30 September 2016
Antimicrobial resistance (AMR) was high on the political agenda recently, with the UN high-level meeting on AMR coinciding with the publication of reports on the issue from the UK government and the World Bank.
Resistance of pathogens to the drugs used to treat them, such as HIV to anti-viral drugs and bacterial pathogens to antibiotics, is a growing global concern. The development of antibiotics, in particular, is considered one of the three measures that have significantly improved human health, lifespan and wellbeing in the last 70-100 years, along with vaccination and improved sanitation. It is now widely recognised that our collective failure to manage antimicrobial drugs as a global resource could wipe out many of these hard-won gains.
At the UN meeting 193 global leaders signed a declaration on tackling AMR, which uses the World Health Organisation (WHO) global action plan as a template. This template outlines five key areas of action which all countries will have to tackle:
While the declaration is not legally binding, the fact that countries have publicly and collectively committed to tackling with AMR is important and demonstrates that many have grasped the seriousness of AMR as a societal and economic issue.
The World Bank has also entered the fray, releasing a report on the economic impact of AMR, which contains models of scenarios that calculate differing levels of impact on the world economy due to AMR. Among the report's many startling conclusions is the fact that even in the low-impact scenario, annual global GDP could fall by 1.1% by 2050 due to AMR, with the effects disproportionately falling on low income countries, reducing our chances of meeting sustainability development goals to eliminate extreme poverty. The report also pushes hard the idea that AMR is no longer an isolated medical issue, but a systemic societal and economic issue, which could cause huge damage to individuals and populations if not tackled.
Closer to home, two UK government reports were released, one a response to the AMR review led by Lord Jim O'Neill, the second a progress report on the government's five-year AMR strategy. Both outline the positive steps that have already been taken in the UK, such as a £50 million global AMR innovation fund and a halving of the British meat poultry industry's use of antibiotics between 2012 and 2015. A number of initiatives, policies and procedures are being put in place to drive behaviour change, support healthcare staff to control the most serious infections and to reduce inappropriate prescribing and use of antibiotics in livestock.
All of these initiatives are very promising, and it can be argued that the UK has been world-leading in its efforts to develop and enact policy to meet the challenges of AMR, through the advocacy of the Chief Medical Officer for England (Prof Dame Sally Davies) to push AMR up the political agenda, and the commissioning and completion of the AMR review.
What is vital now is that we do not lose momentum in these politically uncertain times – Theresa May's government reshuffle earlier this year divided responsibility for science between three departments rather than under a single minister and many of those with an interest in science and medicine will have much of their attention occupied by understanding the potential outcomes of Brexit. In addition, it remains unclear whether the resignation of Lord Jim O'Neill as a Treasury minister will have a negative impact on AMR advocacy efforts.
Longer term, we have to acknowledge and manage the danger of 'issue fatigue'. Drug resistance cannot be eradicated and we will only manage the problem by continually and consistently reviewing and updating goals and strategies – even once five- to ten-year goals are met, governments must commit to continuously assess the situation, set new goals and question what further improvements can be made. This is an indefinite process, we will never be in a position where we can give ourselves a pat on the back and congratulate ourselves on a job well done.
It is clear that the societal and economic impact of doing nothing will be devastating and many countries will not be able to recover from the damage – we must follow through with the commitments that have already been ma de to responsibly maintaining and using antimicrobials as a resource for current and future generations.