Access, Prevention and Education: three pillars to tackle antimicrobial resistance

Prof Tim Walsh, IOI Director of Biology and Michael Corley, Head of Policy & Public Affairs at the British Society for Antimicrobial Chemotherapy (BSAC), outline three priorities that global leaders must consider at the UN High-Level Meeting on AMR on 26 September 2024.

The High-Level Meeting on antimicrobial resistance (AMR) at the UN General Assembly later this month is a pivotal opportunity for world leaders to adopt an ambitious and coordinated approach to tackle the biggest health challenge of our lifetime. 

We are seeing the devasting impacts of AMR all around us. Babies in Nigeria are rapidly colonised with multi-drug resistant bacteria in their gastrointestinal gut, and antibiotics are becoming increasingly ineffective in treating common illnesses such as urinary tract infections. Hospital stays for patients with AMR average around 13 days, causing an additional 8 million hospital days annually. 

Currently global progress on AMR is uneven, and monitoring and evaluation systems, such as TrACCS, are voluntary. Without decisive action to arrest and reverse the impacts of AMR, millions of people will be forced to live with life-long consequences of drug-resistant infections, many more will die and the impact on the global economy will be catastrophic. 

However, the solutions to prevent this crisis are not unknown and not beyond what can be afforded, especially with collaborations between governments, research organisations, the finance sector and civil society.

In this article, we highlight three priorities that global leaders must consider to tackle AMR:

• Creation of a UN Framework Convention on AMR.
• Increased AMR surveillance, especially in low-and-middle income countries (LMICs).
• Investing in three pillars of Access, Prevention and Education. 

A challenge of this magnitude needs a coordinated response from all the UN member states to chart a course of action. This could take the form of a UN Framework Convention on AMR, that includes:

1. Appointment of a permanent secretariat to coordinate activity of member states.
   1. An independent expert panel to generate and assess scientific evidence and monitor risks.
   2. A monitoring and accountability mechanism to assess progress; to track and refine targets.
   3. Mechanisms for sustainable investment across AMR activities like new antibiotics, vaccines, diagnostic tools and infection prevention and control programs. 
   4. Enable equitable access to AWaRe antibiotics and, affordable and sustainable diagnostics.

Such a UN Framework Convention on AMR will help build and sustain global political action, bolstered by research expertise, civil society advocacy, and private sector partnerships. 

UN conventions in the past have mitigated the tobacco epidemic and protected our ozone layer. 

Our planet is deeply interconnected. The impact of AMR across the globe will mirror that of climate change. And just like climate change, low-middle income countries (LMICs) will bear the maximum burden of untreatable infections and deaths due to AMR.

However, there is still a lack of accurate AMR related data in these countries. Access to microbiology laboratories is sorely lacking in many low-resource settings. Of 50,000 medical laboratories in 14 African countries, only 1.3% conduct bacteriology testing, and even fewer can perform fungal diagnostics or AMR susceptibility testing.

Robust and strong surveillance systems across the world, especially in LMICs, are essential to tackle AMR. Surveillance projects like IOI’s BARNARDS and BALANCE studies, and capacity-building projects funded by the Fleming Fund are crucial to identify the clinical, demographic and economic consequences of AMR. 

At the national level, data can help inform health policies and responses to health emergencies. At the global level, this data can provide early warnings of emerging threats and help identify long–term trends.

The most cost effective and efficient way to avert the spread of antibiotic resistance is to reduce the need for antimicrobials. Access, Education and Prevention at local and national levels can help achieve this.

1. Access: Lack of access to effective antibiotics, vaccines, and diagnostics put people most vulnerable at the highest risk of drug-resistant infections. Access to the right treatment at the right time is a critical component of an equitable and successful AMR agenda.
2. Prevention: Safe drinking water, effective sanitation, vaccination programmes, and infection prevention and control measures in both hospital settings and farms where animals and raised for meat consumption will prevent the spread of drug-resistant infections. 
3. Education: Antimicrobial resistance affects everyone, everywhere. It’s time to raise awareness about solutions for fighting back. This should be in the form of enhanced medical and veterinary teaching programs, international fellowships, and international scholarships for professionals in LMICs. Online learning tools and apps should also play an important role in supporting a more coherent and cohesive approach to education, training, and professional development.

When governments choose to address health issues through the United Nations General Assembly, it signifies that these challenges merit urgent attention at the highest political levels. The urgency of the antibiotic resistance crisis requires continuous political attention and biannual ministerial convenings could help galvanize multilateral leadership on this issue.