News and Opinions  –  2024

AMR must remain an important piece in the Pandemic Agreement puzzle

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On the 18th of March 2024, the Intergovernmental Negotiating Body (INB) resumed negotiations on the latest version of the Pandemic Agreement (previously referred to as a treaty, instrument or accord). At the time of writing, the INB negotiations are still ongoing in Geneva, where delegates are under pressure to finalize the agreement before the planned adoption at the 77th World Health Assembly in May.

Bacterium Pseudomonas aeruginosa, antibiotic-resistant nosocomial bacterium. Illustration. Photo: Shutterstock.

Addressing antimicrobial resistance (AMR) has been included in the previous versions of the Pandemic Agreement. However, the latest version has notably scaled back reference to antimicrobial resistance which is now only appearing under Article 4 “Pandemic prevention and surveillance” as follows:

“3. Each Party commits to progressively strengthen pandemic prevention and coordinated multisectoral surveillance, taking into account its national capacities, including through:

(h) antimicrobial resistance (AMR): take measures to address pandemic-related risks associated with the emergence and spread of pathogens that are resistant to antimicrobial agents, including through the development and implementation of national and, where relevant, regional antimicrobial resistance action plans, taking into account relevant international guidelines, and with the aim of facilitating affordable and equitable access to antimicrobials.”

In earlier versions, AMR-related provisions were also included under articles related to “One Health”.

While key aspects of AMR-related provision still remain in the latest version, member states should ensure that the opportunity to leverage the full scope of the Pandemic Agreement towards addressing antimicrobial resistance is not missed.

As INB negotiations enter their final stages, member states should emphasize the following:

1. Safeguarding AMR-related provisions in the Pandemic Agreement

There are multiple overlaps between the interventions needed in the prevention, preparedness and response to pandemics, and those needed to address antimicrobial resistance, as outlined by ReAct in previous policy brief. This includes, but is not limited to preventative efforts and improving and expanding surveillance and laboratory capacity. Ensuring equitable and affordable access to effective antimicrobials must remain a clearly stated objective.

As ReAct has outlined in an article last year in the Journal of Law, Medicine & Ethics, the impact of the lack of access to effective antibiotics is disproportionate, with low- and middle-income countries being the most affected. To achieve equitable access, a health systems approach is required, including the strengthening of preventive measures, diagnostics, and infrastructure, as well as coordinated efforts towards health workforce and quality care. Additionally, reforming antibiotic innovation to ensure equitable and sustainable access is crucial.

2. Including antibiotics within the agreement’s definition of “pandemic-related products”

As seen during the COVID-19 pandemic and other viral pandemics, secondary bacterial infections are often a major cause of death. Effective antibiotics are critically needed in the event of a pandemic to ensure that basic and advanced medical care can continue, including for neonatal care, cancer treatment, transplantations, etc. Addressing the growing problem of antibiotic resistance and ensuring availability of effective antibiotics is therefore a critical component of pandemic preparedness and response. ReAct has previously highlighted the importance of considering antibiotics under the definition of “pandemic related products”.

3. Acknowledging bacterial threats: the definition of “pathogens with pandemic potential” should take into account the bacterial pathogens

While viral pandemics often dominate discussions, bacterial pathogens pose significant risks. Historic records of bacterial pandemics such as the plague and the potential of bacteria to mutate and change in potentially unforeseen ways must not be ignored. It is therefore important that the agreement and related processes of assessing pathogen risks, are robust enough to prevent, prepare and respond to potential pandemics of bacterial origin.

4. Equity a central objective to be matched by actionable terms

Beyond the issue of inclusion of antimicrobial resistance in the agreement, member states must ensure the Pandemic Agreement upholds its stated principles and objectives on equity. Lessons learned from the COVID-19 pandemic highlight the urgent need for equitable distribution of medical countermeasures. The agreement’s objectives and guiding principles on equity cannot remain a preamble, but must be matched by a set of actionable terms on equitable access, benefit sharing and related provisions that ensures equity is truly placed at the heart of the agreement.