Addressing the antibiotic emergency

A world without antibiotics would mean millions upon millions of avoidable deaths. Urgent global collaboration is required, with stakeholders from all sectors taking part

The world is facing an antibiotic emergency. As things stand, the greatest discovery of the last century is fast becoming the greatest loss of the 21st century.

Today, antibiotics are the essential infrastructure that support our modern health, food and economic systems. We need them to treat pneumonia, HIV and tuberculosis, to enable safe childbirth and cancer care, and to treat the animals that feed us and underpin the livelihoods of over 1 billion people across the world.

Micro-organisms’ resistance to anti-infectives is called antimicrobial resistance. AMR is a pandemic of pandemics. It is the third-leading underlying cause of death globally and contributes to the deaths of over 4.7 million people each year. AMR thrives on inequality and inequity, with the burden falling on the most vulnerable, including children, those living in sub-Saharan Africa, and wherever access to safe, effective and affordable antimicrobials and diagnostics is inadequate.

Tragically, AMR is exacerbated by climate change, conflict and displacement.

AMR affects families across the world. The god-daughter of one of us died from a drug-resistant infection, leaving behind a son and family.

This inter-generational issue risks the health and well-being of our children and grandchildren unless we work together on global, ambitious and collaborative action. In tackling AMR, we strengthen our health and food systems, thus preventing and responding to other priority health issues too.

In September at the second High-Level Meeting on AMR at the United Nations General Assembly in New York, world leaders from governments, UN organisations, the private sector and civil society committed to bold and urgent action to mitigate AMR. UN members signed a political declaration that lays the foundations to accelerate evidence-based action against AMR. It showed the strength of multilateralism and global solidarity to reduce AMR-related deaths. It gives us all hope.

Collective action

Countries agreed to re-convene in 2029. Without action, 39 million people could be dead as a result of AMR between 2025 and 2050. This is why the hard work to implement the political declaration starts now. This year’s World Health Summit is an important opportunity to consider how we can collectively deliver on our words. Future milestones, including the Saudi Arabia High-Level Ministerial Meeting in November and the World Economic Forum in January 2025, will enable all sectors to move forward together too.

There are six priorities where the world must move quickly and decisively:

Establish the independent One Health Science Panel on Evidence for Action on AMR, because addressing global inequities means making both evidence and action more inclusive and accessible. The Quadripartite organisations will lead a consultation on the design of a truly independent panel with real ownership by low- and middle-income countries. We all need analysis and synthesis of the current evidence for AMR to provide the best guidance to inform national actions. The panel may have an advisory role in helping member states to agree on multisectoral global targets for AMR. We would like strong participation from the Global South and for the panel to be set up in 2025.

Improve sustainable access to effective and affordable essential antibiotic treatments to practically address global inequities. The UK government has committed up to £50 million as seed funding for an alliance to address inequitable access to antibiotics. We hope others will join.

Use the World Health Organization’s AWaRe system (Access/Watch/Reserve) as a clear framework for developing national assessments of antibiotic use as well as manufacturing, procurement and supply chains. Everyone, everywhere, has a right to sustainable access to affordable and effective essential medicines. To do this, the next step is for countries to determine the appropriate levels of antibiotics for effective treatment of their population. This may involve increasing access to essential Access antibiotics, or developing strategies to manage overuse, particularly of broad spectrum Watch antibiotics.

Build laboratory capacity and capability to generate, share and use data to inform national and global decision-making. The UK’s Fleming Fund, a major international aid investment dedicated to AMR, is supporting countries across Africa and Southeast Asia to strengthen surveillance. This means investing in infrastructure for laboratory equipment and whole genome sequencing, and in training. With more data, patient care can be improved in local communities and governments can act on the best available evidence.

Make it easier for countries to access international financing to tackle AMR by mapping out and leveraging existing funding from international organisations, multilateral and regional development banks, and the private sector. With multiple replenishments coming up across global health and development institutions, we need to work together to champion investments in AMR to mobilise funding. We hope that countries will use the World Bank’s Framework for Action on AMR to design interventions that the global community can mobilise funding for, with international financing streams clearly articulating what funding could be available.

Ensure that awareness matches the scale of the threat from AMR, with sustained public and political engagement. Last month saw a sell-out run of a musical theatre production about AMR on Broadway in New York. Lifeline cast professional actors alongside a chorus of volunteer healthcare workers performing songs about the global race to save antibiotics. We are seeking support to take this musical to other locations across the world. We also have new films and documentaries on AMR, including one with Brian Cox playing AMR as ‘the villain’. It is up to all of us to share these initiatives and many more tailored to national and local contexts to bring more people along with us and inspire public champions for AMR action. We need leadership at every level, and we would like to see an AMR ambassador or envoy for every country.

To build this resilience the health community must work hand in hand with our colleagues from agriculture, environment, finance, development and diplomacy. Working together effectively is built on trust.

We do not want to imagine a world without antibiotics, but if we think, act and deliver together, then we can avert millions of deaths and protect antibiotic treatments for all now and in the future.