Antibiotic resistance kills 700,000 people around the globe each year. Now, for the first time, the United Nations will consider whether to combat that threat—and what it decides will determine whether resistance becomes an international priority or fades from the policy landscape.
Next week, the United Nations opens its General Assembly, the annual two-week meeting in New York that allows governments from all over the world to debate issues of global importance. On September 21, the assembly will host an all-day “high-level meeting” on the threat of resistant bacteria that will showcase presentations from representatives of selected governments and a long list of nonprofits and academic organizations. The day is expected to conclude with the first ever UN resolution on the importance of combating antibiotic resistance and—people hope—some sort of commitment to action.
“This is only the fourth time the General Assembly has addressed a health issue, and the others rose to the level of HIV and Ebola,” Keiji Fukuda, a physician and the special representative for antimicrobial resistance for the director-general of the World Health Organization, told me. “Hopefully what will be achieved is to have the highest-level decision-makers in the world acknowledge that we have a major issue that has to be addressed, and also have that level acknowledge that certain actions are needed.”
Political Momentum Builds
It is generally accepted now that antibiotic resistance kills 23,000 people each year in the United States, 25,000 in Europe, and magnitudes more in developing countries—and also consumes national resources, undermines the productivity of economies, and is getting worse. The question has been how to respond to it, given that, like climate change, it built up over decades and affects every society, yet can only be ameliorated by many actions performed consistently over a long period of time.
Medicine and public health have understood the problem for a while. But in the past two years, an unusual amount of political momentum has built around the issue as well. Several actions got that rolling. First was the founding, in the United Kingdom, of the Review on Antimicrobial Resistance, a project chartered by then Prime Minister David Cameron and headed by global economist Lord Jim O’Neill. The project conducted a two-year examination of antibiotic resistance worldwide and issued a detailed prescription for reform.
Second came a decision by the Obama White House to establish a permanent body of experts, the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, and charge it with implementing a national strategy for reducing resistant illnesses and stimulating innovation for new diagnostics and drugs.
In 2016, momentum increased. In January, the business leaders attending the World Economic Forum in Davos called for more research and development funding. In May, the World Health Assembly, the governing body of the WHO, agreed to support an “action plan” the WHO drafted in 2015, including committing the 194 countries that make up the assembly to producing national control plans by 2017.
In June, the G7 group of industrialized nations, meeting in Japan, agreed that resistance is an international priority. And on Monday, the larger G20 group of developing nations, meeting in China, committed to working together to reduce it—an especially important action since developing countries struggle most with over-the-counter and agricultural misuse of antibiotics. Resistance, they said, “poses a serious threat to public health, growth and global economic stability.”
With all those global actors lined up, what should, or can, come next? Every major piece of research on the problem written in the past few years emphasizes a few essential actions: reducing misuse in medicine and agriculture, improving surveillance to spot resistance as it emerges, encouraging the development of rapid diagnostic devices that can detect whether an antibiotic is needed, and creating incentives that will encourage manufacturers who have exited antibiotic development to come back into the market again.
Over the summer, a rotating group of the world’s top researchers on antibiotic resistance, led by Ramanan Laxminarayan, founder of the nonprofit Center for Disease Dynamics, Economics and Policy, attempted to lay out a menu for the meeting in publications in several scientific journals.
In Nature, they called for “an immediate mass mobilization of society” that reframes the fight against antibiotic resistance as the defense of a crucial common resource. In Science, they asked the UN to set global targets, patterned after greenhouse-gas agreements, that would curb overexposure in high-income countries—in medicine, agriculture, and the environment—while protecting low-income countries’ access to antibiotics to treat their citizens.
And in The Lancet, they recommended the UN create what is called a “high-level coordinating mechanism” that would resemble the way the UN responded to the AIDS epidemic by creating an organized body to conduct education and monitoring, negotiate among countries to get them to act, and coordinate how funds from governments and foundations would be spent.
“We are calling for what has worked in the past,” Laxminarayan told me. “The funding would not be a huge amount of money, not compared to what the UN spends on HIV.”
Just the Beginning
By the time the High-Level Meeting opens on the morning of September 21, the resolution that will conclude the day will have been agreed to behind the scenes. Drafts of it are already circulating. What advocates do not yet know is whether it will commit the UN and its member governments to concrete global action, beyond the individual national plans they have agreed at the World Health Assembly that they would compose.
“I think they will create some sort of coordinating mechanism,” Laxminarayan said. “We might not get funding, because often funding is not committed at this early a stage. But I would like to see them set a goal for the mechanism, so that we know what we are working toward.”
Allan Coukell, the senior director for health programs at the Pew Charitable Trusts, cautions that even if the UN meeting authorizes the maximum that experts have asked for, creating it could take a while.
“It is in the nature of these things that first the issue has to be raised and countries have to agree at the level of principle, and then comes a lot of hard work to follow through and create accountability,” he told me. “So this is the beginning of a process, not the whole process. But in terms of getting every country in the world to commit to taking action, it is hopefully the start of something that will be meaningful for tackling the problem of antibiotic resistance.”