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United Nations Assembly Addresses Growing Threat of Antibiotic Resistance

The United Nations General Assembly this week held a high-level meeting on antimicrobial resistance and passed a declaration calling on countries to do more to prevent, diagnose, and treat antibiotic-resistant infections. But participants stopped short of setting specific targets to reduce inappropriate antibiotic use or committing resources to address the growing problem.

The high-level meeting, held September 21 at UN headquarters in New York City, brought together member countries, non-governmental organizations, and representatives from civil society, academic institutions, and the private sector. It wasonly the fourth time a health issue has received this level of international attention, joining HIV/AIDS, Ebola, and non-communicable diseases.

Antibiotic resistance is a "fundamental threat" to health and safety, UN Secretary General Ban Ki-moon said at the opening session. "We are losing our ability to protect both people and animals from life-threatening infections." Ban added that antimicrobial resistance could put the UN's Sustainable Development Goals in jeopardy.

Antibiotic resistance is becoming more common worldwide, rendering some infectious diseases untreatable. Experts estimate that more than 20,000 deaths in the U.S. each year, and over 700,000 worldwide, are caused by antibiotic-resistant infections. Deaths are projected to reach as high as 10 million by 2050 -- more than cancer -- if resistance is not addressed, according to a recent report commissioned by the U.K. government.

High-level resistance is particularly problematic in Gram-negative bacteria, including species that cause gonorrhea, urinary tract infections, meningitis, pneumonia, and wound infections. Researchers in several countries have recently detected a transferrable bacterial gene that confers resistance to the last-resort antibiotic colistin.

One of the main causes of antibiotic resistance is inappropriate of the drugs for both humans and animals, especially in agriculture. In the U.S. around three-quarters of all antibiotics are used to prevent disease or promote growth of livestock. Antibiotics are too often prescribed to treat viral infections like colds and flus, for which they are ineffective. In some countries antibiotics are sold over-the-counter and widely used without medical guidance. Using the wrong dose or stopping treatment too soon can allow drug resistance to evolve. Recognizing the growing problem, medical organizations have increasingly emphasized antibiotic stewardship, or limiting their use.

As organisms have evolved reduced susceptibility to older drugs, development of new agents has not kept up. Infectious diseases are widespread in low- and middle-income countries and antibiotics are typically taken for a relatively short duration, limiting their profit potential compared to drugs for chronic conditions common in wealthy countries.

"The misuse of antimicrobials, including their underuse and overuse, is causing these fragile medicines to fail," World Health Organization (WHO) Director-General Margaret Chan saidat the high-level meeting. "The emergence of bacterial resistance is outpacing the world’s capacity for antibiotic discovery…With few replacement products in the pipeline, the world is heading towards a post-antibiotic era in which common infections, especially those caused by Gram-negative bacteria, will once again kill."

Drug resistance is a threat to the global economy as well as individual and public health.

Last week the World Bank released a report estimating that antimicrobial resistance has the potential to cause more economic damage than the 2008 financial crisis, reducing GDP by up to 3.8%, costing up to $1 trillion in added healthcare costs, and pushing up to 28 million more people into poverty by 2050.

"We now know that -- unless addressed swiftly and seriously and on a sustained basis -- the growing global problem of antibiotic resistance will be disastrous for human and animal health, food production and global economies," Chan said in a World Bank press release. "The fact that, left unchecked, it would penalize the poor more than anyone, makes clear why this needs to be addressed as a critical issue for development."

The General Assembly unanimously approved a declaration that commits member countries to develop action plans to address the threat. The declaration reaffirms the Global Action Plan on Antimicrobial Resistance adopted by the World Health Assembly (the decision-making body for the WHO) in May 2015, which includes 5 goals:

1.    To improve awareness and understanding of antimicrobial resistance through effective communication, education and training;

2.    To strengthen the knowledge and evidence base through surveillance and research;

3.    To reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures;

4.    To optimize the use of antimicrobial medicines in human and animal health;

5.    To develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions.

Key elements of the response include improved sanitation and toilet facilities, better surveillance and reporting systems, regulating the sale of antibiotics for human and animal use, educating the public about the need to use antibiotics judiciously, and encouraging public and private partnerships to develop new diagnostics, vaccines, and treatments.

9/21/16

Sources

United Nations. World Health Leaders Agree on Action to Combat Antimicrobial Resistance, Warning of Nearly 10 Million Deaths Annually If Left Unchecked. Meeting coverage. September 21, 2016.

World Bank. Drug-Resistant Infections: A Threat to Our Economic Future. September 2016.

World Bank. By 2050, drug-resistant infections could cause global economic damage on par with 2008 financial crisis. Press release. September 19, 2016.

World Health Assembly. Global Action Plan on Antimicrobial Resistance. 2015.

World Health Organization. WHO Director-General addresses UN General Assembly on antimicrobial resistance. Statement. September 21, 2016.

J O'Neill et al. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. May 2016.