News and Opinions  –  2022

15 things that need to happen in 2023 – for a robust response on antibiotic resistance!

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2022 is coming to an end. And the silent pandemic of antibiotic resistance is growing right before our eyes. 1,27 million people die from antibiotic resistance every year. 7,7 million people die from bacterial infections every year. To add on to this, bacteria see no borders - we all are connected - humans-animals-environment - so the challenge rises far beyond human health.

Photo: Tumisu, Pixabay.

This makes things even clearer.

We all need to step up and act stronger – on all levels – to mitigate antibiotic resistance – for sustainable access to effective antibiotics for all.

The good thing is that we still can. We can still slow down this rising pandemic and act for the health of humans, animals and the environment. But we need to step up now. Not in five or ten years.

ReAct will continue to act as a catalyst for change and continue our mission to enable collective action that ensures sustainable and equitable access to effective antibiotics for all.

Let’s intensify work in 2023. Together we can work for a world free from untreatable infections.

ReAct’s five nodes see these 15 things as key in 2023 – for a robust global response on antibiotic resistance:

ReAct Africa

Photo: Jozua Douglas, Pixabay.

1, Improved Governance and Finance structures for antimicrobial resistance (AMR) and health systems within the African region
– through strengthened civil society organization platforms

To actualize this there is a need for civil society to engage in antimicrobial resistance issues and advocate for Member States to meet their commitments – this by establishing full time AMR Secretariats and allocating national budgets for antimicrobial resistance.

For global policy on antimicrobial resistance –  the Global South voice and perspective needs to be included in global strategies and solutions.

2, Effective implementation of revised National Action Plans on AMR in the African region

Member States in the African region need to continue develop and revise their costed National Action Plans on AMR – to be able to implement them effectively.

We hope to see strengthened antimicrobial stewardship at facility and community levels, through improved stewardship programs. Key community stakeholders such as students, youth groups and religious leaders need to be engaged via effective behavior change models, so as to bring about behavior change in antibiotic use amongst community members overall.

3, Strengthened capacity for local research, manufacturing and improved access to currently available health technologies (including effective quality antibiotics) within the African continent

Via regional bodies for Member States we hope to see  improved capacity for local research and availability of effective antibiotics in the region.

ReAct Asia Pacific

A pilot project on how to engage a community in India is under progress, lead by ReAct Asia Pacific. Photo: ReAct Asia Pacific.

4, Learning from community engagement to advance the AMR agenda in the region

We wish to see greater harnessing of the power of communities to change things on the community, in the context of antimicrobial resistance. This can be done by convening civil society organizations, community stakeholders and also representatives from a wider network of AMR-sensitive themes such as gender, environment and social equity.

Taking such a whole-of-society approach will help ensure that the network of influential civil society groups amplify the voice of communities at the grassroots to influence the agenda of policy makers in the national capitals and beyond.

5, Decentralizing implementation of National Action Plans on AMR

In countries with a large population and geographical area, with a federal system of governance there is a need to decentralize implementation of National Action Plans on AMR.

For example, in India state governments have power to influence the drivers of antimicrobial resistance in various ways, though it is largely ignored by the traditional narratives around implementation of National Action Plans on AMR.

6, Tackling  environmental transmission of antibiotic resistance

Inferior infrastructure in many low-and middle-income countries results in environmental pollution from antibiotics used in rice cultivation, wastewater in manufacturing units, and human fecal waste being disposed of without treatment.

There is a need for more insights on the  contributing factors to such environmental pollution, its link with antibiotic resistance and the measures needed urgently to mitigate this problem.

ReAct North America

Photo: Shutterstock.

7, Finding clear connection between AMR and pandemic readiness

Before some put COVID-19 in the rear-view mirror, it will be important to draw lessons and synergy between investments made for pandemic prevention, preparedness and response and those needed to tackle antibiotic resistance.

These include common points of shared intervention include zoonotic disease transmission, integrated disease surveillance (e.g., global wastewater surveillance system), infection prevention and control, and an end-to-end approach to enabling innovation and access to needed health technologies.

8, Supporting country-level priorities, targets and financing for tackling antimicrobial resistance

We must continue to make the case for funding efforts to address antimicrobial resistance – how today’s investments can avert tomorrow’s high human and economic toll, if antimicrobial resistance remains unchecked. But part of making that case also means defining priorities. As with climate change, high-income and upper-middle income countries, in particular, that use the most antibiotics ought to take greater responsibility.

As the World Bank has projected, investments to address antibiotic resistance in lower-income countries will return significant economic benefits, but 80% of the benefits will flow back to benefit high-income and upper-middle income countries – those best positioned to make these investments.

9, Making markets work, both to bring forward new drugs, diagnostics and vaccines to address antibiotic resistance – and to curb the unnecessary use of antibiotics

We must target investments effectively at the part of the Research & Development pipeline where we still face the scientific bottleneck and at the small- and medium-sized firms that are doing most of the innovation of novel antibiotics. We need a new business model that takes an end-to-end approach, not just hikes the returns for those taking antibiotics the last mile to market.

There are huge opportunity costs from just meeting profit expectations of large pharmaceutical companies – missed opportunities of making more cost-effective investments to reduce antibiotic resistance.

By changing incentives in the market, we can also enlist others, from food buyers to food producers, as well in these efforts to reduce the use of antibiotics in this One Health effort to address antibiotic resistance.

ReAct Europe

EU flag
EU flag. Photo: Ralphs Photos, Pixabay

10, Antibiotic R&D and access are key topics for the upcoming EU presidency

The EU is currently working through several policy work-streams to strengthen its actions and cooperation at European and international level in response to antimicrobial resistance.

The Swedish Presidency has placed antimicrobial resistance as one of its key priorities during the spring 2023 and its leadership will be instrumental in ensuring strong EU commitments at global level, e.g. by ensuring inclusion of concrete AMR actions in the pandemic treaty, as well as through strengthened EU coordination and collaboration processes to revitalize the stagnated field of antibiotic development and improve global access to both new and existing antibiotics.

11, A globally coordinated public-health driven antibiotic R&D

Major scientific challenges in early stages of drug discovery continue to hamper antibiotic development, and financing for preclinical and clinical development are neither sufficient nor coordinated or targeted enough.

The antibiotic pipeline falls far short of meeting global needs, and global and national discussions need to move away from focusing on “market fixing”, which tend to focus on how to re-enlist the big multinational pharmaceutical companies within the constraints of their traditional business model.

Instead, an end-to-end approach to public health needs-driven Research & Development and equitable access to effective antibiotics is urgently needed.

Collective action and better coordination and collaboration at EU and global levels are cornerstones to set rules, define priorities, and provide sustained funding to boost early discovery efforts, while enabling the progress of promising antibiotic molecules through to clinical development. These efforts should also further explore the roles of publicly funded and not-for-profit models and entities in tackling the vulnerabilities in the antibiotic pipeline.

12, A strong road to UN AMR-HLM 2024 and the WHO Pandemic Accord negotiations

Key stakeholders need to push for stronger and more effective governance mechanisms on both global and national levels – to secure sustainable access to effective antibiotics for all in need.

We need transparent and inclusive policy dialogues to deliberate on key steps towards a roadmap for global agreements on antibiotic resistance, preparing for the upcoming UN High-level Meeting on AMR in 2024, as well as the drafting and negotiating process for a WHO pandemic accord.

In both streams we need: fair representation and voices from low- and middle-income countries, we need to bring together communities, academia, civil society and other relevant actors to more actively engage in governance structures and processes and monitor for accountability.

Decision makers should recognize that a resilient health system relies on equitable and sustainable access to effective antibiotics. Antibiotic effectiveness must be seen as a global public good, and its preservation, a shared global responsibility.

ReAct Latin America

School girl learning about antibiotic resistance. Photo: ReAct Latin America.

13, Engaging and empowering communities

Well-informed, sensitized, aware, mobilized communities must become the heart of health systems – united to implement action plans against antibiotic resistance with a holistic, One Health approach.

We must build a movement of a wide range of actors who are engaged in antibiotic resistance including consumers, farmers, artists, social and environmental organizations, health care professionals and government officials.

We must look for new partners, and identify key entry points for integration of antibiotic resistance in the agendas of their respective organizations. Together, communities with hands-on action are essential to support and accelerate the implementation of national plans at the local level.

14, Children act as agents of change for antibiotic resistance

The Global Action Plan on AMR highlights the need for education on antimicrobial resistance and its related topics and recommends working with schoolchildren to support learning from an early age.

Children and youth must experience meaningful learning that connects the problem of antibiotic resistance in a holistic way to their everyday lives and experiences. This will lead to not only improved health, but also build healthy habits, and support good decision making about their current and future health. Furthermore, children will act as change agents for other children, their families and communities.

15, A holistic One Health approach to antibiotic resistance is needed

The current metaphor of the “war on antibiotic resistance” has proven to be counterproductive and one of the factors behind growing resistance.

We must move to an alternative metaphor which captures the complex human-animal-environmental-medicine-microbe interaction.

We must move towards context-appropriate metaphors like “Dancing with the bacteria” with idioms and language that communities can easily understand and translate into action.

This will also help to bring together a wider network of social and academic organizations, consumer networks, environmentalists, artists to work together based on a holistic understanding to stop the development and spread of antimicrobial resistance.

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