Why we must do more to combat antibiotic resistance

Antibiotic resistance is one of the most pressing challenges for global health in the 21st century

Last week the headlines proclaimed: “superbug resistant to last line antibiotics found in the US”. The week before that it was “superbugs could kill more people than cancer”. You may be asking yourself what is a superbug and why is it in the news?

When journalists write about “superbugs”, they are usually talking about disease-causing bacteria that have developed resistance to one or more antibiotics. This often results in infections that are more difficult to treat and take longer to cure, and in the worst case are no longer treatable at all. These days, barely a week goes by without a news article or report on this antibiotic resistance. And while many of the findings and discoveries of new types of drug resistance make for glum reading, for those who have worked with the issue for a while now, it is exciting to see that the problem finally receives the attention it rightly deserves.

Growing awareness and political commitment

Antibiotic resistance is one of the most pressing challenges for global health in the 21st century, and it may result in the return of many infectious diseases that have so far been routinely treatable with antibiotics. A few years ago, you could have been forgiven for never having hard about antibiotic resistance. Reserved for expert discussions among microbiologists or infectious disease physicians, the topic of antibiotic resistance long occupied a place on the fringes of global health – and awareness of its massive importance for human health and development was as a result limited. But the increasingly rapid progression of drug resistance, paired with a better understanding of its human and financial cost has thankfully resulted in growing awareness and political commitment to address the challenge.

At last year’s World Health Assembly in Geneva, the Global Action Plan (GAP) on Antimicrobial Resistance was launched. The GAP commits Member States to developing National Action Plans on antibiotic resistance and outlines key areas in which countries must act. It has as a result been instrumental in raising international awareness and encouraging states to take action. The GAP also calls for greater international collaboration to support low- and middle-income countries in their efforts to meet the challenge of antibiotic resistance.

Broad scientific agreement on necessary actions

What is encouraging – and perhaps unique for a problem of this magnitude – is that there is broad agreement among experts about the steps necessary to mitigate the effects of antibiotic resistance and to preserve the effectantibiotics in the future. Policy papers such as the GAP or the recently released UK Review on Antimicrobial Resistance all identify similar action points. Mainly these actions are to create awareness of antimicrobial resistance; to strengthen surveillance and research; to reduce the incidence of infection; to use antibiotics carefully and appropriately and to develop new drugs, as well as diagnostic tools.

At this month’s World Health Assembly, antibiotic resistance was again under discussion and civil society organisations and member states called for a strong ‘One Health’ approach. This would combine action on antibiotic use in both humans and animals and led to further appeals for better integration of policies across the the areas of human health, animal health and the environment. Going forward, antibiotic resistance will also be on the agenda of the UN General Assembly in New York, which will gather political leaders in September this year.

Still far from a workable strategy

Sadly, and in spite of the political commitment to tackle antibiotic resistance and the broad scientific agreement on necessary actions, we are still further from a workable strategy to fully address the issue than we would like. We believe that this is because we have failed to succeed in a number of areas so far that will be critical going forward:

A lack of coordination:

While more and more people are beginning to work on the issue of antibiotic resistance, there continues to be a fundamental lack of coordination between different activities. Even at the national level, it can be difficult to monitor all ongoing activities, and because antibiotic resistance is a problem across sectors and affects a lot of policy areas, the potential number of stakeholder is large. This lack of coordination is particularly problematic, because it leads to the duplication of efforts and overstretches the limited financial and staffing resources available.

A lack of sustainable funding:

The good news is that there is an increasing willingness of states to invest into research on antibiotic resistance. The UK’s recently created Fleming Fund, for instance, has pledged several hundred million pounds to research and development. Sadly, we still lack sustainable funding in many places, which has not just resulted in a dearth of research output, but has also led many junior researchers to pursue other fields of specialisation that offer more promising funding opportunities.

A lack of conservation efforts:

Antibiotic resistance is an inevitable byproduct of antibiotic use – and as long as we rely on antibiotics, which continue to be the only effective treatment for many bacterial diseases, we will have to work against the emergence of new resistance. To better prepare health care professionals and veterinarians for this job will require a serious investment in training. We must also build on initiatives such as the World Antibiotic Awareness Week and vastly improve public awareness of antibiotic resistance.

A lack of access

When discussing drug resistance, we should not lose sight of the fact that for many people around the world, the antibiotic era never started. To this day, thousands of people are dying every year because they cannot access cheap antibiotics that remain effective against infections that are commonly treated in richer countries, for example pneumonia. If the goal of our fight against antibiotic resistance is to preserve the effectiveness of available drugs to fight bacterial infections, we must also work towards making them available to everyone who needs them.

Starting point for a stronger response?

It is clear at this point that we must act swiftly and decisively to tackle antibiotic resistance and to urge policy makers and stakeholders to take drastic action. For this reason we are happy that ReAct, the Dag Hammarskjöld Foundation and Every Woman Every Child are today hosting a high-level briefing at the UN. Ambassadors from Member States, UN organisations and civil society groups have been invited to the event, designed to raise awareness about the magnitude and the scope of the problem in anticipation of the upcoming meeting on ABR during the UN General Assembly in September.

In light of the sheer scale of the challenge, we hope that the UN General Assembly meeting will not be the end game, but rather the starting point for a stronger and fiercer response to antibiotic resistance.

Jasper Littmann By Jasper Littmann

Dr Jasper Littmann works as a policy advisor at ReAct Europe, where he focuses on the organisation and coordination of national and international responses to drug resistance. He has a background in both philosophy and public health and his PhD thesis, which he completed at University College London, examined the implications of antimicrobial resistance for distributive justice. Before joining ReAct, he worked as a Senior Research Fellow at the University of Kiel in Germany and as a consultant at the World Health Organization in Copenhagen. He has published widely on questions related to infectious disease control and antibiotic resistance.

Anna Zorzet By Anna Zorzet

Dr Anna Zorzet coordinates the European office of ReAct. In addition she is the programme manager of ReAct’s Gathering and Translating Evidence programme, translating scientific evidence into policy action at the national, regional and global levels. She completed her PhD in medical microbiology with a focus on antibiotic resistance (ABR) at Uppsala University in 2010. She then moved into the policy field when she joined ReAct in January 2011. She is also working with many regional and international networks on ABR, the WHO and is on the Stakeholder Advisory Board for the EU Joint Programming Initiative on AMR.