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29 June 2022

5 takeaways from AMR Stockholm+50 associated event

Group discussion during the webinar. Photo: Therese Holm, ReAct Europe

On June 1st 2022, ReAct in collaboration with The Nordic Council of Ministers, theStockholm Environmental and the Swedish International Agriculture Network Initiative hosted the hybrid event “The silent antimicrobial resistance pandemic urges a concerted global response – but what needs to be done?”. Here you find 5 takeaways from the day and a few next steps.

The event was held in the capital of Sweden and organized in association with Stockholm+50, a healthy planet for the prosperity of all – our responsibility, our opportunity”, a major international environmental meeting convened by the United Nations General Assembly on June 2-3 in Stockholm. This was a unique opportunity to create a dialogue among Global health experts representing different communities on how to contain the antimicrobial resistance (AMR) pandemic with a One Health approach, and how to scale up action at the community, national, as well as  global level.

The response to COVID-19 can speed up antimicrobial resistance actions

COVID-19 exposed huge dysfunctionalities in global health governance and local health systems, showing how unprepared the world is to health crisis. While the world is still recovering from the COVID-19 emergency, another silent pandemic is threatening global health, food security, and the world economy: antimicrobial resistance (AMR). The repeated misuse of antibiotics has triggered a silent AMR pandemic, leading to increased mortality. A recent Lancet study estimated that 1.27 million deaths are every year attributable to antibiotic resistance, with low- and middle-income countries worst affected. The (un)preparedness and response to COVID-19 give the world a unique opportunity to reflect on the lessons learned and to expedite governments´ commitments to curb the AMR pandemic.

The event explored two main questions:

  • How can we implement the lessons learned from the COVID-19 pandemic to effectively contain antimicrobial resistance development and spreading?
  • How do we scale up action for a global concerted One Health response to the antimicrobial resistance pandemic?

5 key takeaways

1. COVID-19 and AMR – the One Health face of two pandemics

Building on the experiences of the COVID-19 pandemic are essential to be able to create a concerted and effective response to antimicrobial resistance.

Both pandemics drastically affect:

  • Global health
  • World economy
  • Food security.
  • Equitable access to medical countermeasures

As for COVID-19, new pathogens arise between the human-animal interface, nonetheless

“Antimicrobial resistance affects humans, animals, crops, plants, environment, and the impact is far more reaching than Covid-19”,

said Sabiha Essack, Professor, International Centre for Antimicrobial Resistance Solutions, South Africa, during the event.

Accordingly, a pandemic response should be grounded in a One Health approach, identifying the synergies among sectors to optimize actions and outcomes.

A pandemic response should prepare for:
  • Strengthening and preserving synergies and interconnections between public health, Infection Prevention and Control, Water Sanitation and Hygiene, food safety, energy, and environmental issues.
  • Implementing/renewing the AMR National Action Plans from a  One Health perspective
  • Investing into targeted research, inclusive of all countries and needs of vulnerable groups are given priority.
  • Scaling up action to better address access and equity.
  • Understand the triggers of behavioral change for a whole-of-society response.

2. Raising awareness about antibiotic resistance

Antimicrobial resistance is not a future pandemic, but a present concern. It is fundamental for everyone to be aware of the death toll of antimicrobial resistant bacteria, in the same way that we know about COVID-19 – and – in the same way we have started understand climate change .

Policy makers  and authorities are often not aware of the global consequences of the AMR pandemic, which results in a lack of long-term financial commitment and action. Investing in awareness raising activities and education, starting from primary schools, should be a key priority.

According to Anders Nordström, Ambassador for Global Health at Ministry for Foreign Affairs of Sweden, in order to effectively deliver emergency messages to policy makers, 4 pillars shall be considered:

  • Peers´ influence
  • People and voters
  • Partners and collaborations
  • Personal experience

3. Surveillance – the core for an effective response

The earlier the detection of the resistance – the quicker we can put in place the response and measures, and  contribute to reducing the scale of the issue of antimicrobial resistance. Surveillance is often highlighted within the Global Action Plan on AMR, as well as within many other global commitments, nonetheless it is not so easily  implemented i. Current surveillance data and health outcomes measurements are not adequate to fully understand pathways of antimicrobial resistance and its full impact. An antimicrobial resistance response without a robust surveillance system will not allow for an effective response. Notably, local capacity building is critical for scaling up a global surveillance system.

“Without surveillance, we are simply just flying blinds”

says Frank Møller Aarestrup Professor, DTU Orbit

A pandemic response should prepare for:

  • Investing in accurate fast diagnostics, capacity building, local-to-global surveillance
  • Strengthening global monitoring and surveillance systems.
  • Strengthening global commitments to data acquisition, transparency, and sharing.

4. Financing – the risks of underfinancing a global health threat

“Another lesson learned  from the COVID-19 pandemic is that when governments invest significantly and set priorities, research can take quantum leaps”,

says Andrea Caputo, PhD and Global Health Advisor, ReAct

Governments have not yet done this for antibiotics. Even though antimicrobial resistance is listed by The World Health Organization (WHO) as being within the top 10 threats to global health, still only 4 countries have pledged to the Multi-Partner Trust Fund. This is a clear lack of commitment and a dangerous underestimation of the AMR threat. Additionally, both the United Nations Inter-Agency Coordination Group (IACG) on AMR and the editorial in Lancet paper following up the GRAM study, have called for expanding the Global Fund mandate.

An effective pandemic response should:

  • Increase global financial commitments from far more countries to allow for the development, distribution, and access to medical countermeasures for all.

5. Accountability – we are all responsible and part of the solution

Antimicrobial resistance requires the same whole of society, government response top-down and bottom-up from policymakers to civil society as it is currently in place for COVID-19. It is important to bring the attention to all the stakeholders, including governments, social and civil societies, academia, resource partners, and the private sector. Bringing multi-stakeholders involvement to antimicrobial resistance  is of utmost importance which is one  the aim of the Stockholm+50 meeting.

“Openness and transparency were very important in order to establish a system that could move us forward when it comes to the use of antibiotics and of course all the reporting we have a very tidy reporting system for all antibiotics”

says Edgar Brun, Unit Director, Norwegian Veterinary Institute

Next steps

Research needed

Medical research related to COVID-19 has been highly encouraged since the beginning of the pandemic. We need much more research focusing on antimicrobial resistance –  not only in medical science but in political economy, understanding not what to do but what will make it happen. Furthermore, it is not enough to increase knowledge, we really need to understand what is incentivizing politicians, the private sector and the whole-of-society for changing behaviors.

Political will AND political action needed

There is an urgent need for a stronger governance for handling antimicrobial resistance. It is a global under-financed threat. It is vital to enhance political will by building on the previous experience from the COVID-19 pandemic, with careful consideration to health, social, economic and political impact. – AMR is a One Health pandemic with enormous impact. Long-term commitment and funding sustainability are in need to address antimicrobial resistance effectively.

 “Political will is the combination of knowledge and peer or public pressure. Political action is different from political will and political action is about being able to find affordable and inclusive ways to be able to move ahead”

says Sunita Narain, Director General of Center for Science and Environment (CSE); Editor of the fortnightly magazine, Down To Earth

Key take aways from Stockholm+50 event

  • Antimicrobial resistance is a One Health issue that is affecting humans, animals and the environment with an impact that is more far-reaching than COVID-19. Building on the experiences of the COVID-19pandemic and its multi-sectoral impact, global governance shall enforce AMR response activities to be a step ahead of this silent pandemic.
  • Antimicrobial resistance requires the same whole of society, government response top-down and bottom-up from policymakers to civil society-  as is currently in place for COVID-19.
  • It is not enough with knowledge, we need to scale-up global commitments and community awareness and then understand what is incentivizing politicians, private sector and people for changing behaviors.

The article was originally published on the ReAct website