The rise of AMR (antimicrobial resistance) is a global health threat. World leaders are set to confront this issue at the dedicated United Nations High-Level Meeting (HLM) in New York today. This gathering presents a critical opportunity for decisive and sustainable action commensurate with the urgency and scale of the crisis.
The concern
AMR is a natural phenomenon that is driven by the widespread misuse and overuse of antimicrobials in medicine, veterinary practice and agriculture. It is also exacerbated by poor infection control practices.
A new global study estimates that, without action, deaths due to AMR could amount to 39 million by 2050. It kills more people that HIV/AIDS, malaria and tuberculosis combined. AMR renders current drug therapies ineffective against antibiotic resistant bacteria and infections. Surgical operations will become increasingly dangerous procedures, as would chemotherapy and indeed childbirth. Minor infections would have the potential to be major tragedies, and healthcare would be transformed for the worse.
Its consequences are not limited to human health. AMR affects animal health, food security, the environment, healthcare systems and socio-economic development. By 2050, unchecked AMR could wipe away up to 3.8% of global GDP annually, disproportionately hurting the most vulnerable and LMIC (low and middle-income countries).
Multisectoral and multilateral commitment to tackling AMR
There is a fundamental role for doctors in tackling AMR, a view shared by healthcare professionals globally. Many have contributed to national and international high-level discussions, including the World Medical Association and European Medical Organisations such as UEMO, of which the BMA is a member, and the EU One Health Network, of which UEMO is a member.
We support a One Health approach, recognising that many disciplines are involved in the use and exposure to antibiotics.
For example, the EU One Health Network, founded in 2017 to combat the growing threat of AMR, has members including researchers, general practitioners, hospital specialists, veterinarians, botanists, environmentalists, wastewater experts, epidemiologists, public health, agriculturalists, pharmaceutical companies, the European Centre for Disease Control and the European Medicines Agency.
The aim is to avoid 'silo working' and to share ideas, innovations and best practice in tackling the problem of the rise in resistance to commonly used antibiotics.
Wastewater experts have found that humans excrete 80% of ingested antibiotics, and these are found in in wastewater around hospitals, and are contaminating the food chain.
By 1953, antibiotics in the UK were available without prescription for animals, and by 2016, 82% of EU prescriptions were for animal use.
AMR therefore demands the cooperation and collaboration of relevant sectors and all countries to devise solutions to mitigate the effects of this potential disaster. The UN HLM is another key moment for stakeholders to come together to address the global scourge of AMR.
The BMA's response
Professor Dame Sally Davies, the UK’s Special Envoy on AMR, has said that the COVID-19 pandemic will seem minor compared with the danger of the growing number of superbugs resistant to current drugs.
She will be at the UN HLM on AMR which is pushing for specific targets by 2030. Her commendable solutions for tackling AMR focus on driving progress through funding National Action Plans, sharing critical data, and establishing a globally representative Independent Scientific Panel to provide an evidence base for action.
Reducing global AMR-related deaths by 10% by 2030 is achievable with sufficient political will and ambitious, measurable and equitable commitments.
The BMA recently wrote to Professor Dame Sally Davies outlining several key priorities in curbing AMR.
- Strengthened healthcare systems through investment in the health workforce, which will ensure better infection prevention and optimise antimicrobial prescribing practices
- A ban on the routine preventative use of antimicrobials for healthy animals and a measurable reduction of critical antimicrobials in agriculture as use in animals exceeds that in humans
- Results must be delivered for the global south. Equitable action is needed, with drastically increased apportioned funding for LMIC, as well as sustained and equitable access to diagnostics, vaccines and effective antibiotics.
AMR may be as big a threat as climate change and this high-level UN meeting is timely and important.