Solving the Problem of Antimicrobial Resistance: The UN Can't Do It Alone

Despite the growing threat of antibiotic resistance worldwide, the global consumption of antibiotics continues to increase at an alarming rate. In fact, it is estimated that the number of defined daily doses of antibiotics was 35 billion in 2015, a 65% jump since 2000.

Although the World Health Organization (WHO) has stressed that the world is running out of effective, available antibiotics, and many meetings and action plans have been put into place on a local and national scale, resistance seems to be outpacing development. Which begs the question: what more can be done in the war against resistance?

In a recent webinar produced by CIDRAP-ASP, Ramanan Laxminarayan, PhD, founder and director of the Center for Disease Dynamics, Economics, & Policy (CDDEP), and senior research scholar and lecturer at the Princeton Environmental Institute at Princeton University, stressed that although the United Nations (UN) has acknowledged the severity of the situation by drafting up a plan to address the issue, action and accountability are needed in order to turn things around.

The issue of antimicrobial resistance (AMR) was brought to the UN’s attention for 3 reasons: 1) because AMR is unique as a One Health issue, the WHO needs broader help to address it; 2) the funding needed to take action won't be there if it isn't taken to a higher level; and 3) global attention needs to be refocused back to the health sphere, according to Dr. Laxminarayan.

As a result, AMR was the focus of a high-level meeting in September. It was the first time a One Health topic was brought to the UN and it opened the doors for other health topics to get there. Delegates who attended the meeting became engaged very quickly and within 3 to 4 months, a document was produced.

“The document that came out of [the meeting] provided a very good description of the global problem, highlighted particular issues like access, provided a link to issues like universal health coverage, topics that already had salience at the UN,” Dr. Laxminarayan explained. It also established a broader connection to vaccines, diagnostics, and highlighted a much more multisectoral approach for combating AMR.

“But, did the document do what we wanted it to do?” he asked webinar attendees.

According to Dr. Laxminarayan, in order to take action, 4 key concepts come into play when targeting AMR:

1. Highlighting the issue and calling attention to it—this has been achieved.
2. Setting targets. “Things with targets get done,” shared Dr. Laxminarayan. “But with AMR, there were no targets.”
3. Establishing accountability. "Whose job would be on the line if actions were not put into place? For AMR, literally nobody,” he lamented. “This was a lost opportunity in my opinion. Unfortunately, if we don’t push for things to happen, then the global discussion is happy to settle at a place that is just enough rather than reaching beyond to get something to happen.”
4. Allocation of funds. No money was allocated for AMR. “Today, global antibiotic resistance is funded by the generosity of different organizations, but there is no global fund,” he said. “Far more money has been allocated for HIV or tuberculosis or malaria.”

Dr. Laxminarayan also pointed out that the effort to tie the problem of AMR to the 17 sustainable development goals—which include 'no poverty' to 'zero hunger'—is tenuous and not necessary, as there is already “a clear case to be made” when it comes to AMR. “We don’t need to prove this to do something about it; nearly a million people die because of [AMR] each year, and the number is going to go up.”

He stressed that bringing the issue to the attention of the UN is not enough and that AMR cannot be solved entirely by regulation. The nature of AMR is not like the Montreal Protocol, which was designed to reduce the production and consumption of ozone-depleting substances to reduce their abundance in the atmosphere.

“It’s going to require broad collaboration across all legs of society,” Dr. Laxminarayan stressed. “It’s not a topic that can be solved just through governments, spending, or regulation. It’s unusual in that sense—closest to climate change in that respect. The UN alone can’t solve this problem; we have to broadly engage ourselves.”

An effort needs to be made to try to hold the UN accountable to take action and ensure promises that were made will be kept.

“If we think that we’ve shown it to the UN and that they are going to take care of it, we’re wrong. We need to hold them accountable and we have to make sure that the funding is available,” emphasized Dr. Laxminarayan. “Think of the HIV epidemic; it was stopped not just by UN action, but by patient advocates and physicians who were working on it. Everyone was involved in [stopping the epidemic], even celebrities, and they were shouting from the rooftops about how important it was.

If it were just up to the UN, we probably wouldn’t have had that action. It’s important to take this forward in a way that compliments the UN. They can do stuff, but we have to make sure that they’re doing it.”