Reflections from the week of the UN High-Level Meeting on AMR in New York

2024-10-24

The second UNGA High-Level Meeting on AMR in New York came with unprecedented attention and side-event activities, and left us with a declaration text that sets a target on reducing mortality by 2030 from antibiotic resistance, but without a fully credible pathway on how to achieve it. Here we offer our reflections from a week filled to the brim with events and discussions.

1. The buzz around the meeting was impressive

The High-level meeting (HLM) itself was of course a big day with close to eight hours of member state interventions and two panels with external discussants. But the side events that took place both in days leading up to the HLM and even after, were where the more interesting discussions took place. It was obvious that the global community who cares about antibiotic resistance (and AMR more broadly) has grown immensely since 2016. ReAct was present in New York with representation from all of our four regional nodes and despite being a relatively big delegation, we were far from able to cover or attend all events.

Elevating community voices

ReAct kept up our end by co-organizing a well-attended side event discussion and exhibition with a number of civil society and community groups at a small gallery on the west side of Manhattan. Aside from exploring and discussing the many roles that communities and civil society groups play in the global response to antibiotic resistance, the “From People to Leaders: Act on AMR NOW! Call for Global Action” – with its almost 200 signatures from communities and organizations worldwide – was handed over during the side event to a representative from Malta, one of two co-convening countries of the political declaration negotiation process.

The powerful testimonies from communities and CSOs representatives sharing the stage during the event called for increased inclusiveness in governance and improved accountability mechanisms; for the integration of WASH in healthcare facilities; and for the need to tackle the environmental consequences of overusing antibiotics, especially in the production of animal-based food. The event was web streamed and a recording is available here.

Stronger efforts are needed to reach those outside the bubble

Despite the proliferation of actors and events it was, however, often the case that discussions about antibiotic resistance and how to address it took place between those already converted. Collectively reflecting back on the week, a lesson learned for all involved would probably be that even stronger efforts are needed to reach those outside the bubble – in particular those with power to unlock funding and those yet to be convinced by the magnitude of the problem.

2. The final declaration text did not meet expectations in key areas

Broadly speaking the feeling among most stakeholders in New York seemed to be one of satisfaction that the declaration was actually landed, and that it included at least some steps forward. The diplomatic skills that went into landing the declaration should not be understated. The process was marred by a tense geopolitical backdrop from get-go and all the way through (as the extensive roadblocks around the UN building on the day of the HLM to move demonstrations elsewhere, were a testament to). Even if the declaration was approved to be submitted to the General Assembly during the HLM, the actual adoption of the declaration text which followed afterwards apparently also proved difficult. Multilateralism 2024 is certainly a different game than in 2016.

Implementation pathway is needed

The 10% mortality reduction target by 2030 and the establishment of the evidence panel, are two examples of positive progress. It should be noted, however, that a lot of detail still needs to be fleshed out. The extent to which governments will take responsibility individually and regionally for developing a credible narrative on how to achieve the 10% mortality reduction target, as well as designing a truly independent and globally representative evidence panel, will only become visible in the coming months.

Beyond these positive steps forward, many actors – ReAct included – voiced disappointment with the lack of ambition in other key parts of the Declaration such as on financing, access, research & development, animal use and governance. Stuck positions in the pandemic treaty negotiations at the WHO in Geneva on financing and access to health products played their part in blocking more bold commitments in these areas, and business interests certainly succeeded in watering out initial bold commitments on restricting use of antibiotics in animals.

The onus will now be on the upcoming Ministerial meeting in Saudi Arabia to see if a more convincing implementation narrative, and not least – commitments for action in the above areas – will materialize. With the AMR Multi-Stakeholder Partnership Platform having its second convening on the side of this Ministerial meeting there is ample opportunity for governments to engage with stakeholders there – in particular actors from civil society and communities – to seek inspiration on how to concretely start working towards more sustainable uses of antibiotics (and antimicrobials more broadly) across sectors and in communities.

3. Serious structural problems in ensuring participation from civil society from the global south at UN HQ

It is well-known that the UN headquarters in New York isn’t particularly good at bringing in other voices than those of Member States, and during this year’s UNGA, ReAct experienced firsthand the structural problems which bars civil society colleagues from the global south from participating.

Short registration process

The short registration process for both the stakeholder hearing in May, as well as the actual HLM meant that many colleagues from low- and middle-income countries were unable to secure visas in time to participate. Both meetings were streamed online, but did unfortunately not allow for online participation which seems like an obvious way to ensure better representation. The problem with obtaining visas is unfortunately a well-known for almost all international meetings and academic conferences held in the global North, and it is a real source of concern.

No entry passes despite successful registration

At this HLM it was even the case that colleagues from ReAct Africa had visas and confirmed registration from the UN secretariat for two participants for the HLM in place before flying to New York. Despite being there with all registrations and papers in order, they were notified by email the day before that they would in fact not be granted access to the HLM due to capacity constraints. This meant that on the day of the HLM two colleagues from ReAct Europe were let in, while our African colleagues had to watch the meeting from their hotel rooms in NYC. We find this treatment deeply disrespectful – in particular given that there were indeed seats left in the rooms, which makes the rejection even more unjustified.

It turned out that our African colleagues were not the only ones with this experience. We know of at least two other colleagues from communities and civil society flying in from the other side of the world with all the costs that entails (including to the climate) only to not be granted entry passes to the meeting for unclear reasons.

This arbitrary exclusion of important voices and perspectives from the global south is deeply problematic for the UN and for the global debate, and governments should be concerned about correcting these structural barriers with urgency. At the very first, they should ensure that similar stories are not repeated at the upcoming meeting in Saudi Arabia in just a few weeks from now.