Is it too late for renewed global leadership on AMR?

Global leaders will meet in New York on 26 September for the second UN General Assembly High-Level Meeting (HLM) on antimicrobial resistance (AMR), following the first HLM on the topic eight years ago in 2016. The HLM is billed as an opportunity for world leaders to “collectively address the looming threat AMR poses to global health, food security, and achieving the 2030 Sustainable Development Goals”, but with AMR already one of the top global public health and development threats we must ask the question: is this all too late? 

According to a 2022 study published in The Lancet, AMR caused more deaths than malaria in 2019. Along with the tragic loss of human life comes a steep economic cost, as the World Bank estimates that AMR could result in US$ 1 trillion additional healthcare costs by 2050, and US$ 1 trillion to US$ 3.4 trillion GDP losses per year by 2030. When reviewing the data, it would be easy to think that the stable door has been left unlocked and unattended for too long. The horse, it appears, has bolted.  

Against this backdrop, progress since 2016 has been mixed. There has undoubtably been more attention given to tackling the threat of AMR, with commitments made at the last HLM to develop clear National Action Plans (NAPs) aligned with the Global Action Plan (GAP) on AMR. On the one hand, 178 countries have developed multi-sectoral NAPs but on the other, only 27% of countries report implementing their plans and only 11% have allocated budgets to do so according to Action For Global Health.  

One of the reasons that implementation of NAPs has been so mixed is due to the delay in establishing the global AMR governance and accountability structures. The Interagency Coordination Group (IACG) formed following the 2016 HLM recommended three pillars to AMR governance: the Global Leaders Group, and Independent Panel on Evidence, and the AMR Multi-Stakeholder Partnership Platform.  

The leadership of members of the AMR Global Leaders Group has been welcome and commendable, but the delay in establishing other structures including the Independent Panel on Evidence has left a global architecture which supports countries to develop NAPs without a mechanism to hold countries to account for delivery. 

The issues of funding and accountability are just a sample of the complexities the global community is grappling with in tackling the threat of AMR. However, despite the criticism that can be levelled at the progress since the 2016 HLM, it is not all doom and gloom. 

THET has welcomed the attention and focus given to antimicrobial stewardship (AMS) over the past eight years. AMS is a systematic approach to educate and support healthcare professionals to follow evidence-based guidelines for prescribing and administering antimicrobials. Since 2018, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, funded by the UK Department of Health and Social Care’s Fleming Fund and managed by THET and the Commonwealth Pharmacists Association (CPA), has been working to leverage the expertise of UK health institutions and technical experts to strengthen the capacity of the health workforce in Commonwealth countries to address AMR challenges, all whilst creating opportunities for bidirectional learning. 

During Phase 1 of the CwPAMS programme, Health Partnerships, which have benefitted from the time of over 370 NHS volunteers, more than 6,500 health workers have received training with 96% showing an increase in knowledge and practice of antibiotic use after the training.

Projects delivered through CwPAMS have also led to the production of 67 new or revised guidelines in LMIC healthcare institutions, and the delivery of Point Prevalence Surveys in 30 healthcare facilities to identify poor practices and inform delivery of interventions to address shortcomings.  

With the efforts of those delivering projects in CwPAMS, and AMR-related projects across all One Health sectors, a glimmer of hope starts to appear that we might just be in time to tackle the threat of AMR after all. Indeed, renewed global leadership through the HLM on AMR in September is coming at the perfect moment to continue pushing global efforts to tackle drug-resistant bacteria further.  

Ahead of the HLM, THET and the CPA have developed a briefing for delegates at the meeting based on the evidence and learning from CwPAMS. Our briefing highlights the critical role of health professionals in AMS, including influencing policy at local, regional and national levels, and offers recommendations to sustainably improve practices to tackle AMR in health systems in LMICs and the UK.  

We recommend the following interventions to improve AMS at the national and global levels:  

1. Invest in a health system strengthening approach by leveraging the full skill set of the health workforce though the encouragement of multidisciplinary working, including the empowerment of more pharmacists to lead alongside doctors and nurses in their respective areas of expertise, and to encourage skills’ retention and consider succession planning aligned with UK National Action Plan commitment 5.1 (Political Declaration points 51 and 94 , but more focus is needed on workforce). 
2. Urgently and properly fund a health systems approach to delivering AMR National Action Plans, including the establishment of reliable systems to identify resource and sustainability limitations for AMS interventions at health facilities, including timely and equitable access to lab consumables, IPC supplies, and safe, quality medicines (Political Declaration points 29,53, 63, and 64). 
3. Establish sustainable mechanisms for generating and disseminating data between clinical teams and to raise awareness at local, regional, and national stakeholder level. This will help to inform AMS decision-making, monitor the impact of interventions, and create policy that reflects real, impactful actions that are replicable in everyday settings (Political Declaration points 97 & 98). 
4. Support the Health Partnership approach and scale up the work of CwPAMS to continue promoting long-term exchange of knowledge, data and best practice across health systems (Political Declaration point 9). 
5. Invest in patient and public engagement and awareness activities to improve understanding and behaviours for AMS supported by behavioural theory of change to promote more effective AMS (Political Declaration point 51).  

Implementing these recommendations will provide the foundation for the next phase of global leadership on tackling AMR, with equitable global Health Partnerships at the core of the solution to winning the battle against drug-resistant infections.