While the COVID-19 crisis is top of mind right now, the next pandemic threat that could once again upend our lives and devastate economies — antimicrobial resistance — is looming. The United Nations is working to address these superbugs through several financing and collective action policy solutions, but it will take significantly increased commitment and all sectors working together to help stop this growing threat.

While global attention has been consumed by the COVID-19 pandemic, another pandemic is already simmering. The threat of antimicrobial resistance (AMR), or superbugs that don’t respond to existing antibiotics, is not lurking in the distant future — it is already claiming at least 700,000 lives around the world each year. In the United States alone, someone dies of a difficult-to-treat infection every 15 minutes. Some estimates predict that by 2050, as many as 10 million people globally could die from untreatable bacterial infections. Without effective antibiotics, surgical procedures will become so high risk as to be nearly impossible; compromised immune systems will make cancer patients vulnerable to common infections; and neonatal sepsis — a common, treatable condition — will become untreatable.

It is not sensational or naive to say that the impending AMR crisis could have even worse consequences on global health and prosperity than the current pandemic. In building back better from COVID-19, the United Nations is giving serious consideration to tackling AMR and bringing diverse stakeholders to the table to develop innovative solutions to this existential threat.

Global Leaders Meet to Urgently Tackle AMR

The President of the UN General Assembly hosted a virtual High-Level Interactive Dialogue on AMR on April 29, during which global health officials, scientists, and world leaders underlined their commitments to confronting AMR through an urgent Call to Action. Participants pointed out that the COVID-19 crisis has clearly depicted the devastating impact of untreatable infections on lives and economies around the world. Although some parallels with COVID-19 were ominous, other event speakers offered important lessons to tackle AMR more effectively.

The One Health Mantra

The concept of One Health — the principle that the health of people, animals, and environment are intrinsically linked and that collective action and collaboration across multiple sectors are required to influence these linkages — has become common in recent global health discussions, including the High-Level Dialogue. Throughout the meeting, participants reaffirmed their commitment to financing and implementing policies that promote multisectoral collaboration. However, it is clear that One Health as a conceptual model must be translated into action more effectively. National Action Plans on AMR that promote One Health approaches have faced difficulty in integrating various ministries, departments, and budgets. Jeremy Farrar, Director of the Wellcome Trust and member of the One Health Global Leaders Group, acknowledged this complexity during the meeting, saying, “We mustn’t be intimidated into inaction by thinking things are too complex to solve. They can be solved if we put our collective minds to it.”

Financing the Future of AMR

While consensus is growing around One Health, many unanswered questions remain on financing AMR activities. One of the foremost concerns relates to the cost of developing new antibiotics to replace those that are becoming ineffective. Shockingly, scientists have not developed a new class of antibiotics since 1987; the financial risk of new drug discovery precludes all but the wealthiest pharmaceutical companies from even attempting to do so. Participants in the High-Level Dialogue shared several new approaches — all of which are necessary — to incentivize scientists and pharmaceutical companies to pursue new treatments. Public-private partnerships such as the AMR Action Fund are directly financing the development of new antibiotics; governments are introducing subscription models to guarantee income upfront to pharmaceutical companies taking on antibiotic development; and initiatives like the Year of Investor Action on AMR are encouraging top investment authorities to leverage their influence to promote compliance with international guidelines such as the 2015 World Health Organization Global Action Plan on AMR.

 

While financing for drug development at the global level is gaining traction, National Action Plans to address AMR through One Health approaches remain underfunded. In 2020, the United Nations dedicated a platform within its Multi-Partner Trust Fund (MPTF) to allow countries to help finance other countries’ National Action Plans. The MPTF has been recognized by the United Nations Secretary-General as the mechanism to secure consistent and coordinated development financing to support National Action Plans. To date, however, three high-income countries have contributed a mere US$15 million to the MPTF.

New and generous financing is needed, and this may finally be more forthcoming as COVID-19 has vividly shown the dire consequences of globally circulating infectious diseases. The refrain that “no one is safe until everyone is safe” applies just as much to AMR as it does to COVID-19. Simply, it’s in high-income countries’ self-interests to strengthen the ability of low- and middle-income countries to prevent, detect, and respond to emerging health threats like AMR. As Mirfin Mpundu, Director of ReAct Africa, recently noted, “If we make gains in the high-income countries and we don’t in the low- and middle-income countries, we know what will happen. It will be far worse [for everyone] in the next 10 years, and we will come back and have the same discussion.”

Maintaining the Momentum

The growing interest in a One Health approach is a sign of building momentum for action on AMR. The High-Level Interactive Dialogue marked an important moment for reactivating discussion on AMR at the highest levels. This conversation will undoubtedly continue during two more major events in 2021. The first is the UN Food Systems Summit in September, in which livestock and agriculture industries can weigh in on their role in the fight and the consequences of inaction on global food systems. The second is the UN Climate Change Conference (COP26) in November, a key opportunity to dive deeper into the intersection of AMR and the health of the environment.

The COVID-19 pandemic has illustrated the severe impact of unstoppable infections on individuals and societies. Despite increased interest in global health security, more urgent efforts will be needed to ensure that the unique challenges of AMR are featured prominently in ongoing pandemic preparedness discussions. If, as with COVID-19, the warnings on AMR are not heeded, the very foundations of modern medicine will crumble. Though it sounds like the stuff of fiction, a post-antibiotic era is not unthinkable, or even that far away.

 

Featured Photo:  Nicholas S. Tenorio/ CDC