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Info Service on Health Issues (Sept16/03) (This article was first published in The Star of Malaysia on 26 September 2016) World leaders at the Summit of the UN General Assembly last week spoke on the need to save millions of lives by controlling the crisis of antibiotic resistance and adopted a landmark political declaration calling for global action. -------------------------------------------------------- At the opening of the summit of the United Nations General Assembly on 20 September, it sounded much like the swansong of two of the regular stalwarts of this annual affair. It is the last General Assembly to be attended by UN Secretary General Ban Ki Moon and the United States President Barrack Obama. Both made interesting speeches. Ban listed all the woes afflicting the world, especially terrorism, while praising the Paris agreement and the sustainable development goals as big achievements of his eight years as the UN leader. Obama, sounding like a professor, gave a lengthy analysis of the state of the world and the role of the US, earning a laugh when he said it sometimes seemed the US was being blamed for all the ills of the world and at the same time it was being asked to solve all its problems. At the lunch for heads of states and organisations, Ban and Obama praised each other for their leadership in the past eight years. Someone at my table wondered aloud what would happen to next year’s lunch if Donald Trump, who is known to dislike and distrust the UN, won the US election. Perhaps as leader of the host country, he would have the traditional lunch cancelled. This year’s UN summit will be remembered most for its high-level event on anti-microbial resistance (AMR), held on 22 September, with many heads of governments and Ministers speaking on the need to fight this crisis. The leaders adopted a landmark Political Declaration on AMR that recognized that antibiotic resistance is the “greatest and most urgent global risk” and that “due to AMR many 20th century achievements are being gravely challenged, particularly the reduction in illness and death from infectious diseases…” This is the first ever statement by the heads of all the countries that recognize the AMR crisis and in which they pledge to take action. Ban Ki-Moon said that AMR has become one of the biggest threats to global health. “All around the world, many common infections are becoming resistant to the antimicrobial medicines used to treat them, resulting in longer illnesses and more deaths. At the same time, not enough new antimicrobial drugs, especially antibiotics, are being developed to replace older and increasingly ineffective.” World Health Organization Director-General Margaret Chan warned that AMR poses a fundamental threat to human health, development, and security. Common and life-threatening infections like pneumonia, gonorrhoea, and post-operative infections, as well as HIV, tuberculosis and malaria are increasingly becoming untreatable because of AMR.” Referring to the Declaration, she said “the commitments made today must now be translated into swift, effective actions …We are running out of time.” I was invited to be part of a panel discussion during the AMR event. Others in the panel were the Russian and Kenyan health ministers, the chairman of Doctors Without Borders, the European Commissioner for Health and the CEO of drug company GSK. I made the point that AMR was as serious a threat to human life as climate change. The crisis is caused by the overuse of antibiotics in people, and its use in the feeding livestock to fatten them, passing on resistant bacteria to humans through the food chain. The problem is made much worse by certain genes that accelerate resistance and that move from one type of bacteria to others, thereby spreading resistance to many diseases. People in developing countries are the most affected. It is estimated that the number of AMR-related deaths will rise from the present 700,000 a year to 10 million in 2050 and of this more than 9 million will be in developing countries. The adoption of the Declaration is a big step forward, but more important is the implementation of the actions agreed to. To help make that happen, developing countries should be supported with funds, technical equipment and access to existing and new antibiotics, vaccines and diagnostic tools at low prices. Among the actions needed are regulation of the sale, prescription and use of antibiotics, the phasing out of antibiotics used as growth promoters in livestock, the prevention of infections, the control of AMR in hospitals, better surveillance and data collection, provision of equipment such as microscopes and diagnostic tools. There must also be the discovery of new antibiotics to replace those that no longer work because of resistance. However the dominant system of research and development has a lot of weaknesses. Although governments provide R&D subsidies, the companies that produce the new medicines are granted private patents and are able to charge high prices, beyond the reach of most patients. There is need for another system in which adequate public funding of R&D leads to discoveries of new medicines, and licenses are easily and cheaply provided to manufacturers to make them available at affordable prices. Such a model is implicitly recognised in the political declaration, which acknowledges the importance of delinking the cost of investment in R&D from the price and volume of sales so as to facilitate equitable and affordable access to new medicines, diagnostic tools and vaccines. The declaration also stressed that “affordability and access to existing and new antimicrobial medicines, vaccines and diagnostics should be a global priority,” The declaration established a task force of agencies (co-chaired by the WHO and Secretary General’s office) which would provide guidance for global action on AMR and requested the Secretary General to report on progress of implementation of the Declaration and to make further recommendations. The elevation of the AMR issue to the highest political level at the UN General Assembly is a landmark event in the battle against AMR, a crisis that has been neglected too long and which is now recognised.
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