Global cooperation as a life-and-death issue

The uncertainty generated by the United Kingdom’s recent vote to leave the European Union – which has sent shockwaves through global markets – has been dominating headlines. But, as we prepare to face new political trials, we must not lose sight of the challenges we already face, especially global health challenges like the rise of antimicrobial resistance (AMR), which has no regard for economic performance or political stability.

As it stands, an estimated 700,000 people are losing their lives to drug-resistant infections each year. By 2050, this figure could skyrocket to ten million per year, at a cumulative cost to world GDP of $100 trillion..

To avoid that outcome, in May the Review on AMR that I lead published its strategy for tackling such infections, laying out proposals to ensure the development of the necessary new antibiotics, and to use existing antibiotics more efficiently in humans and agriculture. Of the ten major interventions we proposed, four are particularly important:

· Launch a global campaign, tailored for different regions, to i mprove public awareness of AMR.

· Address the market failure in the development of new antibiotics by introducing lump-sum market-entry rewards to developers of successful new drugs, while ensuring global access.

· Advance innovation and improve use of diagnostic technology to support more efficient use of antibiotics.

· Implement country-level targets focused on reducing unnecessary use of antibiotics in agriculture and humans.

With our final report complete, the Review will now continue to make the international case for action directly to political leaders. For example, in my capacity as the Review’s Chairman, I recently discussed our recommendations at the World Health Assembly in Geneva, and with United Nations and United States policymakers in New York and Washington, DC.

In these discussions, policymakers’ growing awareness of the danger posed by AMR stood out. Just two years ago, the topic of drug-resistant infections would usually be met with questions like “What is AMR?” or, “Why would a finance minister take charge of a health crisis?” Few understood the scale and multifaceted nature of the challenge, and thus the need for a comprehensive approach. I asked myself similar questions when British Prime Minister David Cameron first asked me to lead the Review on AMR.

The situation has changed considerably since then. Policymakers from countries with a wide variety of economic and political systems are engaging on the AMR problem, with some countries already taking steps to tackle it. All of this provides grounds for hope that 2016 may be the year when real change gets underway.

But hope is one thing; action is another. While high-level meetings and speeches about AMR send the right message, they will mean nothing if we do not manage to translate the current momentum into concrete action, beginning at the G20 and UN meetings this September. And while my most recent discussions suggest that agreements are likely to be reached at both of these meetings, it is far from certain that they will match the scale of the problem.

At the G20, the needed agreement should focus on developing a global mechanism to re-invigorate the market for new antibiotics that are globally affordable, accessible, and used as efficiently as possible. At the UN, the goal should be to turn the mantra of “access, not excess” into a reality, with an agreement to reduce the unnecessary use of antibiotics in agriculture, and to spearhead a global awareness campaign. Increased funding for research and development of new antibiotics and diagnostics to fight AMR is also vital.

Crucially, the agreements must have teeth. Countries should set their own objectives to fit their particular circumstances and needs, but there must be some provisions to ensure that all are pulling their weight. For starters, efforts to fight AMR should be incorporated into broader economic-development strategies, including the implementation of the UN Sustainable Development Goals.

Moreover, progress should be measured, not only so that policymakers, companies, and health systems can be held accountable, but also so that others can emulate their successes. To this end, we may need new metrics for calculating the impact of AMR. While this sounds technical (and it is), the reality is that top AMR scientists think that agreeing on common measurements could change the way individual countries set their own targets and improve our capacity to measure progress in the coming years.

Finally, to account for changing political priorities and personalities, we need a constant champion in the fight against AMR. For example, a UN envoy on AMR could be appointed, to continue making the international case for addressing the issue and to challenge countries to meet their targets. Without such a consistent reminder of the need to tackle AMR, not to mention transparency about progress, the world could become sidetracked and miss the rapidly closing window of opportunity to deliver the changes needed to stop the rise of drug-resistant infections.

Over the last couple of years, governments, industry, and international organizations have made important strides in meeting the AMR threat.

But the really hard decisions must be taken now. If we are to prevent the slow-motion car crash of rising AMR, our leaders must take evasive action now. We know what we have to do; now we must get on with doing it.