Tackling antimicrobial resistance: looking towards legal mechanisms

The rapid emergence of antimicrobial resistance (AMR) over the past decade has been described as one of the major health threats of the 21st century.

While antibiotics have saved millions of lives from once deadly infectious diseases, today the misuse of antibiotics and other antimicrobials in humans and animals has led to bacteria evolving resistance. Antibiotic resistance –when bacteria change so antibiotics are no longer effective – touches on all areas of health and impacts the whole of society. Last week the Dag Hammarskjöld Foundation convened a group of experts for a two-day meeting at their Uppsala headquarters to explore legal mechanisms that could stimulate coordinated, universal action.

According to a recent UK-issued report, “Drug-resistant superbugs could cost the global economy as much as $100 trillion between now and 2050, a threat that warrants as much attention as climate change,” according to the review led by economist Jim O’Neill a former Goldman Sachs Group Inc. economist.

“Antibiotics are the cornerstone of our modern health system,” explains Otto Cars, Professor of Infectious Disease at Uppsala University and founder of ReAct, co-host for last week’s meeting. “All of modern medicine is built on antibiotics – everything from communicable diseases to cancer treatments and now, due to the misuse and overuse of antibiotics, we are facing a crisis.” The very real risk is that the world is headed for a post-antibiotic era in which common infections and minor injuries, treatable for decades, can once again kill.

AMR is of particular concern to poorer regions of the world where antibiotic resistance will disproportionately cause death and suffering, especially in Africa. At the same time, it is in those regions that many die through lack of access to antimicrobials.

There is now a general consensus that significant action is needed to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics so that we can ensure the continued availability of effective antimicrobials.

Numerous initiatives are underway such as the World Health Organization’s (WHO) ‘draft global action plan on antimicrobial resistance’ that represents significant progress but, so far, no successful and comprehensive policy solution to the problem has been found. More is required if the world is to grapple effectively with what Dr. Jasper Littmann, of the Institute of Experimental Medicine in Germany, calls a “super wicked problem.” Littmann, also in attendance in Uppsala, goes on to explain that super-wicked problems are, by definition, immune to quick, technology-driven fixes and require the consideration of a much broader range of potential solutions. In this case, AMR “defies a quick fix but instead calls for a shift in path dependency where we move away from current patterns of antibiotic use to those that could be more sustainable.”

Regardless of the solution, what is clear is that this problem requires global, coordinated action. “This is one of those key areas that even if we do a lot in a few particular countries, it’s not enough, “ says Steven Hoffman, Assistant Professor of Global Health, Harvard School of Public Health and Assistant Professor of Law, University of Ottawa. “AMR is a transnational and multi-sectoral issue that requires global collective action since states cannot address this individually. We need all countries to adopt minimal standards of stewardship to make sure we are using antimicrobials effectively and to also ensure that we scale up universal access to existing and effective antimicrobials. This means that we need to be exploring international legal mechanisms for in order to strengthen this ‘grand bargain’.”

The Dag Hammarsjöld Foundation, as part of its Global Disorders programme, will continue to play a catalytic role in bringing together diverse stakeholders and experts from across the globe in support of finding an innovative solution to this and other global governance challenges.