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Antimicrobial resistance (AMR) is a silent pandemic. Antibiotic resistance in particular is one of the biggest public health threats of current times. The misuse and overuse of antibiotics in humans, animals and crops is making antibiotics ineffective due to growing resistance in bacteria against antibiotics. About 5 million deaths worldwide were associated with antibiotic resistance in 2019.
AMR isn’t just a health crisis — it encompasses socio-economic as well as business challenges. As such, low- and middle-income countries (LMIC), which have a high burden of the effects of AMR, may not be well-equipped to tackle the problem. There are finance and access gaps that need to be addressed.
Delhi-based think tank Centre for Science and Environment (CSE) organised a webinar titled Global Action on AMR: Priorities of LMICs July 16, 2024 to underline the need to bring up their demands at the United Nations General Assembly (UNGA) High-Level Meeting, during which a global political declaration on AMR is expected to be adopted in August.
CSE’s new report Priorities of LMICs to Inform the High-Level Meeting on AMR at UNGA 2024 was released and discussed at the online event. It was based on an international workshop for LMICs organised by organisation in April 2024.
The webinar brought together key stakeholders and experts, including Jean Pierre Nyemazi, director, Global Coordination and Partnership & Quadripartite Joint Secretariat on AMR, World Health Organization, Switzerland; Sujith J Chandy, executive-director, International Centre for Antimicrobial Resistance Solutions, Denmark; Leena Menghaney, IP Advisor & South Asia Head, Medecins Sans Frontieres, Access Campaign, India; Yewande Alimi, One Health Unit Lead, Africa Centers for Disease Control, Ethiopia; Benedict Sim Lim Heng, infectious disease consultant and coordinator of technical working group 1 at the National AMR Committee, Department of Medicine, Sungai Buloh Hospital, Malaysia; Rajeshwari Sinha, programme manager, Sustainable Food Systems Programme, CSE. The webinar also included inputs from Viviana Munoz Tellez, coordinator (health), Intellectual Property and Biodiversity Programme, South Centre, Switzerland, through a video message.
Experts at the webinar shared their reflections and perspectives on the way ahead in view of the ongoing negotiation on the draft political declaration, which is being discussed currently among UN member states. The broad areas of discussion were national action plans (NAP) implementation and financing, prevention and access, and targets.
LMICs are becoming more vocal and coming to the table to discuss solutions to the AMR threat, the experts observed. These countries bear a very high burden of the effects of AMR.
LMICs are now stepping up to address AMR and are even taking the lead in terms of developing the right strategy including financing their national action plans (NAP). There is a need for all LMICs to come together as their settings and needs are similar. This should not be a missed opportunity for the populations that really face the highest burden of AMR.
With negotiations on a draft political declaration on AMR underway — and expected to be adopted at the high level meeting likely to conclude in August — the time is now to give the document the desirable shape. Geopolitics or any other difference should not become a reason to suppress some aspects of the declaration, which otherwise may be very useful, the panelists stressed. Member states negotiators must commit to bold, specific, time-bound and measurable actions in the declaration.
It came out that the four key points critical for moving forward with NAP are science, political will and commitment, reframing the narrative and sustainable financing.
For effective NAP implementation, a top-down, bottom-up approach with understanding, planning and on-ground evidence generation would be key.
Some of the other important areas highlighted were:
Need for assessment of gaps in science and evidence, especially in LMICs
Catalytic funding and progress-linked incentives
Coordination and support mechanisms within sectors and ministers
Sector-specific risk versus benefit analysis
Implementation studies and socio economic analysis for the same
Community engagement
Local evidence
Experts also touched upon the importance of local research, which would be needed for managing and highlighting issues related to AMR.
There is a need to go deeper into weak links to produce safer, accessible and therapeutics not just for human health but for animals too. In primary healthcare settings, incentives that lead to overprescribing antibiotics need to be addressed.
Access issues need to be included in the political declaration, the experts concurred, especially because they affect people directly in terms of diagnosis and treatment.
Other access-related concerns discussed include importance of pool procurement mechanisms for older as well as newer antibiotics, particularly in Africa; monitoring of gaps, such as in resource-constrained settings, on whether antibiotics are placed at the right level of healthcare and they are available when needed backed by diagnostics and tools to start such monitoring; having funding from governments for research and development not linked to high processing or volumes; involving communities who are directly affected by antibiotic resistance on the table.
In food animal production, it is important to prioritise prevention, aiming to reduce the chances of disease, the panlists advocated. Similarly, in case of antibiotic manufacturing, effective process control measures can reduce entry of antibiotic moiety into the effluent. Prevention approaches are cost-effective in most cases and the returns on investments are much higher. So prevention has to be the basis of a lot of interventions, and the agenda for LMICs, they added.
As a sensitive element for LMICs, access would be needed not only for antibiotics or treatment but also for safe water, hygiene facilities and diagnostics, the experts underlined.
Access to new and old antibiotics can also prevent the spread of resistant bacteria, so access and prevention have a very strong connection, they said.
With respect to the African continent on targets, there is need for conversations in areas such as prevention as a top agenda, ensuring equitable access of antibiotics, sustainable investments for improved health systems, presence of LMIC voices in G77 or G20 advocating needs of low- and middle-income settings.
Targets must be set to help improve sustainable access to effective antibiotics, the speakers noted. Countries should have the resources and capacity not only to meet these targets but also to monitor their implementation. Governments should be incentivised to achieve these targets.