An increasing number of infections are untreatable due to antimicrobial resistance (AMR). An estimated 214,000 newborns die every year from sepsis caused by antibiotic resistant bacteria, and lack of effective antibiotics threatens both basic and advanced medicine. The negative impact  also extends well beyond health with serious implications on poverty reduction and inequality, animal welfare, the environment, food safety and security. The World Bank estimates that 28 million people could be pushed into extreme poverty every year by 2050, with an overall cost to the global economy of US$1 trillion per year. As such, antimicrobial resistance must be seen as a development problem.

The causes of antimicrobial resistance are complex and multifaceted. They include a lack of adequate health services, inappropriate use of antibiotics both in humans and food animal production, suboptimal water and sanitation systems, gaps in both access and research and development for essential health technologies, and environmental pollution. A collective and sustained effort by the United Nations and international organizations, governments, civil society and the private sector is needed to adequately respond. The magnitude of AMR was recognized in the political declaration from the 2016 UN high-level meeting on AMR. The recent UN Inter-Agency Coordination Group recommendations stressed that the Food and Agricultural Organization, the World Organisation for Animal Health and WHO should work together with UN Environment, other UN agencies and the World Bank to further strengthen our joint One Health action.

Assessing priorities

For UNDP, its 2018-2021 Strategic Plan, its experience convening multisectoral health and development responses at country level, and priorities such as addressing inequality and promoting planetary health provide important entry points.  At the country level, support is needed to design, finance and implement National Action Plans. A 2018 survey found that while 117 countries had AMR National Action Plans, only a fifth of these had the necessary funding  to put them in place. UNDP’s work on multisectoral responses to HIV, Noncommunicable Diseases, Tobacco Control and health systems strengthening, could be expanded to supporting the multisectoral design and implementation of AMR National Action Plans.

In its strategic plan for 2019-2023 ReAct, one of the first international independent networks to articulate the complex nature of antibiotic resistance, will focus on enabling collective global action that ensures sustainable and equitable access to effective antibiotics for all. This will be done by supporting the development and implementation of National Action Plans, mobilizing a broader AMR movement as well as advocating for stronger global governance to be established and innovation to be public health driven.

The global response to tuberculosis and neglected tropical diseases also contains important lessons that should shape our approach to AMR.  In both cases, the traditional innovation system does not produce the technologies needed by patients and a variety of incentives and funding strategies are being used to promote innovation. We must continue to support new models to incentivize innovation for effective and appropriately available vaccines, point of care diagnostics and a new generations of antibiotics. As vitally important as it is to develop new technologies, innovation without focusing on access does not improve health outcomes. Getting the right health innovations to the right people, in the right places, is a complex challenge. Each health system is unique and requires targeted interventions to address local or specific bottlenecks. The UNDP-led Access and Delivery Partnership is one such approach.

Greater co-ordination

The multifaceted complex challenges posed by AMR cannot be addressed by any one person, institution or government.

The One Health approach that governments have committed to, requires greater coordination, stronger governance and effective partnerships, as prioritized in the 2030 Agenda. The One Health approach being implemented by the United Nations in Vietnam is an example of the success that is possible through greater co-ordination. The multifaceted complex challenges by AMR can not be addressed by any one person, institution, or government. It requires a comprehensive, coherent effort from us all.