Drug resistance: Could global goals be the answer to this worldwide health crisis?

When thinking about the top 10 global public health threats, your first thoughts might include viruses with pandemic potential, climate change, or poverty. Drug-resistant infections might not immediately jump to mind.

But drug-resistant infections, caused by antimicrobial resistance (AMR), are a huge global issue. Research published in The Lancet in 2022, unveiled the very real human cost of this crisis – causing 1.27 million deaths in 2019 alone, and associated with an additional 3.7 million deaths (which is more than deaths caused by HIV/AIDs and malaria combined).

This is not a new crisis, but it is one that requires urgent action to avoid a world where a common medical procedure poses a high risk of infection and lengthy hospital stays, with fewer, if any, effective treatments for drug-resistant infections.

This year marks a decade since the beginning of the landmark Review on Antimicrobial Resistance led by economist Lord Jim O’Neill, which provided the bigger picture of the scale of the problem, elevating this global health threat up the global agenda and offering solutions for governments and industries to prevent it from growing.

In the 10 years since the review there have been a raft of global reports and political commitments, including the World Health Organization’s (WHO) global action plan on AMR, a High Level Meeting on AMR at the UN General Assembly in 2016, and the 2022 Muscat Ministerial Manifesto on AMR. But these have delivered limited impacts, and we have seen little concrete action to address this issue.

For too long drug resistance has not been seen as a high priority for decision makers, despite the risk it poses to modern medicine and potential cost to economies. And on the rare occasion it does feature on the global agenda, the spotlight is focused on building capacity and understanding. While both are essential, we are still missing ways to measure progress, setting evidence-based goals and ensuring action is taken to fill the gaps so global efforts are kept on track.

Establishing bold clear targets – like the 1.5C target for climate change – is the key to incentivise and galvanise support for action against drug resistance. With achievable but ambitious targets and mechanisms to track progress against them, we can drive progress through global collaboration to develop new novel antibiotics and engage with communities most affected in low-and middle-income countries.

There are already a number of data sets for monitoring the local and global scale of drug resistance, including analysis and evaluation of new data from the Global Research on Antimicrobial Resistance (GRAM) and AMR Data to Inform Local Action (ADILA) projects, which are connecting experts on AMR, modelling, policy and other areas to expand our understanding of AMR and inform mitigation measures.

In 2021 the WHO launched the Global Action Plan Monitoring Framework to review progress towards Sustainable Development Goal 3 – healthy lives and well-being for all – and the the global database TrACSS allows countries to self-assess the impact of national action plans against drug-resistant infections. However, these tools and data are not being used to hold governments or pharmaceutical industry accountable to the promises made, or to encourage collaboration for concrete action.

There are already examples of what can be achieved when industry and governments coordinate action against this issue, through the investment in AMR research from funding partnerships like the AMR Action Fund and CARB-X which have driven advances in innovation and development of new and novel antimicrobials, and improved the process of getting these to market. But despite this progress, the pipeline of new antimicrobials is weak and has not delivered a new class of antibiotics since the 1980s. Global commitment from both governments and pharmaceutical companies for sustained investment to AMR research and development is key to not lose progress gained against infectious diseases to drug resistance.

Vaccines are another vital tool in preventing drug-resistant infections. According to research published in the British Medical Journal earlier this year, half a million AMR-related deaths could be averted through vaccination, particularly in the WHO African and South-East Asian regions, which current carry two-thirds of the vaccine-preventable drug-resistant burden. Investing in increasing coverage of existing vaccines, and in developing new vaccines, is a necessary ingredient to achieve a long-term sustainable solution to prevent infections and reduce drug-resistance.

This autumn will see global leaders gathering for a High-Level Meeting on AMR at this year’s UN General Assembly. We cannot afford to miss the opportunity to call for global targets to ensure that progress made against drug-resistant infections has a real impact to protect those most at risk and save lives.