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Antimicrobial resistance is a global threat. Now it is finally recognized

Microbes are evolving mechanisms to protect themselves from drugs. Twenty years ago, this problem was rarely discussed by world leaders and decision-makers. Now it is recognized as a global heath threat comparable to climate change

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Antimicrobial Resistance

Antimicrobial resistance (AMR) occurs when microbes (bacteria, viruses, fungi and parasites) develop mechanisms that protect them from the effects of antimicrobials (drugs used to treat infections). This means infections become harder to treat, leading to longer illnesses, higher medical costs, and greater risk of spreading disease.

Antibiotic resistance is a type of AMR, and arises when bacteria become resistant to antibiotics.

Source: Wikipedia

I have just returned from New York, after a significant career milestone. Having spent more than 20 years working on the issue of antimicrobial resistance (AMR), it was personally rewarding to contribute to the United Nations General Assembly’s adoption of measures to fight it.

The final UN declaration on AMR, while ambitious, reflects the delicate compromises required to bridge the North-South divide on global health.

The divide between high-income and low- and middle-income countries was pronounced, where health equity remains a sensitive topic. Especially following the COVID-19 pandemic, which highlighted global disparities in access to diagnostics, vaccines and treatments.  During the AMR negotiations, the Global South emphasized the urgent need for financing mechanisms and equitable access to new antibiotics, vaccines, and diagnostics. For many low- and middle-income countries, AMR is not just a health issue—it is a development issue that deepens existing social and econmic inequalities. The UN General Assembly’s declaration acknowledges this.

One Health approach

Another major challenge was the ’One Health’ approach.

‘One Health’ is an approach that recognizes the interconnection between the health of humans, animals, plants, and the environment. And in relation to AMR, the One Health approach is crucial because AMR is not confined to a single sector.

One Health is widely accepted in scientific circles. But it is a point of contention at the political level. Some countries are concerned about its potential economic implications for food production and exports.

What will the UN do?

Key commitments and takeaways from the United Nations General Assembly (UNGA) High-Level Meeting on Antimicrobial Resistance (AMR):

Reducing Global Deaths from AMR: The political declaration commits to reducing global AMR-related deaths by 10 per cent by 2030. This is crucial for low- and middle-income countries, where healthcare systems are under-resourced and drug-resistant infections pose significant risks.

Financing for National Action Plans: Currently, only 11 per cent of countries have dedicated funding for AMR national action plans. The declaration sets a target of USD 100 million in international support.

Reduction of antimicrobial use in agriculture: Countries commit to significantly reduce the use of antimicrobials in agriculture by 2030, promoting responsible use and investing in alternatives to antimicrobials to prevent infections in animals and plants.

Disease Prevention: The emphasis on animal vaccination strategies, with a goal for all countries to have defined plans in place by 2030. This is crucial for reducing the need for antibiotics in livestock, a major driver of AMR.

Science-based Solutions: The creation of an independent panel by 2025 to provide scientific evidence for tackling AMR.

Equitable Access to Veterinary Tools: The supply of affordable veterinary medicines, vaccines, and diagnostics, especially for low- or middle-income countries.

Environmental action: The declaration acknowledges the role of environmental factors in the spread of AMR and commits to addressing pollution from antimicrobials, including waste and wastewater from pharmaceutical manufacturing and other sectors.

2029 Review: A high-level meeting on AMR will be convened in 2029 to assess progress.

Despite these misunderstanding and challenges, the final declaration commits to tackling AMR through a One Health approach, signaling a critical step forward in addressing the root causes of AMR. This is a victory for those of us who champion this cross-sectoral way of working.

Important for lower income countries, and for scientists

From the perspective of low- and middle-income countries, the declaration has a strong focus on equitable access to antimicrobials, vaccines, and diagnostics, which is particularly significant.

In these countries, the burden of AMR is the greatest, yet the resources to combat it are often scarce.

As a scientist who works extensively in lower- and middle- income countries, the declaration feels like a long-overdue acknowledgment of the challenges we face daily. Challenges like limited access to effective antimicrobial drugs, scarcity of diagnostics, and the struggle to implement stewardship programs in fragile veterinary health systems.

The declaration promises that countries, regardless of income status, will be equipped with tools, governance structures, and funding needed to tackle AMR head-on.

In the room where it happened

Being in the room when the declaration was confirmed was a profound experience and I couldn’t help but reflect on how far we’ve come. Twenty years ago, AMR was a topic that rarely entered high-level political discussions. Today, it is recognized as a global threat on par with climate change and demanding immediate and coordinated action.

But the real work begins now. The commitments made in New York must be translated into action. The road to 2030, when many of the targets set out in the declaration are meant to be achieved, is long and fraught with obstacles, especially in countries where human and animal health systems are fragile, and AMR is just one of many pressing issues.

Sense of accomplishment, and responsibility

As I settle back into my routine in Denmark, I can’t help but feel a sense of accomplishment but also responsibility.

The political declaration is a significant milestone, but let’s hope that the momentum leading up to and from New York carries forward, and that by 2030, we can look back on this declaration as the turning point in the global fight against AMR.

For now, I return to my work with renewed energy!

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