On an­timi­cro­bial re­sis­tance, it’s now or never

Financial Mirror (Cyprus) - - FRONT PAGE -

We of­ten take it for granted that any in­fec­tion we en­counter can be cured, and that all-pow­er­ful mod­ern medicine will do pre­cisely what it is sup­posed to do.

But imag­ine an al­ter­na­tive sce­nario: You are di­ag­nosed with a po­ten­tially life-threat­en­ing in­fec­tious dis­ease that was once treat­able in weeks or months, but you are told that your treat­ment will take at least two years, and will in­volve months of daily in­jec­tions and some 14,000 pills, with se­vere side ef­fects. You are one of a “lucky” mi­nor­ity to have been di­ag­nosed and treated at all, but your odds of beat­ing the dis­ease are still only 50-50.

Most of us would not as­so­ciate this sce­nario with “mod­ern medicine,” but it is a tragic re­al­ity for the ranks of peo­ple – 500,000 and grow­ing – suf­fer­ing from multi-drug-re­sis­tant tu­ber­cu­lo­sis. MDR-TB is what hap­pens when drugs lose po­tency against new strains of pre­vi­ously treat­able in­fec­tions. TB is now the world’s dead­li­est in­fec­tious dis­ease, killing well over one mil­lion peo­ple every year, and MDR-TB con­tin­ues to spread in low- and mid­dle-in­come coun­tries as health-care providers strug­gle to com­bat it.

MDR-TB im­poses a mas­sive bur­den on coun­tries’ pub­lichealth sys­tems and economies, and it is a harbinger of what rich and poor coun­tries alike can ex­pect as an­timi­cro­bial re­sis­tance (AMR) be­comes more preva­lent. With­out con­certed ac­tion, drug-re­sis­tant strains of other com­mon in­fec­tions such as Sta­phy­lo­coc­cus Au­reus or E. coli will be­come ever more com­mon, with seis­mic ef­fects on global health and health-care sys­tems world­wide.

As AMR ren­ders es­tab­lished an­tibi­otics in­ef­fec­tive, un­treat­able in­fec­tions will make rel­a­tively rou­tine pro­ce­dures such as or­gan trans­plants or cancer chemo­ther­apy in­creas­ingly risky. The hu­man and eco­nomic toll of ris­ing AMR could eas­ily spi­ral out of con­trol: left unchecked, dru­gre­sis­tant in­fec­tions could claim ten mil­lion lives an­nu­ally by 2050, with the cu­mu­la­tive cost in terms of global GDP reach­ing $100 tril­lion.

Only by launch­ing an ef­fec­tive re­sponse im­me­di­ately can we avert a bleak fu­ture. For­tu­nately, at the G20 sum­mit in Hangzhou,

China, ear­lier this month, world lead­ers put AMR on the group’s agenda for the first time, sig­nal­ing that the in­ter­na­tional com­mu­nity recog­nises AMR as a real threat to global eco­nomic de­vel­op­ment and pros­per­ity. The G20 also made the largest ef­fort to date to re­plen­ish stalled phar­ma­ceu­ti­cal-de­vel­op­ment pipe­lines for new an­tibi­otics (which are ur­gently needed to re­place drugs that have be­come in­ef­fec­tive) and to roll out di­ag­nos­tic tests en­abling clin­i­cians to use the drugs they have more ef­fec­tively.

This week’s United Na­tions Gen­eral Assem­bly meet­ing in New York presents an­other op­por­tu­nity for global lead­er­ship on AMR. There, too, the is­sue will be on the agenda for the first time, with Sec­re­tary-Gen­eral Ban Ki-moon and world lead­ers set to pledge to con­front ris­ing drug re­sis­tance at a ma­jor high-level meet­ing.

To stymie AMR, the UN must build on the work that the G20 started. As the largest, most in­clu­sive global-gov­er­nance fo­rum we have, the UN is the only in­sti­tu­tion that can mar­shal the re­sources and lead­er­ship com­mit­ments the prob­lem de­mands. But the UN will be ef­fec­tive only if it takes some cru­cial steps.

First, UN mem­ber states should be­gin to in­te­grate their re­sponses to AMR across all reg­u­la­tory bod­ies and rel­e­vant sec­tors, in­clud­ing health care, agri­cul­ture, and fi­nance. The UN is uniquely po­si­tioned to help coun­tries do this. It can con­vene the world’s lead­ers and foster in­ter­na­tional and in­ter-or­ga­ni­za­tional co­op­er­a­tion on global eco­nomic and so­cial prob­lems; and it can tap the power of its own agen­cies to mo­bi­lize global re­sources against AMR.

Sec­ond, to keep things on track, the UN should es­tab­lish clear bench­marks, based on mea­sur­able out­comes, and it should com­mit to putting AMR back on the Gen­eral Assem­bly’s agenda every two years. This would cre­ate a frame­work for mea­sur­ing global progress, while also send­ing a strong mes­sage that the UN is in it for the long haul, and that AMR should be a high pri­or­ity for the next sec­re­tary­gen­eral.

Fi­nally, the UN should ap­point a Spe­cial En­voy for AMR to en­sure con­tin­ued progress in the com­ing years. The en­voy would need to be de­fined as a high-level po­si­tion, au­tho­rised to work with coun­tries and mul­ti­lat­eral gov­er­nance bod­ies to main­tain mo­men­tum in the bat­tle against AMR.

We can now be cau­tiously op­ti­mistic that AMR is fi­nally get­ting the global at­ten­tion it de­serves. But the world’s at­ten­tion can be all too fleet­ing, as those of us who have lived through pre­vi­ous and cur­rent de­bates about in­fec­tious dis­ease know all too well. If we fail to hold our lead­ers’ feet to the fire, the con­se­quences for ev­ery­one could be deadly.

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