Responses to Antimicrobial Resistance Urgently Need Strategic Leadership by WHO

The WHO tackles issues that will affect future generations, such as the steady increase in Antimicrobial Resistance (AMR). Urgent attention is required to avert global suffering in future years. What is the problem and why has it come about?

14 January 2017

Background

One recent projection suggested that by 2050 more people will die of causes related to AMR than due to all forms of cancer.  Despite the imprecision of such estimates, there is now broad agreement that the lives of millions of peo ple will be in danger in coming decades as a result of AMR unless the right actions are taken now.

Why has this situation come about?  Antibiotics are an extensively used class of antimicrobial medicines.  They are low cost, effective and easily available. They are designed to treat illnesses caused by bacteria but are often used unnecessarily, and sometimes are mis-used, both in humans and animals. 

AMR is more than a human health issue.  It involves animal health, agriculture and food production, the pharmaceutical industry and environmental protection.  This problem applies across the world and affects all countries. As a result, microbes are increasingly becoming resistant to them.  At the same time, few new antibiotics have been developed in the last 3 decades.  There is only a small number in the development pipeline. Analysts suggest that this lack of innovation is a result of insufficient economic incentives rather than insurmountable scientific hurdles.

Accelerating action

The threat posed by AMR has been well known to scientists for many years.  A Global Action Plan has been developed by the WHO, the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE), in collaboration with the World Bank and other development banks.

AMR is receiving increasing attention from parliamentarians and civil society groups who are challenging experts to act decisively.  This is an interesting development.  Why?  Responses to climate change and HIV/AIDS gained momentum when people’s organizations become actively involved in the issues. Till recently AMR suffered from low political and societal attention but public interest and concern about is on the rise and with that comes growing political will. 

Now world leaders are engaged and expect action.  They took part in a high-level meeting on antimicrobial resistance at the United Nations General Assembly in September 2016.  They supported the Global Action Plan on AMR and committed to developing national action plans.  They agreed to return to the UN General Assembly and describe the steps they are taking.  

In my view, it is great that AMR is receiving an increased level of attention.  At the same time, it is important not to underestimate the difficulties we will face as this work is taken forward.  Tackling AMR is complex because a range of actions need to be taken across different sectors.  This means that multiple perspectives and interests must be taken into account and that different organizations must work together in synergy.  Credible coordination mechanisms are needed - within countries as well as in regions and globally. 

Defining priorities

The overarching goal is to ensure that everyone can access antibiotics that work when they need them while reducing the overuse and misuse of these medicines in animal and human health.   The urgency is to move towards this goal quickly before the spread of AMR leads to a big drop in the numbers of people who are able to access antibiotics that work.  There are three important areas for priority attention: 

Improve Access to Antibiotics

Firstly, given that more people die from lack of access to antibiotics than from AMR, action must be taken now to better enable all people to access the medicines they need in ways that do not slow down global action to tackle AMR.   This means maintaining the momentum for ensuring that all people can access essential medicines as and when they need them. 

Reduce the Overuse of Antibiotics

Secondly, it is important that overuse of antibiotics in agriculture is reduced quickly.  This will not be accomplished easily.  A high level of livestock productivity is critical for the wellbeing of millions of people who work in agriculture as well as for the economic growth of their nations.   This suggests that priority must be given to sustaining optimal livestock production while advancing action on AMR.  The need for antibiotics in livestock production will diminish as the incidence of infectious diseases in animals is contained.  Hence the increasing emphasis, in animal health, on ensuring good hygiene and functioning sanitation within livestock production systems. 

Address Industrial and Environmental Issues 

Thirdly, there are industrial and environmental issues to be tackled.  The waste from antibiotic manufacture is substantial and needs proper disposal if environmental impacts are to be avoided.   The water in some rivers has higher concentrations of antibiotics than are found in the body of someone taking a course of these medicines.   Many countries are prioritizing the development of capacity to manufacture and benefit from antibiotics.  They must be enabled to do this without there being any increase in the risk of AMR because environments are contaminated.

WHO'S Role

Pursuing these priorities requires work across different country contexts – with experiences being shared between high, middle and low-income settings.  WHO has a vital role to play in enabling people’s organizations and parliamentarians to appreciate the importance of tackling AMR in ensuring healthy futures for everyone.