Tweet
Source: http://www.cidrap.umn.edu/news-persp...hat-comes-next
After the UN declaration on AMR, what comes next?
Filed Under:
Antimicrobial Resistance;; Antimicrobial Stewardship
Chris Dall | News Reporter | CIDRAP News
| Sep 28, 2016
With last week's approval of a United Nations (UN) declaration on antimicrobial resistance (AMR), world leaders have made a commitment to fight the rise of drug-resistant pathogens and ensure continued access to life-saving antibiotics. Now comes the hard part: Turning the commitment into action.
Advancements will take place on the national level, with governments creating plans to monitor antibiotic resistant infections, reduce the inappropriate use of antibiotics in human and animal health and agriculture, and educate the public about antibiotic stewardship. Some countries have already started down this path. But for others, especially low-income nations with weak healthcare systems and a host of other health challenges, the task will be more difficult.
"It's very hard to deny medicines to people who are sick," said Laura Kahn, MD, MPH, a physician and research scholar at Princeton University and author of the book One Health and the Politics of Antimicrobial Resistance. As Kahn explains, many developing nations use antibiotics as a substitute for sanitation, hygiene, and medical care. Asking them to reduce antibiotic use essentially removes a critical tool from their healthcare arsenal.
This is where organizations like the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE) will play a significant role. But how these UN bodies will ensure every country is holding up its end of the bargain remains an open question.
The challenge of implementation
"Implementing this will not be easy, at all," said Gian Luca Burci, JD, former legal counsel for the WHO. The UN declaration calls for the creation of a body that will coordinate the efforts of the WHO, FAO, and OIE. But coordination will be a challenge, Burci explained, because those organizations represent different constituencies with different priorities.
The organization that is in the best position to take the lead, Burci said, is the WHO. The agency's AMR action plan, put forward in 2015, forms the blueprint of the UN declaration. The plan calls for nations to improve public awareness and understanding of AMR, increase surveillance for drug-resistant organisms, reduce the incidence of infection through improved sanitation and hygiene, promote antimicrobial stewardship in human and animal health, and increase investment in new antibiotics, diagnostics, and vaccines.
In Burci's view, implementation of the plan could follow two paths. The WHO could work with experts to create detailed national action plans that include targets and goals for reduced antibiotic use. Or member states could take the lead and come up with "soft" targets that are more politically viable. Given how many sectors will be affected by targets, in particular the agricultural sector, Burci said this might be the likelier path.
"I wouldn't be surprised if you see member states try to take the lead, or at least be part of the follow-up process," he said.
One of the fears, though, is that some countries might come up with soft targets and then fail to meet their commitments, leaving other countries to shoulder the burden. Big food-producing nations like Argentina and Brazil, for example, could have a lot to lose from phasing out the use of antibiotics in livestock. "The issue is a level playing field," Burci said. "There is a fear of free-riding."
Political pressure
This is where the UN plays an important role. By acknowledging the grave and urgent threat posed by AMR and committing countries to take action, the UN declaration adds a level of political pressure that can force nations to make AMR a priority and facilitate policy coherence.
Any movement on AMR, though, could be hampered by transitions going on at the UN and the WHO, where leadership changes will occur in the coming months. "I think a lot really depends on who the next UN secretary-general is and who the next director-general of the WHO is," notes Ramanan Laxminarayan, PhD, MPH, director of the Center for Disease Dynamics, Economics and Policy (CDDEP). "They've got many other priorities, but will they recognize that this is a really important issue they should not put on the back burner?"
Laxminarayan is hoping that the UN reaches to other parties to help fight AMR. "This problem can be solved only partially by UN agencies and their ways of working," he said. "Unless they reach out to the broad set of academics, clinicians, veterinarians?that lie outside of governments, it will not get solved."
That's because reducing drug-resistant infections and antibiotic use is not as straightforward as fixing the hole in the ozone, Laxminarayan explained. That effort required governments to change regulatory standards and companies to meet those standards. AMR, on the other hand, requires a broader set of stakeholders.
Holding the UN accountable
Laxminarayan is among those who think targets for reducing inappropriate antibiotic use are a critical element in the battle against AMR. These types of targets, he argues, will enable the UN to measure progress.
If the UN effort against AMR lags, Laxminarayan said he and others will be there to "hold their feet to the fire." To that end, CDDEP has joined with other public health and infectious disease groups to form CARA, the Conscience of Antimicrobial Resistance Action. CARA envisions its role as something of a watchdog that will hold the UN?along with international health agencies and member states?accountable for meeting its commitment to fight AMR. Among the tasks of the organization will be to monitor progress toward agreed-upon goals, and independently establish a set of targets that countries should aim to meet.
"It is not enough for countries, politicians, businesses and the healthcare community to make pledges for change," Laxminarayan and Dilip Nathwani, OBE, of the British Society of Antimicrobial Chemotherapy wrote recently in New Scientist. "They must know that they're being watched, but also that our community of experts stands ready to help."
See also:
Sep 21 UN draft political declaration on AMR
Sep 21 CIDRAP News story "UN leaders pledge to fight antimicrobial resistance"
May 2015 WHO Global Action Plan on AMR
Sep 20 CARA press release
Sep 22 New Scientist commentary (free registration required)
After the UN declaration on AMR, what comes next?
Filed Under:
Antimicrobial Resistance;; Antimicrobial Stewardship
Chris Dall | News Reporter | CIDRAP News
| Sep 28, 2016
With last week's approval of a United Nations (UN) declaration on antimicrobial resistance (AMR), world leaders have made a commitment to fight the rise of drug-resistant pathogens and ensure continued access to life-saving antibiotics. Now comes the hard part: Turning the commitment into action.
Advancements will take place on the national level, with governments creating plans to monitor antibiotic resistant infections, reduce the inappropriate use of antibiotics in human and animal health and agriculture, and educate the public about antibiotic stewardship. Some countries have already started down this path. But for others, especially low-income nations with weak healthcare systems and a host of other health challenges, the task will be more difficult.
"It's very hard to deny medicines to people who are sick," said Laura Kahn, MD, MPH, a physician and research scholar at Princeton University and author of the book One Health and the Politics of Antimicrobial Resistance. As Kahn explains, many developing nations use antibiotics as a substitute for sanitation, hygiene, and medical care. Asking them to reduce antibiotic use essentially removes a critical tool from their healthcare arsenal.
This is where organizations like the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE) will play a significant role. But how these UN bodies will ensure every country is holding up its end of the bargain remains an open question.
The challenge of implementation
"Implementing this will not be easy, at all," said Gian Luca Burci, JD, former legal counsel for the WHO. The UN declaration calls for the creation of a body that will coordinate the efforts of the WHO, FAO, and OIE. But coordination will be a challenge, Burci explained, because those organizations represent different constituencies with different priorities.
The organization that is in the best position to take the lead, Burci said, is the WHO. The agency's AMR action plan, put forward in 2015, forms the blueprint of the UN declaration. The plan calls for nations to improve public awareness and understanding of AMR, increase surveillance for drug-resistant organisms, reduce the incidence of infection through improved sanitation and hygiene, promote antimicrobial stewardship in human and animal health, and increase investment in new antibiotics, diagnostics, and vaccines.
In Burci's view, implementation of the plan could follow two paths. The WHO could work with experts to create detailed national action plans that include targets and goals for reduced antibiotic use. Or member states could take the lead and come up with "soft" targets that are more politically viable. Given how many sectors will be affected by targets, in particular the agricultural sector, Burci said this might be the likelier path.
"I wouldn't be surprised if you see member states try to take the lead, or at least be part of the follow-up process," he said.
One of the fears, though, is that some countries might come up with soft targets and then fail to meet their commitments, leaving other countries to shoulder the burden. Big food-producing nations like Argentina and Brazil, for example, could have a lot to lose from phasing out the use of antibiotics in livestock. "The issue is a level playing field," Burci said. "There is a fear of free-riding."
Political pressure
This is where the UN plays an important role. By acknowledging the grave and urgent threat posed by AMR and committing countries to take action, the UN declaration adds a level of political pressure that can force nations to make AMR a priority and facilitate policy coherence.
Any movement on AMR, though, could be hampered by transitions going on at the UN and the WHO, where leadership changes will occur in the coming months. "I think a lot really depends on who the next UN secretary-general is and who the next director-general of the WHO is," notes Ramanan Laxminarayan, PhD, MPH, director of the Center for Disease Dynamics, Economics and Policy (CDDEP). "They've got many other priorities, but will they recognize that this is a really important issue they should not put on the back burner?"
Laxminarayan is hoping that the UN reaches to other parties to help fight AMR. "This problem can be solved only partially by UN agencies and their ways of working," he said. "Unless they reach out to the broad set of academics, clinicians, veterinarians?that lie outside of governments, it will not get solved."
That's because reducing drug-resistant infections and antibiotic use is not as straightforward as fixing the hole in the ozone, Laxminarayan explained. That effort required governments to change regulatory standards and companies to meet those standards. AMR, on the other hand, requires a broader set of stakeholders.
Holding the UN accountable
Laxminarayan is among those who think targets for reducing inappropriate antibiotic use are a critical element in the battle against AMR. These types of targets, he argues, will enable the UN to measure progress.
If the UN effort against AMR lags, Laxminarayan said he and others will be there to "hold their feet to the fire." To that end, CDDEP has joined with other public health and infectious disease groups to form CARA, the Conscience of Antimicrobial Resistance Action. CARA envisions its role as something of a watchdog that will hold the UN?along with international health agencies and member states?accountable for meeting its commitment to fight AMR. Among the tasks of the organization will be to monitor progress toward agreed-upon goals, and independently establish a set of targets that countries should aim to meet.
"It is not enough for countries, politicians, businesses and the healthcare community to make pledges for change," Laxminarayan and Dilip Nathwani, OBE, of the British Society of Antimicrobial Chemotherapy wrote recently in New Scientist. "They must know that they're being watched, but also that our community of experts stands ready to help."
See also:
Sep 21 UN draft political declaration on AMR
Sep 21 CIDRAP News story "UN leaders pledge to fight antimicrobial resistance"
May 2015 WHO Global Action Plan on AMR
Sep 20 CARA press release
Sep 22 New Scientist commentary (free registration required)