With the onset and fast pace of globalization, global governance helps address issues that affect all countries regardless of borders. Antibiotic resistance is one such threat to the security of people all over the world.
Global policies are often used in advocacy initiatives to remind countries of their global commitment to antimicrobial resistance and to hold governments accountable to track progress towards managing these commitments.
Global burden of antibiotic resistance in 2019
In January 2022 the most comprehensive data to date on the global health burden of antibiotic resistance was published in the Lancet. An estimated 1.27 million deaths were found to be a direct result of antibiotic resistant bacterial infections in 2019.
Based on data from 204 countries and territories in 2019, the study provides compelling evidence that antibiotic resistance is not a future threat. The magnitude of this health problem is already at least as high as major infectious diseases like HIV or malaria.
The Sustainable Development Goals (SDGs) are one set of global commitments that include 17 goals that affect all countries and for which global coordination and collaboration are necessary to achieve. It will be impossible to achieve these goals without addressing antimicrobial resistance. In 2019 a new indicator was added to the SDG framework specifically addressing resistance (Indicator 3.d.2: Reduce the percentage of bloodstream infections due to selected antimicrobial resistant organisms).
Antimicrobial resistance and antibiotic resistance
Antimicrobial resistance is a wide term that includes resistance in different microorganisms to their respective treatment: Antibiotics for bacterial infections including TB, antivirals for viral infections, antifungals for fungal infections and antiparasitic agents for parasite infections. Global discussions on antimicrobial resistance today are in fact often about antibiotic resistance, as this is the most urgent global risk requiring increased attention and global coordination.
Antimicrobial resistance global governance timeline
Recent global efforts to address antimicrobial resistance began in 1994 with scientific working groups convened by the World Health Organization (WHO). The WHO released the first global strategy on antimicrobial resistance in 2001. Global uptake was slow and fifteen years later, the WHO released the Global Action Plan on Antimicrobial Resistance. Also released in 2015, were Global Action Plans from the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation of Animal Health (WOAH, founded as OIE). Together the three organizations are known as the Tripartite.
In 2016, Heads of States, during the United Nations General Assembly (UNGA), signed a political declaration on antimicrobial resistance committing to a broad multi sectoral approach. That is, in agriculture, human and animal health – to strengthen regulation of antimicrobials, improve knowledge and awareness, promote best practices and to foster innovative approaches using new technologies in diagnostics and vaccines. This was only the fourth time in history that a health topic was discussed at the UNGA. Shortly thereafter, the UN Secretary General convened the Interagency Coordination Group (IACG) on Antimicrobial Resistance. The IACG submitted their recommendations to the UN Secretary General in April 2019.
In line with the IACG recommendations to facilitate global governance mechanisms, a Global Leaders Group (GLG) on Antimicrobial Resistance was established in 2019, an Independent Panel on Evidence for Action Against AMR (IPEA) with a One Health context is soon-to-be-constituted, and a Multi-stakeholder Partnership Platform is being developed to bring several stakeholders together across the One Health approach for collective action.
Given the complexity of antibiotic resistance, Tripartite launched the AMR Multi-Partner Trust Fund (AMR MPTF) in 2019 to support coordinated actions on AMR in key areas at national and global levels.
In 2021, the WHO published a Comprehensive Review of the WHO Global Action Plan on Antimicrobial Resistance that identifies eight pillars of action that should be taken to comprehensively address the global solutions to antimicrobial resistance. During the same year, an Intergovernmental Negotiating Body (INB) was founded by the World Health Assembly to strengthen pandemic preparedness and response.
The formal inclusion of the United Nations Environment Programme (UNEP) in 2022 to the Tripartite, now known as the Quadripartite, will accelerate the coordination of strategies across sectors with a One Health perspective.
Learn more about some ReAct reflections on the current status of the global governance structure on AMR here.
The IACG on Antimicrobial Resistance was tasked with outlining a blueprint of how to tackle resistance. The IACG included stakeholders across the UN, international organizations, and individuals with expertise in human, animal, and plant health, as well as the food, animal feed, trade, development, and environment sectors. On 29 April 2019, the IACG completed its mandate upon submission of its report to the Secretary-General. The report included recommendations around five central themes outlined in the box below.
Themes and main recommendations of the IACG
- Accelerating progress in countries: Member states need to accelerate their progress on development and implementation of AMR National Action Plans
- Innovating to secure the future: Intensify efforts to support research into the development of new antimicrobials, diagnostics, vaccines, waste management tools, and safe and effective alternatives to antimicrobials across the One Health spectrum with sustained investment and the aim of equitable access.
- Collaborating for more effective action: Strengthen the systematic engagement of civil society and the private sector to optimize their contributions to the response to antimicrobial resistance, including working with national governments.
- Investing for a sustainable response: Develop innovative approaches to mainstream antimicrobial resistance-related activities and leverage resources from existing funding streams, as well as to mobilize new and additional funding including domestic financing commitments by national governments.
- Strengthening accountability and global governance: Create a platform that will raise the profile and urgency of addressing antimicrobial resistance; build and maintain political momentum and public support;enable more comprehensive monitoring of the science and evidence related to antimicrobial resistance;ensure accountability among all stakeholders; and recognize the central role of national governments.
Establishment of a GLG on AMR
The Global Leaders Group (GLG) on Antimicrobial Resistance was established on November 2020 to speed up the political action on AMR in response to the IACG recommendations. The GLG is composed of world leaders, experts across sectors, and members of the Tripartite agencies, and the United Nations Environment Program (UNEP).
As a global advisory and advocacy group, GLG works towards keeping ABR on the global agenda, assisting the Tripartite organizations in expanding their work, monitoring and reporting progress, and identifying AMR-related gaps.
From Tripartite to Quadripartite Collaboration
As antibiotic resistance affects different sectors of society, key stakeholders have come together to address the AMR problem. The Tripartite organizations have worked to address AMR risk in humans, animals, plants, and the environment. Early in 2022, the United Nations Environment Programme (UNEP) became an official partner of the Tripartite (WHO, FAO, and WOAH) to form a new Quadripartite Collaboration for One Health. The Quadripartite Collaboration aims at encouraging countries to further develop and implement their National Action Plans on AMR, focusing on One Health.
More action in pandemic preparedness
The COVID-19 pandemic reminded us that governments and institutions must be better prepared and more aware of future pandemics in order to protect and promote people’s health. As a result, the World Health Assembly established an Intergovernmental Negotiating Body (INB) under the WHO Constitution to strengthen pandemic prevention, preparedness, and response in December 2021. The INB, in collaboration with the WHO Member States, started working on a new accord that will establish the principles, priorities, and targets for pandemic preparedness and response. The goal of the agreement is to help prevent disease outbreaks on the local, national, and regional levels as COVID-19 did by supporting global coordination and making WHO more accountable, supporting prevention and response to outbreaks, and ensuring equitable access.
|RADAAR Bi-Regional (Africa & Asia) AMR Policy Workshop||Workshop aimed at highlighting actions that LMICs can take to fight AMR (including: One Health analysis; approaches to AMR economic analyses; integrated surveillance systems; policy implications from global projects aiming to address AMR; and translation of AMR data into policy briefs). Organized by RADAAR (The ‘Regional Antimicrobial resistance Data Analysis for Advocacy, Response and policy’).|
|Antimicrobial resistance and the United Nations sustainable development cooperation framework: guidance for United Nations country teams||Guidelines for better integrating antimicrobial resistance within the UN sustainable development cooperation framework.|
|Global Leaders Group on Antimicrobial Resistance||Website of the Global Leaders Group. Lists current members and related documents such as current priorities and the Terms of Reference.|
|No Time to Wait: Securing the future from drug-resistant infections. Report to the Secretary-General of the United Nations||Report. Final report from the IACG on Antimicrobial Resistance. Contains five groups of recommendations for global action on antimicrobial resistance. Summary of recommendations and key messages, as well as more detailed IACG discussion papers can be accessed on the same page.|
|Global Action Plan on Antimicrobial Resistance||Global action plan adopted by the World Health Assembly in 2015. Outlines five objectives; improve awareness and understanding of antimicrobial resistance, strengthen the knowledge and evidence base, reduce the incidence of infection, optimize the use of antimicrobial medicines in human and animal health, and develop the economic case for sustainable investment.|
|The FAO Action Plan on Antimicrobial Resistance 2021–2025||Action Plan from FAO describing the 2021-2025 key objectives for (1) reducing AMR prevalence and slow the emergence and spread of resistance across the food chain and for all food and agriculture sectors, and (2) preserving the ability to treat infections with effective and safe antimicrobials to sustain food and agriculture production.
|When the Drugs Don’t Work – Antibiotic Resistance as a Global Development Problem (PDF 6,4MB)||Report from ReAct that describes the negative impact of antibiotic resistance on global and national efforts to eradicate poverty, spur economic growth, reduce inequality, improve global public health, reduce hunger and protect the environment (Sustainable development goals 1, 2, 3, 5, 6, 8, 10, 12, 14 and 15).|
|Pulling Together to Beat Superbugs Knowledge And Implementation Gaps in Addressing Antimicrobial Resistance||Report from the World Bank which highlights the need to re-frame antimicrobial resistance (AMR) as a global development issue. Chapter 3 (p.47) describes key knowledge and implementation gaps (table 1, p. 48) that may stand in the way for effective action. It also contains a framework – based on the expected level of risks (table 3, p. 56) for AMR emergence and spread – that aims to guide countries to suitable interventions (figure 5, p 58; table 4, p. 59).
|Resetting the agenda for antibiotic resistance through a health systems perspective||Viewpoint from ReAct published in the Lancet Global health, arguing that a health system approach nationally and globally is critical to mitigate the devastating consequences of antibiotic resistance.|
|Briefing paper: Tackling Antibiotic Resistance for Greater Global Health Security (PDF)||Policy brief for Chatham House provides an overview of the problem and how it relates to global health security, and also discusses current initiatives and options for action.|
|Antimicrobial policy interventions in food animal production in South East Asia||Journal article that describes key policies for tackling antimicrobial resistance (in relation to food animal production) in the South East Asia Region (open access).|