Prof Essack presented data on the impact of AMR. The O’Neil report, commissioned by the UK Government and published in May 2016, concluded that if nothing is done, by 2050 there will be 10 million deaths attributed to AMR. This would cost the world US$10 million; a modelling exercise by the World Bank
predicted that global GDP would be reduced by 1.1% in a low AMR scenario and by almost 4% in a high AMR scenario.
Due to the scale of the potential impact, AMR is receiving unprecedented political attention across the globe. The pinnacle of the political commitment was when AMR was addressed at the UN General Assembly in September 2016. The UN political declaration strongly endorses the Global Action Plan that was formulated by the tripartite alliance of the World Health Organisation (WHO), the Food and Agricultural Organisation of the United Nations (FAO) and the World Organisation for Animal Health (OIE).
In terms of the WHO approach, Prof Essack outlined the five principles underlining the Global Action Plan on AMR:
1. Whole-of-society engagement
2. Prevention first
3. Access not excess
5. Incremental targets for implementation
These are supported by five strategic objectives:
1. Improve awareness and understanding of AMR
2. Strengthen knowledge through surveillance and research
3. Reduce the incidence of infection through effective hygiene and infection prevention and control (IPC)
4. Optimise the use of antimicrobial medicines in human and animal health
5. Ensure sustainable investment through research & development
To support each of these strategic objectives, the WHO has been doing a tremendous amount in terms of guidelines and implementation. Alongside World Antibiotic Awareness Week,
the WHO Competency Framework on the education and training of healthcare workers has just been completed. Furthermore, the Global Antimicrobial Surveillance Systems and the Global Programme for the Surveillance of Antimicrobial Consumption provide different ways to monitor consumption. In addition, the IPC section of WHO is working to develop core infection control programs, while the WHO list of essential medicines was updated in 2017 to include a section dedicated to AMR, flagging which antibiotics should be made available and which require monitoring in order to measure any increase in resistance.
The FAO is another key member of the tripartite alliance. It has its own action plan on AMR that focuses on:
1. Improving awareness on AMR and related threats
2. Developing capacity for surveillance and monitoring of AMR and antimicrobial use (AMU) in food & agriculture
3. Strengthening governance related to AMU and AMR in food and agriculture
4. Promoting good practices in food and agricultural systems and the prudent use of antimicrobials
The third member of the alliance is the World Organisation for Animal Health (OIE) who have a strategy on AMR and the prudent use of antimicrobials in animals. OIE monitor the
consumption of use stratified by terrestrial, aquatic food and wild animals every year, using information provided by individual countries. This increases awareness and understanding, strengthens the knowledge base for surveillance and research, encourages the implementation of international standards and supports good governance and capacity building. After the UN political declaration, the Inter-Agency Coordinating Group (IACG) on AMR was formed. The purpose of this group is to coordinate all actions taken at global and regional levels and give guidance on how to address AMR comprehensively. Currently the IACG is addressing AMR through 14 content areas consolidated into three groups that are intended to reduce the need for and unintentional exposure to antimicrobials, to optimise the use of medicines, and to invest in innovation supply and access.
AMR is “a tragedy of the commons”. This is where individuals and groups act in self-interest to the detriment of the best interests of the whole of society by depleting a common resource, in this case antimicrobials. Antibiotic conservation requires coordinated, multi-pronged, multi-stakeholder, multidisciplinary partnerships underpinned by national and international policies that suspend sectoral interests for public good. This requires a One Health approach and the conscious decision to be unbiased and do the best that you can to conserveantibiotics for future generations.