Arthy Santhakumar: The verdict is out on superbugs

arthy-santhakumarA global health peril that demands global action. 

For only the fourth time in history, a health issue has reached the great political heights of the United Nations General Assembly. Following HIV, non-communicable diseases, and Ebola—antimicrobial resistance (AMR) has taken the grand stage, receiving a standing ovation in the form of a united political declaration which promises to combat AMR and has been signed by 193 member states.

The high-level meeting, held on 21 September concluded with world leaders making a pledge of more than £600 million, to mobilise the human and financial resources needed for innovation and preservation of this public common good.

And about time too.

The gravity of the problem has been slowly creeping up on the global community—predicted to claim ten million deaths annually, with a projected price tag of 100 trillion USD by 2050, the luxury of inaction has already passed us by. “We are at the beginning of the end”, gravely warned Professor Dame Sally Davies, the force behind getting this health threat firmly on the political agenda.

Superbugs are vying to become the next biggest killer, and will dwarf that of cancer deaths.

But how can we ensure our future generations will reap the benefits of modern medicine that we so abundantly enjoyed?

The causes are all well-known now and littered throughout the literature—overuse, misuse, and unnecessary use within humans, animals and agriculture. And there is clear consensus on what needs to be done internationally. The O’Neill Review puts forward ten recommendations to take on drug-resistance, comprehensively—improve hygiene and prevent the spread of infection; reduce unnecessary use in agriculture; promote alternative therapies and the use of vaccines; promote innovation; improve our global surveillance capabilities to monitor resistance and antimicrobial consumption; stewardship; coupled with a targeted global public awareness campaign to encourage behaviour change in different audiences.

No one recommendation in isolation is the answer. We need a coordinated multi-sectoral action—uniting under the “One Health” approach, and more importantly the political will and leadership—it is this after all that will release and allocate the much needed resources.

We must not leave anyone behind

Echoing the UN Sustainable Development Goals (SDG) mantra “we must not leave anyone behind”—there is a necessity to take into account the needs of all countries. So while we call for greater global surveillance, we must invest and support laboratory and surveillance capacity in low income countries, which have been severely affected by drug resistance. The high levels of AMR already seen in the world today, coupled with the predicted cumulative economic loss of 2-3.5% of the global GDP,  has the potential to severely hamper medical and healthcare systems in low resource settings. This in turn has the potential to reverse many of the gains already made towards the SDGs, in particular the health-related goals. We must continue to support developing countries with weak regulatory controls, and ensure improvements in access to efficacious and quality antimicrobial medicines—by focusing on strengthening supply chains, tackling counterfeits, falsified and substandard drugs, and reducing the use of over-the-counter (OTC) antibiotic abuse.

So what will this political declaration mean?

Each signatory has agreed to—develop surveillance and regulatory systems, encourage innovation within research and development, educate health professionals and empower the public on how to prevent drug resistant infections. The declaration concludes with a request to the Secretary General, to establish an ad hoc interagency coordination group, which can be argued as a strong signal that this is an issue that will remain high on the political agenda.

Countries have reaffirmed their commitment to develop national action plans on AMR—but we need to ensure that those that do not uphold their commitment, are held to account (as difficult as this has proven historically for the international body). And we need and must ensure coherence at the international, regional, and national levels.

The threat is intrinsically a cross border threat, and so regionally we must continue to strengthen our capacity to monitor use of antibiotics and development of resistance. The EU, and through the support of the European Centre for Disease Prevention and Control, is already a leading region globally in the fight against drug-resistance. There is an opportunity to learn and share best practice of national measures between our neighbours.

Nationally, we have set our own set of targets that will further reduce inappropriate prescriptions and the incidence of high risk bacterial infections in hospitals by 50%, and cutting the level of antibiotic use in the agricultural sector to 50mg/kg by 2020.

Everyone has a role and a share of the collective responsibility. Now it is time to put  rhetoric into action.

Arthy Santhakumar is a senior policy advisor in the international division of the BMA. Her focus is global health and international development.

Competing interests: None declared.