A Hidden Pandemic: The global response to antimicrobial resistance

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Around the world, November 2020 looks markedly different to Novembers gone by. From Baby Boomers becoming “Zoomers”, to Formula 1 teams developing ventilators, global health is having far-reaching impacts — on lives and livelihoods. This November also marks the first World Antimicrobial Awareness Week, to raise awareness of another pandemic that is hiding in plain sight: antimicrobial resistance (AMR). Previous campaigns focused on “antibiotics”, but there are lots of tools to fight diseases in humans, animals and plants, including antibiotic, antiviral, antifungal and antiprotozoal medicines. We call these treatments “antimicrobials”.

Antimicrobial treatments — from penicillins to lipopeptides and everything in between — are the bedrock of modern medicine. From caesarean sections to organ transplants and chemotherapy — and even to treating COVID-19 patients on ventilators — antibiotics and other antimicrobials enable safe healthcare. Unfortunately, our current treatments, especially those against bacteria, are becoming less effective. Antibiotics are over-consumed, not just by humans but also by food-producing animals. In developing countries especially, this is compounded by a lack of access to clean water and poor infection control in health-care facilities and on farms. The result is that the SARS-CoV-2 virus is not the only pandemic threat we are facing. Antimicrobial resistance is happening at the same time and it's on the rise, with the potential to have even greater social, economic and well-being impacts.

Unfortunately, our current treatments, especially those against bacteria, are becoming less effective. Antibiotics are over-consumed, not just by humans but also by food-producing animals.

 This is not just a health issue. If we can't treat patients and we lose their productivity, there is a macro-economic impact. The 2016 O’Neill Review, jointly commissioned by the United Kingdom government and the Wellcome Trust, estimated the cost of AMR to the global economy to be over GBP 80 trillion by 2050: equivalent to wiping the United Kingdom’s economy from global output annually. Moreover, in 2017 the World Bank estimated that the loss of productivity and lives as a result of the failure of antibiotics would contract the global economy by up to 3.8% by 2050, pushing an additional 28 million people into poverty. Like COVID-19, AMR will have disproportionate economic consequences for people in developing countries, where health systems are often weaker.

These are more than just numbers. These are neighbours, friends, parents, employees. Right now, we are witnessing how catastrophic a global health threat can be for families, communities and whole economies when you are fighting an infection that can’t be prevented or treated. Modern medicine and our future economy depends on us addressing this. Our globalised economies and supply chains depend on us making everyone and everywhere safe.

Also on the Forum Network: Resilience of Health Systems to the COVID-19 Pandemic in Europe: Learning from the first wave by Francesca Colombo, Head of the Health Division, Directorate for Employment, Labour and Social Affairs, OECD

This is why the United Kingdom government is working with non-government stakeholders to protect our shared environment as part of our action on AMR. Earlier this year, the Department of Health and Social Care, in collaboration with the FAIRR Initiative, the UN Principles for Responsible Investment and the Access to Medicine Foundation launched the Investor Action on AMR initiative during the World Economic Forum in Davos. We are calling on investors to commit to making sustainable investments and align with global best practices to tackle AMR. Investing in sustainably sourced goods and being transparent about supply chains can make a huge difference.

Today, I am delighted to announce that 12 global investors and financial institutions have announced they are joining the initiative. Together, the 12 investors manage over USD 4.8 trillion worth of assets, and include some of the largest asset managers and institutions globally.

Business as usual can be done differently — and more sustainably — without sacrificing that crucial bottom line. Across the world, we are seeing consumer purchasing habits trend towards sustainably farmed livestock. McDonald's have pledged to reduce the use of antibiotics in its global beef supply by the end of this year. In the United Kingdom, six of the ten leading supermarket companies have now banned the routine use of antimicrobials in their food supply chains. By reducing antibiotic usage in humans as well as livestock farming and fishing, along with practising good hygiene and animal husbandry, we can address AMR. A recent report showed that 25 countries across Europe have reduced their antibiotic sales for food-producing animals by 34% between 2011 and 2018. Investors must be a part of these trends and future-proof their investments — for our global capital markets and our global economic health.

As countries around the world respond to and recover from COVID-19, we have an opportunity to move the direction of global economies towards certainty, dignity and sustainability.

Some pharmaceutical companies are also changing their business practices in order to limit drug-resistant infections. According to the 2020 Antimicrobial Resistance Benchmark, ten pharmaceutical companies have decoupled bonuses from antibiotic sales volume, or avoid using sales agents altogether for antibiotics. This is important because it reduces the risk of overselling to healthcare professionals. At the same time, Pfizer became the first-ever pharmaceutical company to share the raw data behind its surveillance programme in an open-access database. Hospitals and governments need to know where resistance is developing so they can adapt treatment guidelines and inform prescribers of antibiotics.

As countries around the world respond to and recover from COVID-19, we have an opportunity to move the direction of global economies towards certainty, dignity and sustainability. We can reset, reshape and reimagine the future — if we act now. Guided by the United Nations 2030 Agenda for Sustainable Development, the global community can contribute to a more resilient future. By reducing long-term risks, including from AMR, we can drive further economic growth. I believe that the collective efforts of private and institutional investors to promote sustainability will lead to significant positive impact, changing our economic trajectories and building resilience for people and the planet.

Watch Angel Gurría, Secretary-General of the OECD, addressing European Antibiotic Awareness Day 2020.

Last year, the United Nations ad hoc Inter-Agency Coordination Group on AMR (on which I sat as co-convenor) advocated for more action to be taken at a global level to tackle AMR effectively. Our recommendations called for unprecedented co-operation across sectors, across countries — globally, nationally and individually. One year on, it is clear that we need to accelerate global solutions to our global problems. Health and business solutions will go hand in hand.

The value that we gain and create by curbing AMR and behaving more sustainably will be evident in our ability to enable global access to treatments for all who need them. We must think long term. That’s why this November’s World Antimicrobial Awareness Week will centre on handling antimicrobials with care. This means building sustainable, secure and environmentally-friendly pharmaceutical supply chains. This means using consumer power to change the way our food is produced. This means strengthening health systems so that they are more resilient and only using antimicrobials when a healthcare worker prescribes them to you. Everyone can play a part.

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Dame Sally Davies

UK Special Envoy on Antimicrobial Resistance, UK Government

Dame Sally Davies was appointed as the UK Government’s Special Envoy on AMR in 2019. She is also the 40th Master of Trinity College, Cambridge University. Dame Sally was the Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011-2019. She has become a leading figure in global health including serving as a member of the World Health Organisation (WHO) Executive Board 2014-2016 and as co-convener of the United Nations Inter-Agency Co-ordination Group (IACG) on Antimicrobial Resistance (AMR) reporting in 2019. In the 2020 New Year Honours, Dame Sally became the second woman (and the first outside the Royal family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for services to public health and research, having received her DBE in 2009.

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