How the UN declaration on antimicrobial resistance could take the world in the right direction

In a new documentary called Maddie’s Transplant, we meet a US teenager who contracted MRSA after a liver transplant aged 14 and who now pins her hopes on the sole antibiotic that is still effective against the recurrent infection.

“When I think about this one antibiotic that works for me, I’m very grateful,” Maddie reflects. “Also, I’m very nervous, because if I get sick, then where do I go? It’s almost like living life on the edge.”

Maddie is one of millions of people around the world affected by the growing problem of antimicrobial resistance (AMR), one of today’s most urgent health crises.

It’s a natural process for bacteria and other microbes that cause infection to become resistant to the drugs designed to kill them.

However, when we fail to develop enough new drugs and misuse existing ones, resistance grows faster than our ability to combat these microbes, meaning that many common infections that were once treatable are becoming dangerous again, even fatal.

The good news is that the world already has the knowledge and tools needed to tackle AMR, but we do need to act now. At the Novo Nordisk Foundation – like many other organizations – we are committed to addressing this issue by supporting research, innovation and advocacy efforts, and we have been pleased to see the development of coordinated action across borders in the last years.

But there is a clear need for the world to convene again and take concrete steps towards ensuring a strong pipeline of new antibiotics in combination with much stronger market incentives, the development of new diagnostic tools, and sufficient access to existing antibiotics.

We are cautiously hopeful that the political declaration being discussed at the UN General Assembly High-level Meeting on Antimicrobial Resistance on 26 September could help the world take these steps and tackle this issue.

The draft of the declaration is the result of a months-long, collaborative effort involving governments, organizations and experts.

We welcome the draft’s clear focus on a multi-sectoral, collaborative, global approach that spans research and development, healthcare, agriculture, manufacturing and financing.

We’re also pleased that the draft document acknowledges both the urgency and the inequity of the problem, with women, people in low-income settings, and people with limited access to clean water, sanitation, and hygiene more likely to experience AMR.

A recent report by the European Observatory on Health Systems and Policies, based on research supported by the World Economic Forum and the Novo Nordisk Foundation, details these inequities, also addressing the exacerbating effects of conflict, climate change and pollution.

The declaration’s focus on implementation is also welcome. There is a clear sense that the world needs not only new policies and plans, but for these to be effectively implemented through, for example, national action plans.

We hope that the follow-up meeting in Saudi Arabia in November, where member states will discuss how to put the declaration into action (if approved), will result in concrete and ambitious implementation plans.

But the declaration and all other efforts will only succeed if we keep the human cost of this crisis front of mind. In 2019, an average of 3,500 people lost their lives every day because of AMR, with countless others trapped in a cycle of illness, hospitalization and fear of the future.

Maddie is of course one of them. The film Maddie’s Transplant is one of a pair by US filmmaker Michael Graziano.

In the second, Bradley’s Burden – which is part documentary, part science fiction – we meet a young, previously healthy US man who woke up one morning to find the side of his head swollen and blackened due to a bacterial infection that returned again and again over the next five years.

At one point, Bradley’s mother recalls a moment when she asked her son’s doctor, “When is this going to stop? How do we get rid of this?” He responded, “I don’t know.”

“This was not a once-a-year occurrence,” she explains in the film. “It was a weekly or every other week occurrence. And the thought of that was just horrendous to me, that this could be his life.”

Interviews with experts throughout both films also remind us that this issue is complex and nuanced, that there is no silver bullet solution, and that we do not know everything, so information-sharing is key.

Crucially, we are also reminded that the goal is not to end resistance – if we aim for that, we will always fail. Instead, in the words of Patrick O’Carroll, President and CEO of the Task Force for Global Health, “the goal is to always have effective antibiotics where they’re needed, when they’re needed, everywhere they’re needed".

Even more fundamentally, it’s not about fighting microbes, but instead figuring out “a way to live with them that doesn’t cause us ill-health and suffering and premature death”.

We are pleased that this nuanced, collaborative perspective is reflected in the draft of the UN declaration, which we urge the world to both adopt and implement. We look forward to sitting alongside many others at the high-level meeting and to continuing the Novo Nordisk Foundation’s work to tackle this urgent issue.