The G20, the UN and the future of antimicrobial resistance

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’ public-health 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 asStaphylococcus 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, drug-resistant 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 recognizes AMR as a real threat to global economic development and prosperity. The G20 also made the largest effort to date to replenishstalled 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 secretary-general.

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, authorized 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.