It has been almost 5 years since the global leaders committed at the UN General Assembly in 2016 and adopted the landmark UN Political Declaration on antimicrobial resistance.
At the time of the UN High-level Interactive Dialogue on Antimicrobial Resistance taking place today, it is a cold reality that identified barriers and systems challenges common to COVID-19 and antibiotic resistance remain valid today, while coordinated action has not kept pace on a global scale. It should be a wake-up call and time is ticking for the global community to walk the talk on antibiotic resistance, of which the individual and societal consequences are more detrimental and far reaching.
Given the slow progress despite country commitments, global governance and financing structures must be urgently established and functioning to deliver sustained and inclusive responses to mitigate antibiotic resistance. Strong authoritative assessments on evidence and options for mitigation are needed for the priority-setting and steering the direction of the One Health Global Leaders Group on antimicrobial resistance, as are the perspectives and contributions of the broader communities and non-governmental actors.
The Political Declaration on antimicrobial resistance of the UN General Assembly in 2016 called for an ad hoc Interagency Coordination Group (IACG) to provide practical guidance to ensure sustained effective global action to address antimicrobial resistance. In its recommendations issued in April 2019, the IACG recommended the establishment of three new global governance mechanisms:
- A One Health Global Leaders Group on AMR;
- a multi-stakeholder partnership platform (to be established)
- an Independent Panel on Evidence (to be established)
By far, antibiotic resistance has not been visible in the global funding landscape. While the establishment of the Antimicrobial Resistance Multi-Partner Trust Fund has been a positive first step, commitments from only a few countries and the US$14.6 million pledged so far, are very far from matching the actual needs. An important priority for the One Health Global Leaders Group on antimicrobial resistance should be to follow through and move forward implementation of the ad hoc Interagency Coordination Group (IACG) recommendations and mobilize donors globally to strengthen and coordinate funding streams to manage antibiotic resistance.
Antibiotic resistance should be included as an important component in funding streams for the Sustainable Development Goals, Universal Health Coverage, and Health Systems Strengthening.
The IACG recommendations urged existing financing mechanisms, such as the Global Fund to fight AIDS, tuberculosis, and malaria, to give the issue greater priority in their resource allocations, including assessing the need to expand their scope and mandate.
In low- and middle-income countries, a major problem is the scarcity of incentives and resources to fund and support implementation of national action plans. Another barrier in many countries is the lack of political leadership at national level with underfunded and understaffed national AMR secretariats leading to poor coordination and engagement across sectors. Civil society organizations have been an underutilized resource, even though it has been evident that they can be mobilized to carry out several components of the national action plans.
IACG called for:
‘‘the systematic and meaningful engagement of civil society groups and organizations as key stakeholders in the One Health response to antimicrobial resistance at global, regional, national and local levels”.
Evidence gaps, narrative barriers and scarce data on context specific needs and related consequences were among the main barriers for national champions to convince policymakers. Yet the enormous amount spent on the COVID-19 pandemic should serve as a clear example that reluctance by governments to invest in preventing and managing the cross-border threats of antibiotic resistance now, only means paying far more later. Tangible funding for national action plan implementation needs rapid expansion, with an ultimate goal to be financed from sources within countries’ budget lines.
Securing equitable and sustainable access to effective antibiotics is a global responsibility. As most countries in the near term will likely be entering a period of fiscal austerity, synergies should be achieved through well-designed interventions and investments in areas that address all key functions of One Health systems. Calling is not enough, this time, we must walk the talk: all countries should take coordinated actions across sectors to tackle antibiotic resistance! Time is ticking now!
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