Interagency Group Identifies Antimicrobial Resistance Threat as Formidable but not Unsurmountable

29 April 2019: The UN Interagency Coordination Group (IACG) on Antimicrobial Resistance released its final report, finding that antimicrobial resistance is a global crisis that “threatens a century of progress in health and achievement of the SDGs.”

In 2016, the Political Declaration of the UN’s High-level Meeting on Antimicrobial Resistance (resolution A/RES/71/3) called for establishing the IACG in consultation with the World Health Organization (WHO), the Food and Agriculture Organization of the UN (FAO) and the World Organisation for Animal Health (OIE). The IACG, appointed in March 2017, was mandated to provide practical guidance on approaches to ensure sustained effective global action to address antimicrobial resistance, and to report back to the UN Secretary-General in 2019. The IACG consists of representatives of UN and multilateral agencies, and individuals with expertise across human, animal and plant health and in the food, development, environment and trade sectors.

The Group’s final report titled, ‘No Time to Wait: Securing the Future from Drug-Resistant Infections,’ observes that antimicrobial agents are critical for fighting diseases in humans, aquatic and terrestrial animals and plants, but they are “becoming ineffective,” and misuse and overuse of existing antimicrobials are accelerating the development and spread of resistance. The authors state that countries of all income levels have reported “alarming levels of resistance,” resulting in common diseases becoming untreatable and making lifesaving medical procedures riskier to perform. In some Organization for Economic Cooperation and Development (OECD) member countries, about 35% of human infections are resistant to currently available medicine. In some low- and middle-income countries (LMICs), resistance rates are 80-90% for some antibiotic-bacterium combinations. Further, resistance to second- and third-line antibiotics, the “last lines of defense against some common diseases,” are projected to nearly double between 2005 and 2030.

Without a sustained effort to contain antimicrobial resistance, the report projects that approximately 2.4 million people in high-income countries could die between 2015 and 2050. Drug-resistant diseases already result in at least 700,000 deaths annually around the world. The authors warn that uncontrolled antimicrobial resistance also could result in economic damage comparable to the 2008-2009 global financial crisis, as a result of increased health expenditures and food, livelihood and trade impacts.

The report stresses the “formidable challenge” antimicrobial resistance poses to achieving universal health coverage (UHC) and progress on many of the SDGs, including SDG 1 (no poverty), SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 6 (clean water and sanitation), SDG 10 (reduced inequalities) and SDG 12 (responsible consumption and production). Despite the complex and multifaceted challenges of antimicrobial resistance, the report emphasizes that they are not insurmountable, as implementation of proposed recommendations will “save millions of lives, maintain economic and other development gains, and secure the future from drug-resistant diseases.”

The IACG calls for a “sustained One Health response” to address the drivers and impact of antimicrobial resistance, and engage and unite all stakeholders around a shared vision and goals. The report underscores the importance of strong political leadership, accountability, coordination and advocacy to enable this response. As part of such a response, the IACG recommends establishing a One Health Global Leadership Group on Antimicrobial Resistance, supported by a Joint Secretariat managed by the FAO, OIE and WHO, and calls for joint One Health action based on country priorities and needs and target setting.

The IACG requests the UN Secretary-General in coordination with relevant agencies to convene an ‘Independent Panel on Evidence for Action against Antimicrobial Resistance in a One Health context.’ The Panel would provide Members States with regular reports on “the science and evidence related to antimicrobial resistance, its impacts and future risks,” as well as recommend options for “adaptation and mitigation.” The IACG calls on Member States to accelerate development and implementation of One Health National Antimicrobial Resistance Action Plans within the context of the SDGs.

Recommendations focus on accelerating progress, increasing investment and innovation, collaborating to promote more effective action, and strengthening accountability and global governance on antimicrobial resistance. Recommendations call for, inter alia:

strengthening infection prevention and control in health care facilities and farms;
ensuring access to clean water, sanitation and hygiene to minimize disease transmission and the emergence and transmission of antimicrobial resistance;
strengthening regulatory frameworks and oversight of antimicrobial prescription and use, including through professional education;
increasing awareness among all stakeholders to ensure responsible use of antibiotics; ending the use of antimicrobials for growth promotion;
addressing financing and capacity constraints; and
increasing investment and incentives to drive innovation in antimicrobial medicines and alternatives to antimicrobials.

The IACG Secretariat is hosted by WHO, with contributions from FAO and OIE. In January 2019, the WHO listed antimicrobial resistance among the ten biggest health challenges facing the world. [Report Webpage] [Publication: No Time to Wait: Securing the future from drug-resistant infections] [UN News Story] [WHO Press Release]