By Sascha Marschang, Policy Manager for Health Systems, EPHA
The high-level declaration reached at the UN General Assembly in New York on 21 September appears to be a major turning point in the fight against Antimicrobial Resistance (AMR). Political leaders have finally acknowledged the global scale and urgency of the problem. This was the hoped-for response to the recommendations and dire warnings outlined in the work of the UK Review on AMR led by economist Jim O’Neill, especially the estimated cost of inaction. The declaration was welcomed by key AMR stakeholders from the civil society community including the Save Our Antibiotics Alliance.
So does this mean we can clink our glasses and file AMR under “work in progress”? Not yet. Political statements and commitments will now have to be turned into prompt and decisive actions, UN Secretary General Ban Ki-moon has declared. Solving a problem on the scale of AMR needs coordinated action across borders and between sectors: from now on, governments, industries, health services, farmers, consumers and patients will need to deliver. It is crucial to ensure that responsibilities are clear and actions aligned – incoherent policy responses have haunted public health for too long. The next step globally should be negotiation of an international agreement on AMR to commit all countries and sectors to agreed actions. Governments have been tasked with preparing national action plans.
In Europe Commissioner Andriukaitis has pledged Commission support for countries to address AMR. An updated EU AMR Action Plan, to be presented in early 2017, will need to define what this will mean in practice. Significant differences remain between countries in terms of resistance, antibiotic consumption and prescribing, highlighted at the recent EPHA conference on AMR, and in definitions of responsible use in both humans and animals. The availability of financial and human resources differs profoundly, as do laboratory capacities, which challenge effective monitoring and control of both (over-) consumption and consequences. The EU Action Plan must ensure rapid transfer of best practices, such as those presented at the conference from Sweden, the Netherlands and the UK, throughout Europe. This will likely require increased European support and resources as well as binding legislation, to make sure there are no holes in the safety net to undermine progress elsewhere.
At the same time, any stricter regulations must consider how to improve access to lifesaving antimicrobials for millions of people worldwide, be it because they are too expensive or unavailable, or because local healthcare infrastructures are weak.
It is promising that pharmaceutical industry, too, was adamant to leave its mark in New York by releasing a pledge signed by both branded and generic companies. They vow to clean up manufacturing processes by 2020 – environmental pollution at antibiotics factories is an issue highlighted in a recent report by EPHA and Changing Markets – support governments in providing education about AMR and antibiotics to patients and doctors, and to ‘work with stakeholders’ to develop a new business model to improve access. Notably, some of the main offenders named in the supply chain reports are conspicuous in their absence from the pledge, demonstrating that action may well need to be supported by binding measures.
Ultimately, tackling AMR will not only require coordinated action, targets and stricter application of regulations, but also systemic changes that go way beyond combating drug-resistant infections. By rectifying health and social inequalities, providing fair and universal access to healthcare, and fostering a prevention culture, we can create a healthier society where fewer antibiotics are needed. Countries like the Netherlands, Sweden, and Denmark are showing the way to the rest of the world. All of Europe needs to be empowered – or compelled – to follow.