The Current Column
UN General Assembly High-Level Meeting on Antimicrobial Resistance 2024
Power up One Health to effectively combat antimicrobial resistance!
Srigiri, Srinivasa / Angela R. SchugThe Current Column (2024)
Bonn: German Institute of Development and Sustainability (IDOS), The Current Column of 9 September 2024
Bonn, 9 September 2024. Nearly a decade has passed since antimicrobial resistance (AMR) emerged as an issue of international cooperation. Without sufficient action at all levels, human life losses caused by AMR are estimated to reach up to 10 million each year and economic losses to the tune of 3.8 percent of world’s GDP and up to 5 percent in low and middle income countries by 2050. Inappropriate use of antimicrobials in humans, animals and plants is a major driver of AMR, making it a classic One Health problem.
At the 71st United Nations General Assembly (UNGA) in 2016, member countries have committed to develop and implement multi-sectoral National Action Plans on AMR. Eight years after the initial political declaration and on the brink of the second High-Level Meeting (HLM) on AMR at the 79th UNGA, some progress has been achieved, but significant gaps still need to be addressed. This year’s HLM presents an opportunity to address the gaps in combatting AMR and build momentum by making comprehensive commitments and setting measurable targets.
The draft of the political declaration to be signed at the HLM is quite elaborate and aims at scaling up action to achieve the target of reducing AMR-induced mortality by 10 percent against the 2019 baseline, by 2030. Further, it addresses some of the gaps through commitments spread across different dimensions (governance, financing, access, coordination, research, surveillance, monitoring and follow up) and sectors (human health, agriculture, animal health and environment) of AMR. From a One Health perspective, critical gaps in AMR governance concern the financing of the implementation of the national action plans, multisectoral coordination and the integration of the environmental dimension.
One important gap lies in the urgent need to move from paper to action and the insufficient implementation of National Action Plans, especially in low and middle income countries. Only 11 percent of the countries that have a national action plan, have allocated funds to the activities from their national budgets. The commitments to mobilise domestic and diversified multilateral financing to achieve the target of funded national plans for at least 60 percent of the countries are crucial in the declaration. In order to move beyond lip service, leveraging other global funds related to AMR, such as the Pandemic Fund and the Global Fund, is needed. At the national level, policy makers should be innovative in repurposing domestic funds and link AMR with broader topics, such as universal health coverage, sustainable food production, and environmental sustainability. Additionally, international cooperation to ensure sustainable financing for implementation of national plans is essential, with the AMR Multi-Partner Trust Fund serving as a key instrument.
As the governance of AMR involves multiple stakeholders spread across sectors, as well as industry, academia and civil society, coordination is challenging. In many countries, there was a good start in raising awareness of key stakeholders at different levels on AMR and putting in place mechanisms for coordination across sectors and levels. However, only 52 percent of the 178 countries that developed national action plans have a functioning multi-sectoral coordination mechanism. Emphasising the co-definition of a clear, common goal among stakeholders across all levels and sectors (e.g. “AMR Dialogues” in Thailand) is essential to ensure full ownership in the fight against AMR. Effective coordination mechanisms in countries should include clear mandates, roles, protocols for cooperation, strong political commitment, and robust accountability measures. Additionally, it is crucial to ensure that resources are allocated to all relevant sectors at different levels as well as devolution of authority to implement the AMR control strategies.
Environmental resources act both as a reservoir and medium of transmission for AMR, but also ecosystems suffer from AMR and antimicrobial pollution. Activities for containment of AMR in the environment were missing in most of the national plans. Only in 2022, the One Health Joint Plan of Action that explicitly addresses environmental integration came into being. Lack of data on antimicrobial pollution and AMR in the environment poses challenges for effective control policies. Additionally, limited knowledge of the risks associated with AMR in the environment hinders the formulation of regulatory norms. Commitments mentioned under the environment sector of the draft are crucial for effective integration of this dimension. With initiatives for domestic production of antimicrobials in regions with less access (e.g. in East African countries), immediate strengthening of regulatory capacities of environmental agencies is paramount for sustained effective control of AMR.
AMR is an urgent global threat. Without effective action, we risk losing some of the medicines that have been the cornerstone of medical progress. Member countries must make binding commitments and rally support for effective AMR control strategies across all sectors. Failure to act decisively could jeopardise global health security and endanger human wellbeing.
Srinivasa Srigiri is a senior researcher in the Department of Environmental Governance at the German Institute of Development and Sustainability. He is experienced in analysing the governance of natural resources and interlinkages among water, energy, food, health and ecological systems.
Angela R. Schug is an advisor at GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit), working on various aspects of international cooperation concerning AMR within the Sector Initiative One Health and the Global Programme Pandemic Prevention and Response, One Health.
