Scanning electron micrograph of methicillin-resistant Staphylococcus aureus (MRSA) bacteria (yellow, round items) killing and escaping from a human white cell (via Flickr/NIAID).
‘An extraordinary gathering at the United Nations on September 21 may have permanently changed how the world deals with antibiotic resistance, which is believed to kill 700,000 people around the world each year.
During the UN meeting, the entire assembly signed on to a political declaration that calls antibiotic resistance “the greatest and most urgent global risk.” But it is what they do next that will determine whether the threat can really be contained.
And alarming news announced while the meeting was happening made clear how urgent it is that antibiotic resistance be reined in.
‘At a simultaneous meeting in Atlanta, the U.S. Centers for Disease Control and Prevention (CDC) disclosed that the sexually transmitted disease gonorrhea—which has become steadily more drug-resistant over several years—has taken a dramatic turn toward becoming untreatable.
‘Meanwhile, a multinational research team announced that they have identified a new strain of the drug-resistant staph bacterium MRSA that appears to be traveling on poultry meat.
‘The UN meeting, formally the High Level Meeting on Antimicrobial Resistance, marked only the fourth time that the world body has acted on a health issue. (The last time was the Ebola emergency in 2014.) Leaders signaled right from the start that they considered the day important.
‘“Antimicrobial resistance poses a fundamental long-term threat to human health, sustainable food production, and development,” UN Secretary-General Ban Ki-moon said in a speech opening the meeting. “In all parts of the world, in developing and developed countries, in rural and urban areas, in hospitals, on farms, and in communities, we are losing our ability to protect both people and animals from life-threatening infections.”
‘His assessment of the dire situation was backed up by the World Health Organization’s executive director, Margaret Chan. “Antimicrobial resistance poses a fundamental threat to human health, development, and security,” she said as the meeting opened. “The commitments made today must now be translated into swift, effective, lifesaving actions across the human, animal, and environmental health sectors. We are running out of time.”
The agreement made by the world governments . . . commits them to creating national plans for combating antibiotic resistance in medicine, agriculture, and the environment, and to reporting back to the General Assembly in 2018 on their progress.
It also commits the UN and its partner agencies—World Health Organization, the Food and Agriculture Organization, and the World Organization for Animal Health, known as the OIE—to creating an “ad hoc interagency coordination group” that will be led by David Nabarro, a physician who works within the Secretary-General’s office and has led UN efforts on Ebola, pandemic flu, and the Haitian cholera epidemic.
But, in a gesture toward respecting the needs of developing countries that might have further to go to tackle the problem, the declaration did not set hard targets for reducing international antibiotic use.
‘“We got further than I had expected, but not as much as I had hoped for,” Ramanan Laxminarayan, director of the nonprofit Center for Disease Dynamics, Economics and Policy (CDDEP), said in a conversation while the meeting was going on. Over the summer, Laxminarayan and a group of academics and strategists laid out a menu of issues in a series of articles in medical journals for the UN meeting to consider.
‘“This is day zero, which means we now have to start figuring what happens next: what this coordinating mechanism does, what its mandate is. How does progress get measured?” he said.
“This is a multisector problem, which means the UN has to quickly make friends outside of governments. We’ve got to get doctors, the whole medical practice community, the pharmacists, manufacturing, the whole agricultural sector. It’s not amenable to control-type regulation.”
‘As the meeting started, CDDEP and eight other organizations in the United States and Europe announced that they are forming an alliance—the Conscience of Antimicrobial Resistance Accountability (CARA)—to help hold governments, manufacturers, food producers, and health-care organizations to the commitments made at the UN.
In its mission statement, the group stressed that the problem of antibiotic resistance has a shadow side, because many low-income societies do not have adequate access to antibiotics. Fighting antibiotic resistance, they said, should not be allowed to deprive people of the drugs they need for treatment of disease.
‘. . . Just before the UN meeting, both the G7 and the G20 groups of governments signed on to supporting action on antibiotic resistance, pointed out Lord Jim O’Neill, a prominent economist who led a two-year independent review that provided much of the agenda for the UN conclave. . . .
‘In truth, not even the most optimistic representative at the UN meeting expects antibiotic resistance to go away entirely. The goal of the declaration that governments agreed to is to slow down resistance by ceasing the misuse and overuse that force bacteria to evolve.
‘Still, as the meeting ended, it was clear that they felt the cause had been handed an extraordinary opportunity that could make a real difference in the health of the world—an opportunity that will occur only once.
‘“We only get one crack at this,” Laxminarayan said. “If we fail to do this, the world will only have checked off a box that says, We have dealt with antimicrobial resistance, it went to the UN, it is done.”’
Read the whole article by Maryn McKenna at National Geographic: How we’ll tackle diseases that are becoming untreatable, 22 Sep 2016.
The 21 Sep 2016 UN High-Level Meeting on Antimicrobial Resistance
UN High-Level Meeting on Antimicrobials—what do we need?, commentary published in The Lancet by Ramanan Laxminarayan, Carlos Amábile-Cuevas, Otto Cars, Timothy Evans, David Heymann, Steven Hoffman, Alison Holmes, Marc Mendelson, Devi Sridhar, Mark Woolhouse and John-Arne Røttingen, 16 Jul 2016. Excerpt:
‘The UN General Assembly High-Level Meeting of Heads of State will discuss sustainable access to eﬀective antimicrobials in September, 2016. The meeting must develop realistic goals, stimulate political will, mobilise resources, and agree on an accountability mechanism for global collective action on this issue. . . . We believe that the UN General Assembly High-Level Meeting should establish a UN High-Level Coordinating Mechanism on Antimicrobial Resistance (HLCM) with four core functions’:
(1) Raise awareness about lack of access to antibiotics and drug resistance
(2) Establish, monitor and report on global and national enforceable targets
(3) Finance implementation of global and national level action plans and a global coordination and monitoring platform
(4) Support member states to pursue national level, multisectoral action for implementation of WHO’s Global Action Plan on Antimicrobial Resistance alongside national eﬀorts to improve access to eﬀective antimicrobials.
United Nations prepares to tackle antibiotic resistance, commentary by Molly Miller-Petrie published on the Center for Disease Dynamics, Economics and Policy (CDDEP) blog, 26 Jul 2016. Excerpts:
‘On June 29 , Ambassador Gómez Camacho, Mexican Permanent Representative to the U.N. and lead for the high-level meeting, invited CDDEP to speak to the U.N. Member States as a part of a civil society panel on antimicrobial resistance. . . . Each organization presented their view on what should be included in the final outcome document, after which member states were able to ask questions of the experts directly. A similar panel was conducted with members of industry the following week. As the only participating organization with a major focus on low- and middle-income countries, CDDEP was also invited to speak to the Group of 77 Member States plus China, representing 134 low- and middle-income member countries. On July 18, CDDEP Director Dr. Ramanan Laxminarayan and Molly Miller-Petrie met with the group at the U.N. Headquarters to address the particular challenges of combatting resistance in low-resource settings. . . .’
On the ILRI News blog: Apocalyptic numbers: Antibiotic resistance as the classic ‘One Health’ (and classic ‘One World’) planetary issue, 4 Aug 2016.
Earlier research on antimicrobial use in food animals
Global trends in antimicrobial use in food animals, by Thomas Van Boeckel (Princeton University), Charles Brower (Center for Disease Dynamics, Economics & Policy [CDDEP]), Marius Gilbert (Université Libre de Bruxelles), Bryan Grenfell (Princeton University), Simon Levin (Princeton), Timothy Robinson (ILRI), Aude Teillant (Princeton) and Ramanan Laxminarayan (CDDEP), published in the Proceedings of the National Academy of Science, early edition, 20 Mar 2015. See also a report of this PNAS paper on the ILRI News blog, First global map of the rising use of antimicrobial drugs in farm animals published in PNAS (25 Mar 2016), and also reports published on the ILRI Clippings blog, Reuters: Livestock in poor countries need drugs to stay alive and productive, but how to avoid the rise of ‘super bugs’? (23 Mar 2015) and New publication warns of rising use of antibiotics and other antimicrobial drugs in farm animals (30 Mar 2015).
Animal production and antimicrobial resistance in the clinic, a commentary published in The Lancet, by Timothy Robinson, Heiman Wertheim, Manish Kakkar, Samuel Kariuki, Dengpan Bu and Lance Price, published online 18 Nov 2015, DOI: http://dx.doi.org/10.1016/S0140-6736(15)00730-8. See also a report of this Lancet commentary published on the ILRI News blog, Limiting use of antibiotics in livestock production to stem growing antimicrobial resistance in human pathogens (31 Dec 2015).
Review of evidence on antimicrobial resistance and animal agriculture in developing countries, by ILRI’s Delia Grace, published Jun 2015, DOI: http://dx.doi.org/10.12774/eod_cr.june2015.graced. This 44-page report was produced by ILRI with the assistance of the UK Department for International Development and its ‘Evidence on Demand’ hub. The report identifies key evidence gaps in our knowledge of livestock- and fisheries-linked antimicrobial resistance in the developing world and documents on-going or planned research initiatives on this topic by key stakeholders.