AMR: A gathering storm that threatens a century of progress in medicine

By Bobby Ramakant* 
A strategic roundtable on “Charting a new path forward for global action against Antimicrobial Resistance (AMR)” was organised at the 77th World Health Assembly or WHA (WHA is the apex decision-making body of the World Health Organization – WHO, which is attended by all countries that are part of the WHO – a United Nations health agency).

AMR is among the top-10 global health threats

“Antimicrobial Resistance (AMR) is a growing and urgent crisis which is already a leading cause of untimely deaths globally. More than 2 people die of AMR every single minute,” said Dr Tedros Adhanom Ghebreyesus, Director General of the WHO. “AMR threatens to unwind centuries of progress in human health, animal health, and other sectors.”
Dr Peter Piot, Professor of Global Health, London School of Hygiene & Tropical Medicine (LSHTM) who has held leadership positions at LSHTM, UNAIDS and WHO earlier, chaired the WHA roundtable on AMR. He said: “AMR is a gathering storm that threatens a century of progress in medicine. Each year, drug-resistant bacteria claim more than a million lives globally, especially in low and middle-income countries. Yet this crisis is still a silent one. We take for granted that infections that once spelled death are routinely cured with antibiotics. In the age of ever more advanced and personalized medicine, we have grown complacent about these marvels that allowed us to bring infections under control.”
Mia Amor Mottley, Prime Minister of Barbados, and Chairperson of Global Leaders Group on AMR (GLG) said: “The gravity of AMR hits home when trusted antimicrobials stop working. The terrifying prospect of ineffective medicine is regrettably already a reality for too many.”

AMR is not only a problem but a problem with a solution

Dr Kamini Walia who is the Convener and Co-Chairperson of Scientific Committee of Global AMR Media Alliance (GAMA) and a senior AMR scientist at the Indian Council of Medical Research (ICMR) said: “AMR inflicts significant mortality, morbidity and economic loss in low- and middle-income countries, including India. Several countries in Asia and Africa have observed a worrying trend of increasing drug resistance, while progress towards AMR containment efforts remain scattered and fragmented.”
Dr Peter Piot rightly said that AMR is not only a major problem but a problem with a solution. There is a lot we can do to combat AMR.
“Lack of recognition of the problem at the highest level of governance, limited technical capacity and financial resources, weak regulatory apparatus, half-hearted efforts towards instilling behavioural changes at all levels of healthcare have prevented the effective application of several interventions to minimize the impact of AMR. Countries need to invest in strengthening healthcare systems, and prioritising prevention interventions, like infection control in hospitals and communities, and vaccinations,” added Dr Walia.
The latest Lancet series has has listed 3 targets for sustainable access to effective antibiotics:

• 10% reduction in deaths from antibiotic resistance
• 20% reduction in inappropriate human antibiotic use
• 30% reduction in inappropriate animal antibiotic use

“AMR has set the stage for advancing One Health approach – which is a recognition that our health is intrinsically intertwined with animal health, food and agriculture and our environment. We have the evidence-based tools to fully implement and deliver on the above 3 targets,” said Dr Ramanan Laxminarayan of One Health Trust, who is one of the authors of The Lancet series.

AMR survivors and affected communities must be central to AMR responses

Vanessa Carter, Chairperson of the WHO Taskforce of AMR Survivors, shared her traumatic personal experience of surviving AMR. She met with a severe car accident in 2004 that resulted in massive multiple injuries, that took ten years to recover, during which time she had multiple facial prosthetic implants. Seven years into the accident, Vanessa was eventually diagnosed with highly antibiotic resistant form of MRSA infection. She survived, but with a severe disability- facial disfiguration which was partially caused by the accident but exacerbated by the fact that no antibiotics could treat that infection.
“It was very difficult to look into the mirror back then and watch how antimicrobial resistant infections were eating my skin away,” said Vanessa Carter. “We have to bring the human impact in the centre of AMR response.”

Youth Manifesto on AMR

A youth manifesto on AMR that was prepared by an inclusive and consultative process and co-created by the young people worldwide, was launched earlier this month at the UN. “We must address AMR with One Health approach and enhance multidisciplinary action against AMR. Future of we, the young people, is at stake,” said Audrey Wong, Chair, Quadripartite Working Group for Youth Engagement on AMR. “If we do not address AMR timely and effectively there will not be much of a future left for us,” remarked Dr Peter Piot.

No excuse for inaction

“We casually give out antibiotics, even to healthy farm animals. On top of that climate change brings back many pathogens with a vengeance—exacerbating resistance. As a result, the bacteria we are fighting evolve much faster than our armoury and defy treatment more and more. This endangers the very core of healthcare systems globally: Even routine surgery becomes risky, and we have trouble fighting opportunistic infections during therapy. We risk reverting to the pre-antibiotic age—which is even more threatening given the demographic transition and aging the world is undergoing,” said Dr Peter Piot, Chairperson of AMR roundtable at the 77th WHA.
“Yet this is preventable through global leadership, research and the right incentives. We must reserve antibiotics for genuine need, while aggressively developing new drugs, diagnostics, vaccines and non-pharmaceutical options. And we must ensure second and third-line antibiotics are commercially viable once on the market. Just as urgent is publicly and globally sharing national data on emerging resistance. There is no time to lose: we must act decisively today to fight AMR or lose much of the hard gained progress in health and modern medicine tomorrow," added Dr Piot.

Hope for accelerated action at the upcoming UN High Level Meeting on AMR

The United Nations General Assembly High Level Meeting (UNHLM) on AMR will be held in September 2024.
“We are not on track on the commitments our world leaders made when they met at the UNHLM on AMR held in 2016. I hope commitments that come out of UNHLM on AMR in 2024 will be taken more seriously,” said Dr Peter Piot, Chair of the strategic roundtable on AMR at the 77th WHA.
Professor Dame Sally Davies, Special Envoy on AMR for UK and a member of Global Leaders Group on AMR said that “I hope the upcoming UNHLM on AMR in September 2024 will prioritise prevention, access, governance, and accountability. It should truly address the needs of the most vulnerable communities. There should be fair and equitable access to antibiotics and diagnostics, embedded in a better system of WASH (water, sanitation and hygiene), infection prevention and control, vaccines, and prevention with responsible stewardship. From declaration to implementation, I call upon everyone to make equity, One Health approach, and actions the cornerstone of our next steps to tackle AMR.”

What is AMR?

“Antimicrobial Resistance (AMR) is a problem driven by misuse and overuse of antimicrobial medicines, including antibiotics and antivirals, and results in critical medicines losing effectiveness to treat infections,” said Thomas Joseph, Head, AMR Awareness, Advocacy and Campaigns, World Health Organization (WHO). “AMR is associated with 5 million deaths a year. Besides this, there is the huge burden of morbidity and healthcare expenditure that can affect household welfare severely. The World Bank estimates that Global GDP could fall by $1 to $3.4 trillion annually after 2030 due to AMR,” he added. The World Bank estimates that an additional 24 million people would be forced into extreme poverty by 2030 if no action is taken on AMR today.
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*Global Antimicrobial Resistance Media Alliance (GAMA)