With global leadership spearheaded by the G7, the worrying increase of antimicrobial resistance – which is driven by economic factors – can be predicted and prevented
The world now recognises the economic and social impacts of a severe pandemic and the harsh effects of the parallel pandemic of antimicrobial resistance: 1.27 million lives lost in 2019, while untreatable infections represent the third most important underlying cause of death across the globe. AMR causes more deaths now than each of tuberculosis, malaria and HIV. It hits the most vulnerable the hardest, with children under five accounting for one in five deaths caused by AMR. This suffering is driven by the overuse of antimicrobials and poor diagnostics – aggravated by an empty pipeline of new treatments, diagnostics and vaccines alongside insecure, often polluting, manufacture and supply chains.
AMR is not new. But it is increasingly salient and fatal because our global systems are failing. Like COVID-19 and influenza, AMR is complicated and not limited to humans: animal health, the food chain and the environment are all at risk. As the global population increases, and with it the global demand for cheap protein, more antibiotics are squandered by unnecessary preventive use in food-producing animals, and in turn transmitted into the environment. The marine environment even spreads resistant bacteria to biodiverse places, including the Arctic and the Galapagos Islands.
Governments now understand that health and economic security go together. Infectious disease is now the domain of economists, finance ministries, bankers, investors and insurers, as well as medics.
AMR is driven by economic factors. Market failure stops innovative research reaching patients who need it most, and pushes small companies with new products into bankruptcy. Concurrently, increasing global demand for animal protein drives intensive farming, which reduces costs across much of the globe by routinely using antibiotics to overcome preventable infections and promote growth.
Saving lives and economies
AMR is predictable and preventable with global leadership. G7 attention on AMR was presciently started by Germany’s G7 presidency in 2015. The recognition that AMR is also a pandemic, albeit silent and insidious, ensured renewed G7 work, initiated under the UK’s 2021 G7 presidency, to take forward multi-year, multi-stakeholder efforts, with particular emphasis on:
finance ministers committing to address AMR for the first time ever – supporting incentives to pilot across health systems, designed to ensure a sustainable pipeline of new and equitably accessible antimicrobials;
bolstering supply chain security, to strengthen antimicrobial supply chain resilience through a broader, more geographically diverse, quality-assured manufacturing base – reducing the risks posed by stockouts or shortages so economies and investments will be much better able to withstand shocks;
building understanding of AMR in the environment and developing international standards on safe concentrations of antimicrobials released into the environment, including from manufacturing; and
strengthening integrated One Health surveillance for AMR to ensure capture of food chain and environmental data, including building on wastewater surveillance systems used for COVID-19 detection.
AMR transcends generations, let alone G7 presidencies, and we look to Germany and then Japan to continue leading this work.
We must learn lessons from COVID-19 to be better prepared for and able to respond to any outbreak, including of AMR. Many actions needed to address pandemics overlap with those needed to address AMR. The G7 must ensure this is reflected in any pandemic treaty (or legal instrument) that countries are currently negotiating to bolster global preparedness for the next pandemic.
G7 leaders must capture these synergies and work together to ensure that:
- any instrument is grounded in a multi-sectoral One Health approach that sees infection prevention and control and equitable access as underpinning principles;
- the private sector is included in global multilateral conversations – global health security, long-term sustainability and financial stability go hand in hand;
- institutional investors play active roles as antibiotic ‘stewards’ across the biotechnology, pharmaceutical, food production, food retail, healthcare, veterinary and insurance sectors, supporting and challenging industry and companies to do more through environmental, social and governance standards;
- as recommended by the Pan-European Commission on Health and Sustainable Development, bring together G20 health and finance ministries to enhance cooperation and exchange, and ensure countries and international organisations support the Joint Finance and Health Task Force to address One Health financing gaps; and
- the United Nations secretary-general establishes an ‘Evidence Panel on AMR’ as a subgroup to his new Science Advisory Group, to independently assess evidence to inform global policymaking.
Transforming food, health and environment systems to be resilient, sustainable and equitable presents one of the strongest opportunities to realise the Sustainable Development Goals. This cannot be achieved without tackling and mitigating AMR as a One Health global problem. Compared with responding to COVID-19, preventing AMR will save money and, more importantly, lives and livelihoods. The G7 must lead this work to ensure our security of health, food, environment and economies of the future.