Uniting Against AMR
Global Solutions Need Local and Global Collaboration
CO-AUTHORS: James Headen Pfitzer, Senior Director, Global Policy, Corporate Affairs, Viatris and Melissa Mitchell, AMR IA Secretariat Lead
Our world is rapidly changing, and policymakers face no shortage of challenges. Solutions are increasingly complex requiring global coordination of all stakeholders, all sectors, significant financial investment and engagement with local communities to ensure sustainability and uptake.
Consider this: an environmental crisis has become a major public health threat. It contributes to millions of deaths per year. It’s on track to cost the world economy trillions. And it requires world leaders and businesses to work together to find a solution – rapidly.
In this case, we’re not talking about climate change or biodiversity loss. But this problem is just as frightening: Antimicrobial resistance (AMR), which occurs when bacteria no longer respond to antimicrobial medicines, thereby making antibiotics and other drugs ineffective. Since Alexander Fleming discovered penicillin in 1928, antibiotics have underpinned all aspects of our public health systems. Today, everything from a knee replacement to root canal to heart surgery is achievable because antibiotics can prevent infection and potential death. Unfortunately, that’s not a guarantee of future effectiveness.
AMR impacts everyone and has multiple drivers. Its causes and effects are complex and affect populations unevenly across the globe. And because of climate change, the problem is getting worse. Rising global temperatures accelerate bacterial growth rates and enhance horizontal gene transfer1, which increases AMR not only in humans, but animals, plants, and the environment.
Together, climate change and AMR pressure health systems, particularly the most fragile. Without immediate global engagement, our health systems risk being pushed to their breaking point, no matter where you live. A coordinated global response should focus on three priorities: fostering innovative solutions, further driving access and stewardship, and controlling for AMR in the environment.
First, we must foster the innovation required to solve the problem. We do that by developing new drugs, technologies and approaches and ensuring we use the drugs we currently have in the right way to protect their future efficacy. There is no one-size-fits-all solution. Innovations must span a wide range – from new diagnostic tools and delivery mechanisms to backstopping a broken antibiotic marketplace. Health systems and policy makers need to be adaptable, delivering the right capabilities at the right time, all tailored to local contexts and the needs of people.
Stewardship and access are also critical in addressing AMR, as responsible management of antibiotic use helps slow the development of resistance. Ensuring equitable access to effective and appropriate treatments also prevents the overuse of antibiotics, reducing potential misuse and the spread of resistance. But this doesn’t look the same to everybody. A key lesson from other global health responses, such as HIV/AIDS, tuberculosis, and COVID-19, is the vital role of local communities. Only when health systems, policies, and services are co-designed with the communities that use them can they be scalable, sustainable, and effective. Focusing on people, not just diseases, allows health systems to better address the realities they face.
AMR is often spread in the environment we live and work in through public wastewater or improper sanitation, for example. This can even be true in the manufacturing of the very antibiotics we need to combat AMR. Fortunately, the AMR Industry Alliance (AMRIA) published the Antibiotic Manufacturing Standard in June 2022, facilitated by BSI Standards Limited (BSI), providing clear guidance to manufacturers in the global antibiotic supply chain to ensure that their antibiotics are made responsibly, helping to minimize the risk of AMR in the environment, with an accompanying independent certification in line with the AMR IA Standard for Antibiotic manufacturing. In fact, Viatris, a global healthcare company, earned its first BSI Kitemark Certification under the AMRIA Manufacturing Standard in early 2024 in India, with more sites to follow.
Ultimately, we must work together to ensure all people have access to antibiotics when they need them while at the same time ensuring we have the capacity to innovate for the future. Creative approaches to collaboration will be needed, such as PLATform for Innovation of Existing Antibiotics, which brings diverse stakeholders together with a focus to address the gap between the needs and availability of antibiotics in Sweden while optimizing antibiotic use to preserve efficacy of existing antibiotics in the future.2
Following the 2024 UNGA High-Level Meeting on AMR, the Global Ministerial Conference and World Antimicrobial Awareness Week, now is a critical time to keep the momentum to continue to raise awareness about AMR and ensure progress. Governments, NGOs, civil society, youth organizations, private sector, universities, and media all have roles to play in keeping AMR at the forefront of global health discussions and preventing the dangers of complacency.
The time to act is now. The future depends on it.