Over 60 participants of at least 23 nationalities including experts across the human, animal, and environment sectors, patient groups, parliamentarians, communications experts, and policy makers engaged in discussions over 3 days at Wilton Park.
The dialogue began with discussions on the current responses to AMR globally, the successes achieved since 2016, and the opportunities to raise AMR up the political agenda because of the 2024 HLM. Over the course of the dialogue participants considered and debated high-level political asks centred around three pillars – access, innovation, and stewardship[1] – and reflected on the evidence base for setting high-level targets within these pillars.
“While taking into account the science, data and expertise, which HLM outcomes are the most desirable and which are the most achievable?”
Considerations of politically realistic expectations for the HLM and how the declaration can add most value to the AMR ecosystem underpinned all discussions. Importantly, participants reflected on the unique nature of the Member State process to negotiate the Political Declaration and the current geopolitical context within which this will happen. Finally, the group proposed ways forward and identified how different stakeholder groups from Member States and UN stakeholders, including academics and advocates, can best support this process over the next 9 months in the lead up to UNGA 2024.
The following themes and ideas emerged during the discussion.
The 2024 HLM: balancing ambition and pragmatism
The 2024 HLM on AMR provides a unique opportunity to return AMR to high up the political agenda, crystalising the successes made at the first HLM in 2016, while setting the world on the path to address AMR in the years ahead. Ambition must be tempered with a pragmatism that recognises the unique nature of the HLM as a political, Member State-led process, and appreciates the political context in which the negotiations will take place. Learning from previous HLM processes, the AMR community will aim to align collectively around a small number of priority issues and advance them through this narrow window of opportunity.
Making progress towards evidence-based targets
“AMR must also be recognised as a development challenge – poverty, inequality and lack of access to health care has accelerated it, and on the other hand its rapid spread is sending more people into poverty.”
Measurable and accountable targets are key to drive progress on AMR nationally, regionally, and globally both as means of setting ambitions and for monitoring progress. The lack of globally adopted targets on AMR reflects an absence of collectively agreed priorities and commitments as well as some short fallings in the current evidence base. The 2024 HLM is unlikely to adopt new technical targets for AMR, but could establish a mechanism for setting future targets, including through establishing an independent global science panel. Harnessing the potential of existing targets and political commitments in health, water, sanitation and hygiene, and infection prevention and control, to which Member States have already committed, may be productive.
Recognising AMR as a global development challenge
AMR has historically been viewed as a human health threat. The One Health approach has helped to broaden collaboration across sectors, but AMR is still not recognised as an integrated global development challenge. AMR is both a cause and a consequence of poverty and undermines efforts to meet multiple Sustainable Development Goals (SDG). Conversely, addressing AMR will help advance numerous development goals. AMR should therefore be mainstreamed into development discussions, including for the post 2030 agenda.
Supporting national action through global collaboration
Responses to AMR are highly contextualized, and need to be designed, developed, and implemented at national, regional, and local levels. Some successes include the development of National Action Plans (NAPs) which, when multi-sectoral, costed and funded, provide a foundation for countries to address AMR. However, as AMR is a global agenda, countries, especially Low- and Middle-Income Countries (LMIC), need adequate technical and financial support to develop and implement their national plans.
Overcoming barriers preventing sustained funding
AMR has suffered from chronic underfunding, evidenced most starkly by the lack of implementation of NAPs. The global funding landscape is challenging, characterised by shrinking fiscal space domestically, and high-interest rates and national debt. In the short term, this makes large-scale increases in funding unlikely. There is equally little appetite for the creation of new funding mechanisms. Therefore, focus must be on better harnessing existing funding streams, and enabling access to funding mechanisms for AMR, including the Global Fund, World Bank and AMR Multi-Partner Trust Fund, at the country and community level.
“It is important to realise that no one set of solutions will appease all countries. We need to understand and support the different capacities of countries.”
Strengthening prevention as the foundation for addressing AMR
Prevention should be the bedrock of all efforts to address AMR. Wider immunization, improved infection prevention and control, and clean water, sanitation, and hygiene, will help reduce the overall burden of infections and will slow the progression of AMR.
Accelerating innovation
Innovation across the pipeline of products and services is critical to expand the toolkit on how to address AMR from new antimicrobials to more efficient and easier to use diagnostics. Innovation must also be a facilitator of access to current and future tools. To achieve this, appropriate incentive mechanisms are needed that can catalyse further private investment into AMR-related R&D.
Ensuring equitable access
Equitable access to products and services, including diagnostics, must sit at the centre of efforts to tackle AMR. While overuse and inappropriate use of antimicrobials are major challenges in some countries, in others the lack of access to antibiotics kills more people than AMR itself. Overuse and inappropriate use can also co-exist with lack of access, especially in countries with weaker health systems and disparities in access to healthcare. If the world transitions to a future with lower use of antibiotics, equitable access should be at the core of this.
Strengthening stewardship, governance, and monitoring
Governance and stewardship across the One Health sector are key. Existing structures, such as the Quadripartite, can be further strengthened to support global and national efforts to monitor and coordinate progress on actions to tackle AMR. This could include the formation of the independent global science panel, building on the earlier recommendation by the Interagency Coordination Group on AMR (IACG) in 2019.
“Equity must be woven throughout the response to tackling AMR. Whatever action is taken, it must promote equity.”
Communicating and advocating AMR
Approaches to communicating the risks of AMR and what is needed to address these risks require careful and contextual consideration for the main audiences of policy makers and the public. Cutting through the complexity and noise to present clear and compelling calls for actionto policy makers is critical. Many institutions and initiatives are undertaking communication and advocacy on AMR, these efforts would be mutually reinforced by coordinating strategies, messages and having a strong collective voice.
Next steps and agreed actions
The annex contains the outcome document, which will inform advocacy and engagement efforts of stakeholders on the road to the HLM. Participants agreed that in parallel with political negotiations in 2024, further work is needed around evidence-based targets.
Participants emphasised the need for collective and coordinated efforts ahead of the HLM. The supplementary reading sets out several initiatives and events that stakeholders identified in support of aligning efforts.
[1]These focus areas resulted from extensive discussions in two virtual workshops and discussions with partners.