Antibiotics were once known as “miracle drugs.” And justifiably so: they have been responsible for a great leap forward in medical treatment – heralding an average lifespan increase of about five to ten years worldwide. Now, however, a new threat to human health has emerged, which has the possibility of rolling back this progress.
Resistance to antibiotics makes treatment of diseases ineffectual. But “antibiotics are also fundamental for successful invasive and high-end surgeries including organ transplants, immunomodulatory treatments in rheumatology, oncology and many other medical disciplines. And it is projected to account for over 10 million deaths per year in 2050.”
Laura Kahn, a leader in the One Health Movement, has highlighted the alarming spread of antimicrobial resistance (AMR). She identified key drivers of this crisis: poor sanitation, the overuse of antibiotics in agriculture and medicine, and the transfer of resistance between humans and animals. These factors have accelerated the prevalence of AMR.
Now, the global community is signalling that it is recognizing the dangers and pledging decisive action. In September 2024, during the 79th United Nations General Assembly, a landmark political declaration was adopted to address one of the most pressing health challenges of our time. The declaration ties AMR to the UN’s Sustainable Development Goals (SDG), setting 2030 as the target for progress.
In our globalized world there is no time to waste, as new and formerly contained diseases spill over international borders. AMR poses a significant threat to public health, economic stability and global food security.
WARNINGS SET
Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), underscored the urgency in a stark warning: “AMR could unwind 100 years of medical progress, making infections that are easily treatable today, a death sentence.” No country is immune, he said. And the human and economic tolls are alarming. In 2019 alone, AMR was linked to 4.95 million deaths, and by 2030 — only five years away — it is projected to cost the global economy $3.4 trillion U.S.
However, the lowest income countries bear the heaviest burden, as they have the poorest levels of sanitation, nutrition, medical care and access to clean food and water.
GLOBAL RESPONSE: A UNIFIED DECLARATION
Recognizing the gravity of AMR, the declaration aims to reduce AMR-related deaths by 10% by 2030. As a starting point it establishes a $100 million USD catalytic fund to support the development and implementation of national action plans. The fund’s resources will help it attract new investment for development goals, which multiplies its effectiveness. The goal is for at least 60% of UN member states to adopt funded strategies by 2030.
Mia Mottley, Prime Minister of Barbados, however, emphasized the need for greater investment, calling the fund “a very modest target…to support the low and middle-income countries.” She added that it is nowhere near the research (funding) necessary for pharmaceutical companies to find alternatives to the antimicrobials we now have. “In 2000, there were over 20 firms researching new antibiotics; today, there are four.”
KEY COMMITMENTS TO TACKLING AMR:
The UN declaration outlines three critical areas for action:
Human Health:
- Ensure 70% of antibiotics used globally belong to the WHO Access Group to minimize AMR risk by 2030.
- The Access group contains antibiotics used in the first and second-line treatment of Improve access to clean water, sanitation, hygiene and waste-management facilities.
- Reform pharmaceutical incentives to address AMR and invest in greater surveillance and equitable access to antimicrobials.
- Emphasize infections prevention and control measures.
Preventative Measures:
- Prioritize vaccination programs and biosecurity measures to reduce antimicrobial use in food.
- Implement responsible antimicrobial use aligned with the Food and Drug Agriculture Organization (FAO) framework to reduce antibiotic dependency in farming.
Thanawat Tiensin of the FAO made clear how high are the stakes. “Agriculture systems are the backbone of food security, economic stability, social wellbeing and environmental sustainability,” she said. “Without effective antimicrobials, infections in animals and plants will affect not just our food security but also global health, economic prosperity and the integrity of our ecosystem.”
Environmental Protection:
- Address the discharge of antimicrobial pollutants into ecosystems. These can include common cleaning products, and improperly disposed drugs.
- Advance research to reduce pollution from agriculture and pharmaceuticals, including use of antimicrobials and manure in crop production, and release of waste from animal production.
A UNIFIED APPROACH:
The United Nations Environment Programme (UNEP), FAO, and the World Organization for Animal Health (WOAH), emphasized that they are united in their commitment. By 2026, they aim to update the Global Action Plan, ensuring accountability, international cooperation and transparency.
On a hopeful note, Inger Anderson, UN Under-Secretary-General and Executive Director of UNEP, underscored that the declaration reaffirms the world’s commitment to “tackling AMR by building on what we know, (and) strengthening what we can see…” to save millions of lives and animal health, while protecting the environment and boosting food safety and security.
A CALL FOR RESPONSIBILITY
Nevertheless, the outcome rests on individual countries to take difficult but necessary steps, and acknowledge AMR as a developing crisis. The declaration sets an urgent challenge to global leaders, stakeholders, and individuals to rethink their antibiotic use to protect the health of humans, animals, agriculture, and ecosystems.
However, Mottley cautioned, unless the declaration is taken seriously, the world faces the threat of a reversal of a century of medical progress and “the silent, slow-motion pandemic of antimicrobial resistance.”
Ghebreyesus echoed the call for urgency: “We urge all countries to take immediate action on the commitments in the declaration. WHO stands ready to support them to do that.”
At a time of growing uncertainty, there is some optimism. Through united efforts and shared responsibility, innovative and sustainable solutions can mitigate the effects of AMR, safeguarding health, food systems and ecosystems for generations to come. There is still time – if there is political will. The alternative would lead to a worldwide crisis that respects no borders – and which no country alone is equipped to overcome.