At the U.N. General Assembly in New York on Thursday, all countries approved a major new political declaration to radically scale up efforts to combat antimicrobial resistance (AMR) — a major threat to modern medicine. As director-general of the World Health Organization, I see this declaration as a strong signal from countries that they are committed to addressing this global threat.
AMR threatens to unwind a century of medical progress and could return us to the pre-antibiotic era, where infections that are treatable today could become much harder to treat and potentially deadly tomorrow.
AMR is caused largely by the misuse and overuse of antimicrobial medicines such as antibiotics. As a result, microbes become resistant and diseases more dangerous and deadly.
It’s an issue with widespread implications. Health facilities are often where the most stubbornly treatment-resistant infections emerge and spread. AMR makes all manner of routine medical procedures riskier; in low- and middle-income countries (LMICs), approximately 11% of people who undergo surgery are infected in the process.
The burden of treatment-resistant infections falls heaviest on LMICs, where AMR is worsened by a lack of access to clean water, stretched health systems, limited budgets, poor access to diagnosis and appropriate treatment, and a lack of enforcement of legislation. Sepsis in newborns that spreads in hospitals is a particularly dramatic illustration of how tough the situation is in LMICs.
The crisis in equitable access to new and existing antimicrobial medicines is also felt most acutely in LMICs, where a lack of availability is a much bigger problem than misuse and overuse — the tools aren’t there in the first place. A lack of access to vaccines increases the risk of drug-resistant infections, and a lack of access to diagnostics makes it harder to detect drug-resistant infections and prescribe the right treatments.
AMR also compounds challenges in some of the world’s most difficult circumstances. In Gaza, Sudan, and Ukraine, AMR makes wartime injuries harder to treat. Even before the current conflict, AMR was found to be significantly increasing in Gaza, with a 300% rise in resistance to specific antibiotics in injured patients after the 2018-19 demonstrations.
The drug-resistant infections that start in conflict zones rarely stay within them, as people flee, medical evacuations are arranged, and soldiers are cared for alongside civilians in hospitals, leading AMR to spread. It’s yet another reason why the best medicine is peace.
AMR is associated with more than 1 million deaths a year, with an escalating death toll projected over the coming decades.
Addressing AMR is not easy. What we do know is that plans that span health, environmental, animal, and agrifood systems lead to progress, but so far, they have only been pursued in high income countries. This needs to change.
But while alarms on AMR have been blaring ever louder, solutions have not been developed fast enough, especially in the research and development of antibiotics. Since mid-2017, only 13 new antibiotics have been authorized, with just two representing a new chemical class and considered innovative.
The political declaration just approved at the U.N. General Assembly includes commitments and targets across human health, animal health, agriculture and the environment.
Headline commitments include reducing the global deaths associated with drug-resistant bacteria by 10% by 2030 and ensuring that at least 70% of antibiotics used for human health globally should belong to the safer WHO Access group, which have the lowest potential to cause AMR. Projections show that many of these deaths are avoidable, including by ensuring access to lifesaving antimicrobial medicines in LMICs.
This meeting’s biggest opportunity is for it to become a springboard to bring in more funding, to turn the targets and commitments in its declaration into reality.
The investment case for AMR is clear, in light of the huge cost of inaction. An April study from the Quadripartite Joint Secretariat and partners estimates that globally AMR could lead to additional health care expenditures reaching as high as $412 billion annually in the next decade if a stronger AMR response isn’t mounted. It would also impose workforce participation and productivity losses of $443 billion. But the study also shows that implementing critical AMR interventions is a “best buy,” with $7-$13 expected in return on every $1 invested.
To help ground these important, albeit technical, discussions of mortality projections and catalytic funding, the meeting’s opening and closing segments featured statements from two AMR survivors, Ella and John.
Ella lives with cystic fibrosis. After she contracted the most severe drug-resistant infection of her life, there were no viable antibiotic options left. She had to rely on an experimental treatment to get better. For John, surgery for a simple hip fracture turned into a year of hospital stays after the incision site became infected, spread to his bloodstream and became resistant to multiple drugs. His kidneys nearly stopped working.
A successful response to AMR relies on political commitment, sustainable financing, measuring progress with accountability, and most importantly, placing Ella, John and all those affected at the center of the response.
Dr. Tedros Adhanom Ghebreyesus is director general of the World Health Organization.