We are on the precipice of entering a post-antibiotic era, when a scraped knee or common infection may prove deadly for an otherwise healthy individual. Because of antimicrobial resistance (AMR), common and life-threatening infections are increasingly becoming untreatable. This proliferation of superbugs is being seen worldwide. There is a silent epidemic of multidrug-resistant typhoid raging across Africa and Asia, killing 200,000 each year; multidrug-resistant tuberculosis (MDR-TB) has been identified in 105 countries; and the US Centers for Disease Control and Prevention (CDC) announced that more than 800,000 Americans may soon be at risk of acquiring untreatable gonorrhea each year.
With the growing problem of AMR, even routine medical procedures could prove too risky to undergo. While you reminisce of days when you could take a weeklong course of antibiotics to cure an infection, you may soon find yourself lucky if you are prescribed a treatment with a 50% cure rate that takes two years, hundreds of injections, and 14,000 pills, which is already the case for more than 500,000 suffering from MDR-TB. According to the World Health Organization (WHO) Director General, Margaret Chan, “Doctors facing patients will have to say, ‘I am sorry. There is nothing I can do for you.’”
AMR and the resulting diminishing supply of effective antibiotics are two of the biggest threats to global health today. This is no surprise. Even Alexander Fleming, who discovered penicillin, the world’s first antibiotic, warned of the danger of resistance. Yet, while existing antibiotics are losing efficacy due to widespread resistance, pharmaceutical companies have shifted away from developing new antibiotics in favor of more lucrative opportunities. Each year in the US alone, there are more than 2 million AMR illnesses, 23,000 deaths, and $35 billion in economic losses. Globally, there are more than 700,000 AMR deaths annually. According to an often-cited analysis from the Review on Antimicrobial Resistance, if no action is taken between now and 2050, the true cost of AMR will be 300 million premature deaths and $100 trillion in terms of global gross domestic product.
On September 21st, Small World Initiative President and CEO, Erika Kurt, joined international leaders, experts, and stakeholders for the United Nations (UN) High-Level Meeting on AMR. This marks only the fourth time in history that the UN General Assembly (UNGA) has addressed a health issue – the others being HIV, noncommunicable diseases, and Ebola. This was a welcome first step for many stakeholders who recognize the UN as the only institution that can summon the necessary resources and global commitments to action necessary to combat AMR. The resulting political declaration reflects the commitment of nations to address the crisis in a unified manner.
The declaration, which calls AMR “the greatest and most urgent global health risk,” seeks to spur leaders to action and focuses on recognizing the problem, acknowledging the real causes, and calling for a One Health solution. Countries confirmed their commitment to develop national AMR action plans based on WHO’s Global Action Plan.
Throughout the meeting, the seriousness and urgency of the problem was voiced over and over again:
“[AMR is] a very present reality in all parts of the world [that poses] a fundamental, long-term threat to human health, sustainable food production, and development.” – UN Secretary-General, Ban Ki-moon
“[AMR] threatens the achievement of the Sustainable Development Goals and requires a global response. […] No one country, sector or organization can address this issue alone.” – UNGA President, Peter Thomson
“We are running out of options. AMR is a public health failure and emergency, and we need to get our mind into this mode." – Médecins Sans Frontières International President, Joanne Liu
“We are late to the game on the public health emergency of our time.” – Consumer Reports President and CEO, Marta Tellado
“We are running out of time!” – Chan
In a welcome move, there was also a real acknowledgment of the primary cause of AMR – the mass-scale inappropriate use of antibiotics in agriculture (including farmed fish) and humans. While this is commonly understood among experts, it has often been carefully left out of policy.
The call for a One Health solution focused on proper antibiotic use, prevention and control of infections, and research and development for new antibiotics, alternative therapies, vaccines, and diagnostics. Prevention and control directives included immunization, safe water and sanitation, and good hygiene in hospitals and animal husbandry. Leaders from Europe continually stressed the need for global controls of antibiotic use in agriculture similar to the European Union model. European Commissioner for Health and Food Safety, Vytenis Andriukaitis, contended that a global ban on antibiotics as growth promoters was necessary. Norway’s Prime Minister, Erna Solberg, shared her country’s insights on how to accomplish this without compromising the agricultural industry in describing how Norway was able to reduce antibiotic use in the salmon industry by 99% through an innovative smelt vaccination program.
The existing market failures were also widely recognized by those present as simultaneously encouraging improper antibiotic use, limiting access to essential medicines, and not encouraging the development of innovative solutions and therapies. This culminated in a call for investment in research and development of new, effective, and affordable medicines and therapies as well as rapid diagnostic tests that take into account the needs of all countries. With 13 leading pharmaceutical companies committing to a road map for reducing the overuse of antibiotics by 2020 just ahead of the meeting, there was renewed hope that private industry would take additional steps. In the effort to discover new medicines, during the panel discussion, GlaxoSmithKline CEO, Sir Andrew Witty, recognized that, “There has not been enough fundamental biological discovery. We need to pilot new collaborative systems."
Leaders will report back in two years on their progress.
As Manica Balasegaram, Director of Drugs for Neglected Diseases Initiative’s Global Antibiotic R&D Partnership, asserted, “What we have now, it is on a piece of paper. It is good. It is important, but it is just the first step. […] It is a declaration, as far I am concerned, of intent. We have to see that it is translated into something more concrete [and see] how it will work at the international and national level, how different sectors are going to work together, how financing and funding for things will be done and [if they will be] sufficient.”
There were many calls for action throughout the week, and as voiced by CDC Director, Dr. Tom Frieden, "It is not too late if we respond effectively with global collaboration."
While the issuance of this declaration is a major accomplishment and draws attention to this important issue, we must now take action. The Small World Initiative is engaging students, science educators, and the general public to use antibiotics correctly, change other behaviors related to AMR, and help us discover new antibiotics. Our introductory microbiology course focused on hunting for new medically-relevant microbes in soil is now in 167 undergraduate and high school institutions in 35 US states, Puerto Rico, and 12 countries, and we aim to establish a high-throughput screening lab to determine if student discoveries may be medically relevant and move forward into the antibiotic pipeline. Our program provides a way of conducting mass-scale fundamental biological discovery through a collaborative model. We are calling on others to help us multiply our efforts to increase awareness, change behaviors, and crowdsource antibiotic discovery. While AMR has significant global consequences, we understand the key causes and many of the possible solutions to stemming this problem…if we can only act.
While local, national, and global action are required to solve this problem, even individuals can take impactful action. Consider simple actions like changing what sorts of companies you support, getting vaccinated, washing your hands, and not demanding antibiotics when you have a viral infection like a cold or flu. In the US, consumer demand led to nine of the largest food chains adopting new sourcing policies that require antibiotic-free meat, which will push changes in agricultural practices. It is important for individuals to understand their power as consumers. As Chan emphasized, “You have a very important role to play.”
If you would like to join or support the Small World Initiative’s efforts to take action on AMR, please click here.