Annex 1. Outcomes document

From 4-6 December 2023, Wilton Park and GBCHealth convened a dialogue to consider actions and strategies required to reinvigorate the response to antimicrobial resistance (AMR) focusing on the up-coming UN High-Level Meeting (HLM) on AMR at the United Nations General Assembly (UNGA) in September 2024.  In total, 63 stakeholders of at least 23 different nationalities including experts across the human, animal, and environment sectors, patient groups, parliamentarians, communications experts, and policy makers contributed to the dialogue. The group reflected on the current response to AMR, identified actions needed from different sectoral actors, and contributed perspectives on how to reinvigorate responses from the global to the local level, noting and prioritising where the UN in New York could add most value with commitments from Member States.

The 2024 Political Declaration will build upon previous Political Declarations on Health and Health Security, including the 2016 AMR Political Declaration and the outcomes of the 2023 HLMs on Universal Health Coverage (UHC), Pandemic Prevention, Preparedness, and Response (PPPR), and Tuberculosis, as well as existing country commitments related to animal health, agriculture and food systems and the environment and the SDGs.

This Outcomes Statement summarises the key themes and priority areas participants consider important to address in the 2024 Political Declaration.

Key themes

• AMR is indiscriminate, affects everyone, and requires multisectoral collaboration and coordination across the ‘One Health’ spectrum over a multi-year timeframe.
• AMR is not only a global health but also a broader developmental issue; it is both a cause and consequence of poverty and contributes to a wide range of social and economic harms, affecting sustainable development. The 2030 Sustainable Development Goals (SDG) will only be achieved by containing and controlling AMR. Equally, advancing specific SDGs, including SDG 3 on good health and well-being and SDG 6 on clean water and sanitation, is pivotal to combating AMR. Advancing the delivery of agreed AMR targets through future SDG renewal negotiations and the UN Sustainable Development Cooperation Framework plans are critical.
• AMR needs to be raised up the political agenda as a top global health and development threat, both across and throughout the UN System via New York and Capitals. It is a critical issue particularly for ministries addressing development, health, finance, agriculture, fisheries, climate, environment, tourism, research and education.
• AMR is a natural phenomenon. This means that a sustainable innovation ecosystem delivering new products to prevent, diagnose and treat drug-resistant infections is a prerequisite for controlling the development and spread of AMR, today and in the future.
• Effective antimicrobials underpin our health, food, environment, and economic security.  They are essential infrastructure for life and livelihoods, to which everyone has a right. 
• Equitable access to antibiotics and their appropriate, sustainable use in humans and animals are key to reducing the burden of AMR. In some contexts, inappropriate use is a major challenge, while in low- and middle-income country contexts, a lack of access to antibiotics causes more deaths than AMR itself.
• Access to diagnostics is key in reducing the burden of AMR. Data generated from diagnostics informs appropriate use of antibiotics and allows for the burden of disease to be measured at the local and regional level.
• While global and regional collaboration and engagement are essential, responses to AMR must be contextualised to address the needs and priorities of countries and communities.

Broad vision

A world where reliable access to effective treatment and prevention measures results in the reduction of the burden of AMR through fewer deaths from infection in humans and lower economic and social costs related to poverty, inequalities, livelihoods, productivity, and human capital.

Possible target: a global reduction in death from drug-resistant infections by 50% by 2040. Achieving this vision requires the effectiveness of antimicrobials to be viewed as a global public good for both humans and animals with efforts implemented at country, regional, and global level to ensure that existing and new antimicrobials are accessible and appropriately used, whilst being safe, effective, of good quality, and affordable

Achieving this vision also requires recognition of AMR as a subset of overall infection burden and of substantial benefit to both AMR and drug-sensitive infections as part of health system strengthening measures such as scaling up prevention and control measures.

Priority areas for the 2024 HLM and Political Declaration

Support and accelerate development and implementation of AMR National Action Plans (NAPs)

AMR NAPs provide the foundation for tackling AMR at country level. To be effective NAPs should be cross-sectoral, costed, developed with a multisectoral taskforce, and outline a clear path to implementation including strengthening capacity, and timebound milestones.

Increase access to finance

Access to finance – from both existing and new mechanisms – is necessary for implementation of NAPs as well as innovation to address AMR. International Financial Institutions, Member States, and the private sector all have a role to play to mainstream finance for AMR. This includes through leveraging and making available existing funding streamsincluding the World Bank, Global Fund, AMR Multi-Partner Trust Fund, and Pandemic Fund, and through considering catalytic funds, bespoke mechanisms, and access to finance tools with the goal of enabling countries to access funding according to their needs. 

Accelerate innovation

Mobilizing adequate, predictable, and sustainable financing for the development of new treatments, diagnostics, and vaccines for both human and animal health, and for operational and implementation science to facilitate the scaling of evidence-based interventions is crucial to control AMR.

Further support is needed for existing global initiatives that expedite innovation and access, such as CARB-X and GARDP. Novel mechanisms that can incentivise R&D investment, i.e. pull incentives, should also be implemented swiftly and new procurement models/tiered pricing/voluntary licencing to optimize manufacturing capacity, in alignment with good stewardship principles, considered as potential mechanisms to support broader access. The potential of innovation can be maximized only by creating an R&D ecosystem that can attract sufficient investment, is sustainable, needs driven, evidence based and guided by the core principles of equity, affordability, accessibility, efficiency, and effectiveness.

Achieve universal equitable access to existing and new antimicrobials

Equitable access and appropriate use of effective antibiotics, alongside prevention efforts including immunization, infection prevention and control, and clean water, sanitation, and hygiene are the cornerstones of efforts to address AMR. Significant efforts are needed to achieve availability, affordability, accessibility, and appropriate use of existing and new antibiotics for all, particularly essential antibiotics as defined by WHO.

Strengthen surveillance and robust monitoring and reporting of data

Robust surveillance monitoring and reporting mechanisms will be key to meeting AMR goals. Efforts should be made to have established an agreed monitoring and reporting system in two years’ time, along with strengthen existing mechanisms, with countries contributing data to the AMR-related databases of the Quadripartite, including the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS), the International FAO Antimicrobial Resistance Monitoring (InFARM), and WOAH’s global database on ANImal antiMicrobial USE (ANIMUSE). Monitoring and reporting across the ‘One Health’ spectrum is key to inform national decision-making and to support knowledge sharing at the regional and global level.

Surface existing multilateral guidance and sector-specific voluntary targets

Surfacing of existing targets and commitments through legislation, action plans, codes of practice, and standards that underpin efforts to address AMR is pragmatic and vital, including those related to prevention efforts such as vaccination, water, sanitation, and hygiene (WASH), infection prevention and control, health systems strengthening, and food system transformation. Future targets could be informed by the work of an Independent Science Panel, and a risk-based approach should be taken for future target development.

Sector-specific voluntary targets for each Member State, based on current guidance from United Nations organizations might include:

1. For humans:
   • Countries to use a standardised method to develop and report antibiotic targets based on the WHO AWaRe system.
   • At least 90% of the population to have access to the key essential ‘Access’ category antibiotics.
   • Countries to consider the establishment of national diagnostics strategies as part of their national health plans, and to consider the development of national essential diagnostics lists, adapting the WHO model list of essential in vitro diagnostics.
   • Multistakeholder development of robust yet agile targets relating to new treatments, preventatives and diagnostics successfully developed and approved.
2. For animals:
   • Phase out use of medically important antibiotics for non-veterinary medical purposes over 3 years (Ref: Codex code of Practice Principle 13).
   • Phase out use of all antibiotics for non-veterinary medical purposes over 5 years.
   • Establish a Global Essential Veterinary Medicines and Vaccines list, and AWaRe guidance for veterinary medicines as well as working towards a % access goal for animals.
3. For plants:
   • Prioritize the development and implementation of guidance on the use of antimicrobials for phytosanitary (plant health) purposes.
4. For the environment:
   • Pharmaceutical industry to adopt and develop the independent BSI standards on pollution from antibiotic manufacturing.

Establish an Independent One Health AMR Science Panel

The establishment of an independent panel was recommended to the UN Secretary General by the Interagency Coordination Group on AMR (IACG) in 2019 and remains an important step to inform and advance efforts to address AMR. The panel could be informed by existing models (such as the IPCC for climate), be hosted by UNEP with direct reporting to the UN Secretary General and provide advice and recommendations to inform future evidence-based targets, synthesising the latest science, identify knowledge gaps, and advising on best practice and value of interventions.

Strengthen coordination mechanisms

Coordination across the One Health spectrum is key to support implementation from NAPs to regional and global initiatives. The Quadripartite plays a critical role and can be strengthened by formalising the Joint Secretariat structures and by considering an expanded group inclusive of UNDP, UNICEF, (UNHCR and WPF), formalising the relationships with an annual rotating chair.

Voluntary reporting of country-level data through existing systems remains vital while peer-to-peer review mechanisms for NAPs could be an effective model to support and accelerate progress.  Global progress reports (prepared by the Quadripartite/coordination mechanism should be provided to UNGA every two years. Such reporting would enable opportunities for funding, policy support and new technology. The political declaration of the 2024 HLM should mandate a further HLM for 2029 to embed a One Health feedback mechanism.

Engage civil society and other non-state actors for effective implementation

Communities across the world can play a critical role to support efforts to address AMR in their own locality. Contextually appropriate engagement with non-state actors, including civil society, patient groups, and the public in local efforts to address AMR is an important approach.

The organisations listed below contributed to the Wilton Park discussion which informed the development of this Outcomes Statement. However, this does not represent a formal endorsement of the content and recommendations.

• The Africa Forum for Research and Education in Health (AFREhealth)
• AMR Centre, London School of Hygiene & Tropical Medicine
• The AMR Narrative
• Becton, Dickinson and Company (BD)
• Center for Global Development (CGD)
• Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X)
• Danish Ministry of Health
• The G20 & G7 Health & Development Partnership (G20HDP)
• The Global Antibiotic Research & Development Partnership (GARDP)
• The International Federation of Pharmaceutical Manufacturers & Associations (IFPMA)
• International Centre for Antimicrobial Resistance Solutions (ICARS)
• Merck Sharp & Dohme (MSD)
• Norwegian Cancer Society (NCS)
• PATH
• ReAct – Action on Antibiotic Resistance
• Skating Panda
• Statens Serum Institut
• The Trinity Challenge
• University of Exeter
• Veterinary Medicines Directorate (VMD)