DR. Keiji Fukuda
Antibiotics have been miracle drugs for several decades, saving millions of lives from infections and providing the safety net from infections needed for complex surgeries, cancer chemotherapy and conditions such as diabetes.
The use of antiparasitic and antiviral drugs to prevent and treat malaria and HIV have been life-saving and life-changing for millions. Moreover, antibiotics have been critical tools for farmers to protect livestock, poultry, and fish from infectious diseases, and to help meet a growing global demand for protein-rich food. But the continual capacity of these medicines to work: in keeping people healthy, and in supporting sustainable food, is being lost. The widespread use, overuse, and misuse of these medicines in both health, and agriculture is driving up levels of antimicrobial resistance.
Antimicrobial resistance, or AMR, is when infection causing microbes become increasingly resistant to the antimicrobial medicines used in treatment. The implications of this phenomenon should not be underestimated. AMR is occurring in all parts of the world, both through local use of antimicrobial medicines, as well as through travel or trade, of resistant microbes. It is happening now, and is affecting many common infections. Every year, drug-resistant infections kill an estimated 700,000 people worldwide—most of these in developing countries. Recent estimates suggest that by 2050, the death toll from AMR may rise to 10 million—more than the number of people who currently die from cancer.
By threatening the health and lives of people, especially vulnerable populations such as newborns, children, and women; by creating escalating costs through the need for prolonged or more complex health care, the loss of productive lives, and by undermining critical social needs such as sustainable food and agriculture, AMR is more rightly seen as a broad social and development challenge, and not a health challenge alone. Unless major steps are taken to change the way we use these medicines in humans and animals, AMR is projected to cause a loss of $100 trillion from global GDP over the next 35 years. Developing countries will disproportionately suffer, with the poorest populations suffering the most.
The problem is compounded by a prolonged lack of sufficient research to develop new antibiotics. No new class of antibiotics has been discovered in more than three decades, to replenish the current, eroding armament.
On 21 September, leaders from around the world will gather at a dedicated high level meeting at the United Nations General Assembly in New York to commit to tackling AMR. The purpose of such a meeting reflects growing recognition beyond the health and agricultural sectors that AMR poses a major challenge to achieving the Sustainable Development Goals (SDGs)—the roadmap to end poverty and fight inequality by 2030 adopted at the UN General Assembly last September. Several SDGs depend upon the sustained availability of and access to affordable and effective antimicrobials. Furthermore, it reflects recognition that
without the high-level political commitment needed to enable and foster rapid, comprehensive and multisectoral action, we will continue the slide towards, what has been termed, a “post-antibiotic era”.
Some of the key elements needed to address AMR are in place. A Global Action Plan was adopted by governments at the World Health Assembly in May 2015, and supported by the governing bodies of the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE). The plan provides a technical blueprint for countries to adapt, to meet their specific needs. Other technically solid guidelines are also available. Broader engagement is finally being recognized as necessary. On 5 September 2016, the G20 Leaders’ Summit in Hangzhou, China, acknowledged the seriousness of the threat posed by AMR to global economic growth and stability. They requested WHO, FAO, OIE, and the OECD to work together to fight antimicrobial resistance, including the economic aspects, and to report back on options at the July 2017 G20 Summit in Hamburg, Germany. Perhaps most fundamentally, the private sector, particularly those in the food sector are paying attention to consumers and are taking their own actions by paying much greater attention to whether the food they serve contains antibiotics.
In this context, political commitments by heads of state and governments can further catalyze and intensify the actions needed. This is only the fourth time a health issue has been taken up (the others were HIV, noncommunicable diseases, and Ebola) by the UN General Assembly. The expected outcome of the high-level meeting is a political declaration and not a technical roadmap. But even the UNGA high-level meeting is not the complete answer. Real change will depend on what people do, and what governments do through effective public policies, legislation, multisectoral collaboration, and new drug development to support them. This global health crisis can be reversed through a thorough and collaborative effort from all stakeholders.