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UN addresses ‘great challenges’ of antimicrobial resistance
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The U.N. General Assembly conducted a high-level meeting Wednesday to coordinate a global effort against antimicrobial resistance in human and animal health.
The assembled heads of state approved an agreement acknowledging the current and growing threat of antimicrobial resistance; reaffirming WHO’s “Global Action Plan on Antimicrobial Resistance” and committing to national, regional and global “One Health” initiatives to reduce the impact of resistance. The draft declaration of this agreement was sent to the plenary of the General Assembly and formally adopted.
“For decades, antimicrobial medicines have saved millions of lives by treating people with infectious diseases,” Peter Thomson, president of the 71st session of the U.N. General Assembly, said during the meeting. “In recent years, however, the microbes, or ‘superbugs,’ have adapted, undermining the effectiveness of antimicrobial medicines. When medicines used to treat many types of infections are no longer effective, it is a warning of great challenges that go beyond our health systems, affecting many aspects of our lives.”
This is the fourth time in the history of the U.N. that a health topic has been discussed at the General Assembly, preceded by HIV, various noncommunicable diseases and Ebola virus.
‘Swift, concerted action’ needed to stem resistance
Thomson stressed to delegates in attendance the need for collaboration between nations when dealing with antibiotic resistance.
“No one country, sector or organization can address this global health challenge on its own, and innovative public-private partnerships, funding initiatives and inclusive approaches will be essential,” Thomson said. “For sustainable development to be achieved for all, it is critical that we safeguard our ability to protect our health, feed ourselves and our families, conserve our environment and develop our economies. Ultimately, the future of humanity may depend on our ability to respond to the great challenges of antimicrobial resistance.”
Margaret Chan
While Thomson evoked the consequences of a “post-antimicrobial” world, Margaret Chan, MD, MPH, director-general of WHO, explained how antimicrobial-resistant pathogens are already affecting health care.
“The situation is bad, and getting worse,” Chan told the delegates. “Last month, an increase in the number of drug-resistant pathogens forced WHO to revise its treatment guidelines for chlamydia, syphilis and gonorrhea. On current trends, a common disease like gonorrhea may become untreatable, and doctors facing patients will have to say, ‘I’m sorry, there’s nothing I can do for you.’ ”
Chan listed a number of factors contributing to resistance and exacerbating new drug development, including overprescription and a lack of financial incentive for the private pharmaceutical sector. Along with the support of international partners, she called on physicians and consumers to reduce the demand for therapeutic antimicrobials and cease consumption of antibiotic-fed livestock — a so-called “One Health” approach that also was addressed by José Graziano da Silva, PhD, director-general of the Food and Agriculture Organization (FAO) of the U.N.
“Antibiotics and other antimicrobials should be only used to cure disease and alleviate unnecessary suffering,” da Silva said during the meeting. “Antimicrobial medicines used for growth promotions should be phased out immediately. Effective methods to improve the security, safety and quality of food and nutrition can be found without only relying on antimicrobials.”
These challenges are each key points of the draft declaration unanimously approved by the delegates in attendance. In addition to reaffirming WHO’s current antimicrobial resistance plan and 2030 Agenda for Sustainable Development, the document embodies a commitment by each member country to:
- develop multisectorial programs and policy initiatives focused on antimicrobial resistance;
- mobilize and coordinate investment into new therapeutic technologies, surveillance and research;
- increase awareness of antimicrobial resistance to encourage positive behavior from the general public; and
- request the establishment of an ad hoc interagency coordination group in consultation with WHO, FAO and the World Organization for Animal Health.
“You are here today because you recognize that antimicrobial resistance poses a fundamental threat to human and animal health, sustainable development, to sound economies and social cohesion,” Ban Ki-moon, secretary-general of the U.N., said to the assembly. “The commitments you make today must be turned into swift, concerted action.”
Experts, organizations show support
The General Assembly’s focus on antimicrobial resistance was applauded by expert organizations, including the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the Infectious Diseases Society of America (IDSA).
“Infectious disease physicians are on the front lines of the battle against antimicrobial resistance, caring for increasing numbers of patients with serious or life-threatening infections that can no longer be safely and effectively treated with existing antimicrobial drugs,” IDSA wrote in a statement. “Antimicrobial resistance will receive urgently needed attention on a global stage as a result of the U.N. focus on the issue.”
In an open letter to U.N. President Mogens Lykketoft, ESCMID commended the decision to address the issue and described the importance of the multinational effort in an accompanying release.
“ESCMID is convinced that a coordinated response by the international community is urgently required to successfully tackle this global threat,” they wrote. “ESCMID is offering the support of its experts to help policymakers develop and implement effective measures to tackle the problem.”
The call for U.N. action also was central to a report published in May by Lord Jim O’Neill, chairman of the U.K.’s Review on Antimicrobial Resistance group, and colleagues. In it, they estimated that antimicrobial resistance would result in 10 million deaths annually and a cumulative global cost of $100 trillion by 2050 if left unchecked.
“This is a problem which it is well within our grasp to solve if we take action now,” O’Neill said in a press release. “I call on the governments of the G7, G20 and the U.N. to take real action in 2016 … to avoid the terrible human and economic costs of resistance that the world would otherwise face.” – by Dave Muoio
References:
The Review on Antimicrobial Resistance. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. http://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf. Accessed September 21, 2016.
U.N. Draft Political Declaration of the High-level Meeting of the General Assembly on Antimicrobial Resistance. http://www.un.org/pga/71/wp-content/uploads/sites/40/2016/09/Draft-AMR-Declaration.pdf. Accessed September 21, 2016
Disclosure: Infectious Diseases in Children was unable to confirm relevant financial disclosures at the time of publication.Perspective
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Amesh A. Adalja, MD, FACP
Historically, it has been the rarest of circumstances that have led the U.N. to hold a high-level meeting on an infectious disease-related matter. That the U.N. is convening a meeting on the topic of antimicrobial resistance concretizes just how vital solutions to this issue are.
This meeting provides a platform for an expansive discussion of a challenge that is of the utmost importance and will spotlight the stakes that are at hand. For infectious disease physicians, this level of attention is welcome because we are no strangers to this phenomenon, and understand the consequences all too well. Hopefully, as a consequence of this meeting, infectious disease physicians will be joined with many other stakeholders to find solutions for what is one of the most pressing public health challenges we face.
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