Heads of state from around the globe will gather this week to try to address a long-neglected issue that poses perhaps the biggest health threat the world faces: the growing resistance of bacteria to antibiotics.
Antimicrobial resistance is not traditionally the domain of world leaders, and health-related issues — outside of crises such as the Ebola outbreak — are rarely discussed at venues like the United Nations General Assembly.
But a high-level meeting scheduled for Wednesday at this year’s UN gathering is a testament to fast-rising concern over the rate at which bacteria are learning to evade science’s last remaining tools against them.
“I’ve worked on this issue for almost 20 years. And I think even five years ago I couldn’t have guessed that this would reach the height of the UN General Assembly,” said Ramanan Laxminarayan, director of the Washington-based Center for Disease Dynamics, Economics & Policy.
Antimicrobial resistance is driven by a host of factors. Pathogens — bacteria, viruses, and fungi — can develop resistance to the drugs used to treat them when people take them incorrectly or stop taking them too soon, for instance.
Resistance is also fueled by the massive and often inappropriate use of antibiotics in agriculture and aquaculture; for decades these precious drugs have been used to promote growth and fend off costly infections that can result from the cramped conditions of industrial-scale food animal production.
The consequences of antimicrobial resistance are real and staggering.
A major report on the threat, commissioned by the British government, recently estimated that annual deaths resulting from antimicrobial-resistant infections could rise to 10 million a year in 2050, from the current 700,000.
It’s unclear what nations might pledge to do at this week’s UN meeting to address antimicrobial resistance. Any resolution endorsed by member states is unlikely to include targets limiting the use of antibiotics on a per capita basis, the kind of recommendation experts have urged be taken.
But for Laxminarayan and other experts, the session can already be seen as a major success in that it’s a recognition that the world needs to turn its attention to the issue.
Allan Coukell, an expert on antibiotic resistance with the Pew Charitable Trusts, suggested the assumption — and hope — is that all countries will sign on to a declaration that commits them to tackling the issue in general.
“That in itself is significant. It’s unprecedented that AMR would get this level of attention,” Coukell said, referring to the commonly used acronym for antibicrobial resistance.
Countries will need to develop action plans for reducing antibiotic use, which will be monitored by academics and civil society groups. And there are plenty of instances in which member states have failed to deliver on bold promises made on a global stage.
But Laxminarayan said any resolution would give ammunition to advocates on the issue.
“It gives people and organizations a hammer to hit them on the head to say, ‘You agreed to this and you are not doing it,’” he said.
There are signs that years of warnings about incurable infections are beginning to sink in with political leaders.
The G20, which met in China in early September, included concerns about antimicrobial resistance in its closing communique, saying that AMR “poses a serious threat to public health, growth, and global economic stability.”
The group called for efforts to promote the prudent use of drugs and research to develop new antibiotics and new infection fighting tools.
Dr. Keiji Fukuda, a special representative on antimicrobial resistance to the World Health Organization’s director general, noted that the communiqué was more fulsome on the issue than had been anticipated.
That response might stem increasingly dire warnings from experts.
The report commissioned by the British government and published in May predicted global production losses of $100 trillion between now and 2050 if concerted efforts to stem antimicrobial resistance are not taken.
The chairman of the panel that produced the report, noted economist Jim O’Neill, was chosen for the task because many of the problems that drive antimicrobial resistance are economic ones — and therefore require world leaders to adopt a broader view of the problem.
“What has become clear is that the problem is very large, it’s very extensive, and very complex,” said Fukuda.
“And unless we have a lot of actors at the table — private sector, public sector . . . development, health, agriculture and so on — unless you have all of those players at the table, you’re not going to be able to address it.”
The Pew Trusts estimates that in the United States, 70 percent of the use of medically important antibiotics — antibiotics used both in human medicine and animal production — are given to food animals.
Despite the urgent need for action, there are no simple solutions here.
For instance, producing enough protein to feed the world’s 7.4 billion people requires use some use of antibiotics in agriculture, experts know.
“Developed countries with more stable food supplies are in a very different situation than very poor countries, where a lot of population growth is going to take place,” Fukuda acknowledged.
“What’s good for Europe is going to be seen as very difficult for very poor countries.”