The global crisis of COVID-19 has shown world leaders the danger posed by rapid spread of infectious disease. As the world grapples with COVID-19, another, silent pandemic is looming –antimicrobial resistance (AMR).
Thankfully, the German G7 and Indonesian G20 Presidencies are working to systematically re-focus attention on this major and growing threat to humanity, building on long-standing G7 and G20 commitments.
There is no doubt that the international effort to mitigate COVID-19 has had a detrimental impact on other programmes designed to tackle both non communicable and infectious disease challenges such as cardiovascular disease and AMR. Given the economic and human costs associated with the COVID-19 pandemic, there is no excuse for failing to invest in research and development, health system strengthening and pandemic preparedness.
The G20 estimates AMR will cost the world economy USD 100 trillion by 2050
The G20 estimates AMR will cost the world economy USD 100 trillion by 2050 – a similar order of magnitude to COVID-19. While the greatest burden will sadly fall on low-income countries, it will lead to the emergence and spread of superbugs that will seriously impact routine medical procedures globally, such as hip replacement and caesarean sections, and will place patients at much greater risk including for such treatments as chemotherapy.
The WHO and other UN institutions took major steps to address AMR in 2015 and 2016 with a Heads of State resolution that brought together a new approach under the ‘One Health’ umbrella. It established concerted cooperation to address AMR in the context of human, animal, plant and environmental health sectors.
The UN Interagency Co-ordination Group on Antimicrobial Resistance, which in April 2019 submitted to the UN Secretary-General a set of recommendations under the title, No time to wait – Securing the future from drug-resistant infections, presented a stark warning to global leaders.
In the coming weeks, building on the excellent work of the German G7 Presidency this year, the G20 must elevate AMR to the top of the political agenda, turning to action that can be taken at national and regional levels. Although AMR is recognized as a global health risk in every G20 Leaders’ Communiqué since at least 2015, the necessary progress has not always followed the strong words. In the years since, the threat has only grown bigger – and the time to act is now.
The G7 Leaders’ call to action and the joint report from the Global AMR R&D Hub and WHO has helped to bring greater institutional urgency to tackling AMR. The Global Leaders Group on AMR brings together multilateral institutions with political leaders from a diverse range of countries to support focused efforts on AMR. This must be fully supported and built upon by the G20 Leaders.
Three key areas that Ministers and Heads of State should address with the same determination shown in the COVID-19 response is strengthened monitoring, strict and effective stewardship of antimicrobials and the proper funding of research, innovation, and product development – building on the measures agreed under this year’s German G7 Presidency and the UK’s G7 Presidency last year.
Monitoring is critical, as the evolution of drug resistant bacteria, tuberculosis, viruses and even malaria parasites pose a complex and threatening challenge for humanity.
Monitoring is critical, as the evolution of drug resistant bacteria, tuberculosis, viruses and even malaria parasites pose a complex and threatening challenge for humanity.
There are regional networks that work closely with the WHO on AMR surveillance. These must be strengthened and expanded to all low- and middle-income countries (LMICs). The data collection must operate in real-time and, the outputs from the surveillance requires a systematic response. This work will also help protect the world against other emerging pathogenic threats.
As the British Medical Journal has pointed out, regulation of production and sale of antibiotics is weak in many countries and further exacerbated with over-the-counter sales without prescriptions. This results in indiscriminate use and the ever present problem of counterfeit or substandard antibiotics – particularly in LMICs – deepening antimicrobial resistance across communities. In addition, the continued indiscriminate use of antimicrobials in the agricultural sector increases the risk of developing resistance in animals which could be passed to human infections.
In addition, the continued indiscriminate use of antimicrobials in the agricultural sector increases the risk of developing resistance in animals which could be passed to human infections.
G20 leaders working with the African Union and other regional multilateral organisations must treat antibiotic stewardship as a matter of security and a key pillar in addressing AMR.
The WHO new pathogens list has been a useful tool in shaping the R&D pipeline, but more must be done to address the research, innovation and product development gaps that still exist. Innovation is not keeping pace with evolution of disease, therefore translating commitment into action is vital through incentivising the development of new antimicrobials, vaccines and diagnostics so that patients receive the treatments they need both today and tomorrow.
Public-private partnership is essential in halting the further emergence and spread of drug-resistant pathogens. Successful partnership between public and private sectors underpinned the delivery of unprecedented innovation and scale of vaccines and treatments for COVID-19. This partnership must be built on mutual trust, respect and creating solutions that work for all sides. During the Indonesian G20 Presidency and moving into the Indian Presidency we need a dynamic public-private dialogue to deliver the ‘One Health’ strategy for AMR that compliments and reinforces the work of those currently charged with establishing a political road map.
The work of Carb-X, GARDP and the AMR Action Fund, in collaboration with innovative bioscience companies, requires continued multi-annual support, and it is essential that the bioscience pharmaceutical community plays a full partnership role in strengthening the ‘One Health’ approach. As we saw with COVID, in a complex race to protect humanity, everyone who can contribute to addressing a broken or inadequate health system must be invited to contribute.