ReAct 20 years: Otto Cars on the 20 year journey and the future

As ReAct marks 20 years of global action on antibiotic resistance, we’re celebrating the people in the network. Prof. Emeritus Otto Cars is ReAct’s founder, and has been with the network throughout its 20 years of existence. Being an infectious diseases doctor and having dedicated most of his professional life to catalyzing a strong global response to antibiotic resistance, he shares his reflections on the achievements in the past and the challenges of the future.

Looking back at ReAct’s work over the last 20 year, what deserves in your mind to be highlighted?

– I think ReAct has succeeded in showing how antibiotic resistance can be translated from a technical and scientific issue into something that is more understandable both for the general public and for politicians. Long before “One Health” became the word of the day used to describe the interconnections between humans, animals, environment, ReAct was talking about understanding antibiotic resistance as a holistic ecosystems issue in which we see bacteria as something to live in balance with – not something we in war with!

ReAct has also been able to communicate the impact of antibiotic resistance on broader agendas, such as global social development, and visualizing how antibiotic resistance is disproportionately affecting low-and middle income countries and reflecting global inequity. I think this has helped increase the political attention to the issue – and perhaps as a result – helped to elevate the issue to the highest political level at the UN General Assembly twice.

What do you think ReAct should focus on in the coming 10 years?

– I think that is too long a horizon. The world must be able to show its ability to do the heavy lifting needed urgently. So, in five years from now, I think two things should be underway – with one probably being a prerequisite for the other:

– First, we need to continue to refine the narrative of antibiotic resistance even more. We need to understand that good data does not automatically lead to political action – instead vi need to navigate the political space much more and much better. To do that we need to leave behind the technical language filled with inaccessible abbreviations, and start to formulate the political aspects of what the data is showing us, and what is at stake. For example, we should emphasize how diseases we all know – like cancer – will be much more difficult to recover from, and continue to insist on the injustice of millions of people in LMICs dying needlessly today because they can’t access the antibiotics they need to survive. A narrative that starts in such examples is more relatable, engaging on a human level and easier to understand.

– Second, I believe the world will need to move into negotiating a global agreement on antibiotic development, access and use. Today’s non-binding governance of commitments and goals will in my mind not be enough to rein in the strong market forces at play, which has dried out the development of new antibiotics and diagnostics, and which still drives unnecessary prescribing across sectors, and leads to major problems with lack of access.

 How do we get there?

– Well, with a better narrative to capture the political and societal attention and understanding, I think the pressure needs to increase from below: from communities, professions, civil society. Alongside the availability of good data and actionable scientific advice from experts. I believe these are the actors that can build up the needed pressure, and have the ability to demand more accountability from countries, which could create a momentum for an alliance of champion countries to initiate global agreement process.

– But for all that to happen, we need the urgent engagement of a couple of philanthropists with foresight, vision and commitment to strengthen a bottom-up approach – and with it we need a renewed leadership and vision from a coalition of champion governments.

What has been some of the most memorable moments from your last 20 years with ReAct?

– Witnessing the continuous evolution of ReAct, and the increasing visibility and outreach of the whole network and in the regions has been rewarding. Speaking on behalf of ReAct at the UN last year during the High-level meeting on AMR was certainly a memorable moment for me personally.

But what actually comes to mind more strongly are the numerous – planned or serendipitous – interactions with people over the years. The many meetings that makes you think – and rethink – and which creates renewed energy, and increases influence through synergies. At the inaugural meeting of ReAct in 2005, I still remember a statement of advice given by Dr. Suwit Wibulpolprasert from Thailand, who then said: “friendship and trust is what runs the world”. It has been the case so many times since then – that the change I and the people in ReAct have been part of pushing, has come down to just that – personal relations and trust.

I want to share that because I think it is a good message to send to the wider antibiotic resistance community – to try to come together a bit more, build the relations and the trust – and push more collectively on those big areas, that we all agree need to move forward.

Antibiotic resistance – a silent pandemic. A portrait of Professor Otto Cars and his life-long engagement in saving these life-saving medicines. The film is produced in Swedish by Marcus Holmqvist, Uppsala University. 

ReAct celebrates 20 years of action on antibiotic resistance!

The story of ReAct began 20 years ago with a small group of passionate global health advocates, several of whom are still part of the network today. Driven by the urgency of antibiotic resistance, ReAct has grown into a global movement with offices across four continents, influencing policy, empowering communities, and shaping governance.

Despite progress, global efforts remain insufficient, and urgent action is needed. ReAct remains committed to driving stronger responses to safeguard effective antibiotics for all.

ReAct’s 20-year journey has transformed AMR governance, strengthened health systems, and mobilized communities worldwide. As we look to the future, we invite partners and funders to join us in scaling impact, driving innovation, and securing sustainable solutions — for a world free from untreatable infections.

The story of ReAct.

Learn more about ReAct 20 years celebrations.

More about ReAct.