistance together with other actors both at the global, national and local levels, in order to engage and encourage behavioral change in different groups.

– Antibiotic resistance is not like COVID-19 – it is not an unpredictable pandemic. The world governments already knows know what to do to prevent and manage it. Now it is time to walk the talk – and make the necessary reforms to the health system, the research & development system and the food animal production system. Political will is what is needed.

We also asked Tracie Muraya, Policy Advisor at ReAct Africa, how the declaration has affected efforts in the region.

After the UN declaration was established – what progress and challenges do you see in the African region?

– Following the UN declaration on AMR, many African Member States joined the rest of the world and put in place their National Action Plans (NAPs) on AMR between 2017 and 2018.

– Five years later, significant milestones have been achieved. For instance, the number of countries having AMR NAPs in place is now 38 up from only 3 in 2018. Majority of the countries have, and continue to conduct interventions to promote awareness and understanding on antibiotic resistance, albeit efforts around this objective focus on the annual World Antimicrobial Awareness Week.

Increased efforts on antimicrobial stewardship needed

– Efforts around promoting the prudent use and consumption of antibiotics (antimicrobial stewardship) have been identified by many states as a priority, and while less than a handful have stewardship policies and guidelines in place, the momentum is picking up.

– Through external funding support, the continent’s surveillance on antimicrobial use and resistance continues to take shape with 33 countries currently reporting to WHO’s Global AMR Surveillance System (GLASS).

– Unfortunately, the aforementioned efforts have in the recent past been watered down by the disruptive nature of the ongoing COVID-19 pandemic.

Sub-optimal political will and identifying streamlined funding a challenge

– Furthermore, challenges in identifying and streamlining funding for priority activities, thinly-stretched National AMR Coordinating Committees and sub-optimal political will continue to threaten the sustainability of these milestones.

– On the flip-side, the ongoing pandemic presents opportunities to bolster the continent’s response to antibiotic resistance. For instance, significant investments have been made to strengthen Infection, Prevention & Control (IPC) and Water and Sanitation Hygiene (WASH) in response to COVID-19. Strengthening these sectors can lead to reduce infectious disease transmission and reduce antibiotic use, thus positively impacting efforts to address antibiotic resistance.

– Through the capable coordination by the regional Tripartite body (WHO, FAO, OIE), the United Nations Environmental Program regional office and the Africa CDC, relevant interventions can be streamlined into such sectors – especially now that majority of country National Action Plans on AMR are due for revision – for greater efficiency and impact.

Arturo Quizphe Peralta, Director, ReAct Latin America reflects on actions in Latin America during the last five years.

What are your reflections on the political declaration on AMR and actions in Latin America?

– Although ReAct has been working and promoting the containment of resistance for 15 years and the United Nations Political Declaration on Antimicrobial Resistance is only 5 years old, it has served as a basis to strengthen the agenda with the One Health approach. This by integrating social organizations, professionals and indigenous peoples for a broader vision on antibiotic resistance actions.

– We have taken important steps such as reflecting on the need for access to basic services and healthy environments, food systems that promote antibiotic care, sustainable access, health promotion, and strengthening the first level of health care. But some of the issues raised in the declaration are still missing, such as technology transfer, involving more actors such as the media, more funding and political decision.

In the India the reality is similar as in the African region. To learn more we asked Philip Mathew, Deputy Director, ReAct Asia Pacific, about the impact of the declaration.

How has the UN declaration on AMR affected efforts in India?

– The political declaration of the UN High-Level meeting on AMR went a long way in increasing visibility and support for the Global Action Plan in country contexts. As with several other countries, it helped to facilitate a National Action Plan on AMR in India.

– These action plans have spawned several interventions like a surveillance system for antibiotic resistance, guidelines for infection control in healthcare facilities, standard treatment guidelines for antimicrobial use etc.

Difficult to implement action plans – due to lack of resources and structural limitations

– But the efforts have been rather piecemeal and the country has not been able to implement the action plans effectively, due to resource constraints and structural limitations. The unique federal structure of governance in India requires the states to be actively engaged in any efforts to contain the AMR issue, but only three states have published their own action plans till date. Besides, Covid19 has taken away most of the limited political capital available for the antibiotic resistance issue in a country like India.

Global governance and advisory structures not up and running

– The governance and advisory structures recommended by the Inter-Agency Coordination Group on AMR, which was established as a result of the political declaration, is yet to be fully operationalized. There is an urgent need to push for these structures to be initiated, otherwise we stand the risk of further depleting the limited momentum around the antibiotic resistance agenda in country capitals.

Advocate for a follow up meeting at the UN

– The global AMR community should also advocate for a follow-up meeting at the UN, to assess the progress after the political declaration of 2016, and re-calibrate the global approach to AMR against the background of experiences and lessons learned from the COVID-19 pandemic.