October 09, 2024
The One Health Trust at the 2024 United Nations General Assembly
Over a decade ago, the One Health Trust, founded as CDDEP, began to work tirelessly alongside partners and collaborators to generate evidence and launch initiatives to attain a political resolution during the first United Nations General Assembly (UNGA) High-level Meeting on antimicrobial resistance (AMR) in 2016. The resolution passed by member states helped bring awareness to this growing global health crisis and called for the development of national action plans (NAPs) to address it. However, the resolution did not set clear targets or guarantee funding for mitigation efforts.
Since 2016, our team has spearheaded multiple projects, initiatives, and publications to further drive global action on AMR mitigation. We supported many low and middle-income countries in Africa and Asia in the elaboration of their NAPs on AMR through the Global Antibiotic Resistance Partnership (GARP). Through our office in India, we support World Health Organization member states to assess progress and challenges with the implementation of their NAPs on AMR. We continue to drive research and have contributed to several publications generating evidence on the value of preventive interventions such as vaccines; water, sanitation, and hygiene (WASH); and infection prevention and control (IPC) in mitigating AMR. We are currently using this evidence to bring awareness and impact policy at the country level through our GARP network. Ahead of the second UNGA high-level meeting on AMR, we spearheaded the Lancet Series on Antimicrobial Resistance, publications reviewing the scope of the burden of AMR, quantifying the impact of prevention, and setting clear targets and recommendations to achieve sustainable access to effective antibiotics.
Ensuring Sustainable Access to Effective Antibiotics: From UNGA to Impact
After more than a year of planning, the One Health Trust team was thrilled to co-host an event that kicked off a week of discussions on global AMR control before the second UNGA high–level meeting on AMR on September 22, 2024, in New York City. One Health Trust, alongside partners in the fight against AMR – Africa CDC, AMR Action Fund, U.S. CDC, ICARS, IFPMA, Global AMR R&D Hub, IDSA, FIND, and Bill & Melinda Gates Foundation – convened experts, policymakers, government, and civil society organizations at the Harvard Club in an evening full of discussions of the journey so far and the challenges and commitments that lie ahead.
A Fireside Chat with Prime Minister of Barbados, The Honorable Mia Amor Mottley
To start the symposium, OHT’s Dr. Ramanan Laxminarayan sat down with the Honorable Mia Amor Mottley, chair of the Global Leaders Group on AMR – a position she was called to lead in 2020 by Director-General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus. Mottley affirmed that if AMR is going to be the biggest killer of people by 2050 (as recently predicted), we have a moral duty to raise this issue to the highest possible level. She said that the UN political declaration on AMR (later passed on September 26) could supersize people’s awareness of the problem globally and that the US$ 100 million commitment to AMR in the declaration– however modest and insufficient– signals that we must find a mechanism for funding. Mitigating AMR is critical for the financial stability of the world. Mottley charged that we can motivate better financing for AMR control by calling for changes to entities such as the World Bank to guarantee financing for protecting public goods, including antibiotics. She stated the need for multinational business profits related to the cause of AMR or those that benefit from AMR mitigation efforts (such as pharmaceutical or livestock companies) to be taxed to create a sustainable finance platform for AMR mitigation.
Panel 1: The road to UNGA
The first panel, moderated by Dr. Laxminarayan, included Ambassador Vanessa Frazier of Malta and Ambassador François Jackman of Barbados, the two ambassadors who led the write-up of the UN resolution draft that was passed by all 193 member states on September 26. Ambassador Frazier affirmed that the declaration has a much more targeted approach than the one in 2016, with the concrete inclusion of One Health and the UN quadripartite. Ambassador Jackman added that the success of crystallizing an independent scientific panel within the declaration will move the needle on our understanding of and approach to AMR globally. Ambassador Frazier and Jackman affirmed that every member state of the UN has a stake in AMR control and that it was important that the topic be broached again in this resolution. Those writing the political declaration benefitted greatly from input from experts, industry, AMR survivors, and civil society organizations on the elaboration of the text. They urged nongovernmental stakeholders to help push for the implementation of the agreement because, without calls from civil society, governments won’t act.
Panel 2: Do people understand AMR?
Panel two, moderated by New York Times reporter Apoorva Mandavilli, began with a presentation on emerging research from the Global AMR Monitor, by Ilana Ron Levey, a Managing Director at Gallup. The Global AMR Monitor, focused on driving sustained attention to the problem of AMR, is currently examining the understanding of AMR among different stakeholder populations in India, South Africa, and the United States. The research so far shows varying levels of knowledge and concern about AMR and inconsistent actions regarding the appropriate use of antibiotics.
The panel discussing people’s understanding of AMR included Michael Craig, Director of the Antimicrobial Resistance Coordination and Strategy Unit at the U.S. Centers for Disease Control and Prevention, and Dr. Ghada Zoubiane, Head of Partnerships and Stakeholder Engagement at the International Centre for AMR Solutions. Craig stated that the most shocking aspect of the results of the Global AMR Monitor research is the commonality of the general lack of understanding of AMR in three very different regions of the world. He emphasized the need for more data on the issue to drive better policy and awareness. Dr. Zoubiane highlighted the difficulty of communicating about AMR and how translating the term to different languages is complex and requires digging deep into how to capture awareness in different contexts. She affirmed that we need to frame the problem of AMR for the audience being spoken to, but rebranding and changing the term would not change that. Education, incentives, and penalties are needed to promote the careful use of antibiotics and understanding of AMR. Dr. Zoubiane also pointed to the need for the promotion of patient stories from survivors, caregivers, and those who have lost loved ones to AMR to increase engagement with the topic.
Panel 3: Preventing infections before they occur
The third panel, moderated by Dr. Laxminarayan, began with a presentation by Dr. Joseph Lewnard – Associate Professor of Epidemiology at the School of Public Health at the University of California, Berkeley – on preventing AMR infections before they happen. Dr. Lewnard discussed what could be achieved in AMR mitigation through improving the implementation of existing interventions including infection prevention and control in hospitals; water, sanitation, and hygiene access and infrastructure; and pediatric vaccines. The speakers on the panel were Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance, and Sarah Despres, a counselor to the U.S. Secretary of Health and Human Services for Public Health and Science. Dr. Nishtar reaffirmed the need to include vaccination in NAPs on AMR and the importance of vaccines in AMR mitigation in low- and middle-income countries. Gavi is working to get funding for vaccines for 24 antigens, 8 of which are connected to infections that cause the excessive use of antibiotics. Regarding the question of prevention in hospital infections globally, Despres stated that we know what we need to do and that it is a question of having the political leadership and the funding to do it. She added that AMR cannot be seen in a silo; while we need to highlight it as an issue, AMR is really about the ability to provide healthcare. Additionally, we need to make the link for providers that interventions, including handwashing and vaccines, are important, even though not specific to AMR alone.
Panel 4: Innovation and access
Panel four, moderated by Deepali Patel, Director of International Policy at the AMR Action Fund, included speakers Dr. Trevor Mundel, President of Global Health for the Bill & Melinda Gates Foundation; Dr. Tina Tan, President-Elect of the Board of Directors of the Infectious Diseases Society of America (IDSA); and Dr. Marijke Wijnroks, Head of Strategy, Investment, and Impact for The Global Fund. Dr. Mundel said that the development of an ideal antibiotic that we can ensure has broad access comes with several requirements: it must have a high barrier to developing resistance because it would be a first-line treatment; it needs to be incredibly safe; and most importantly, it needs to be cheap. Mundel charged that these properties are major barriers to getting companies interested in research and development for these types of products, and that is why artificial intelligence (AI) is an interesting tool to leverage for drug discovery. AI not only speeds up the drug discovery process, it helps include more diverse stakeholders in the field. Dr. Mundel expects significant changes in drug discovery in the next three to five years. Dr. Tan affirmed that the Pasteur Act in the United States, if passed, would be the single most important measure that the government could take to transform antibiotic research and development and help reach the global goal of reducing deaths due to bacterial AMR by 10 percent. Dr. Wijnroks affirmed that research and development related to AMR is a priority for funding for the Global Fund as it impacts patients with HIV/AIDS, tuberculosis, and malaria greatly. She and Dr. Mundel both stated that work done to develop treatments and ensure access to medicines for tuberculosis provides a hopeful example of what can be done to address AMR research and development needs in low- and middle-income countries.
To close the panel, Dr. Henry Skinner, CEO of AMR Action Fund, commented that pull incentives to encourage the development of products must be used for the development of products that best serve low-resource settings, and James Anderson, Executive Director of Global Health at IFPMA, affirmed his hope for the future knowing that innovation and access are in the new UN political declaration.
Panel 5: From declaration to implementation: How can we achieve UNGA Targets?
The fifth panel, moderated by Apoorva Mandavilli, included speakers H.E Dr. Jean Kaseya, Director General of Africa Centres for Disease Control and Prevention, and Dr. Hanan Balkhy, Regional Director of the Eastern Mediterranean Region of the World Health Organization. Dr. Kaseya stated that the current outbreak of mpox plaguing many parts of Africa is likely driving AMR emergence and spread as people desperately seek prevention and treatment of mpox by inappropriately using antibiotics, which are often of low quality. Dr. Balkhy explained that challenges related to conflict and humanitarian crises in the Eastern Mediterranean region guarantee the emergence of drug resistance. Further, she stated that continuously compromised health and sanitation conditions in crisis areas will affect all global efforts to control AMR. She called for peace and to seek out ways to ensure sustainable healthcare systems for everyone, especially the most vulnerable. She affirmed that bedside diagnostics for bacteria, parasites, and virus detection are needed to allow surveillance and antimicrobial stewardship for displaced populations like those in Gaza and Sudan. In addressing conclusions from the MAAP study that shows that only around 1.3 percent of laboratories in Africa are carrying out AMR analyses, Dr. Kaseya said that to improve surveillance in Africa, strengthening laboratories is vital. Furthermore, raising awareness of AMR alone will do nothing if people in Africa do not have the tools they need for proper mitigation, including clean running water and vaccines.
To conclude the symposium, Dr. Lesley Ogilvie, Director of the Secretariat for Global AMR R&D Hub, and Dr. Cecilia Ferreyra, Director of the AMR Programme for FIND, provided comments. Dr. Ogilvie stated that we need technical know-how on the ground to implement AMR solutions, and she hopes that the declaration can help ensure we address AMR faster, better, with more specificity, and with accountability. Dr. Ferreyra stressed that new antibiotics are important, but we need to know how and when to use them. Hence, developing accessible diagnostics is a key component of addressing AMR.
The event was live-streamed, and the recording can be viewed here.
Other events on the sidelines of the UNGA
Our team had the opportunity to attend several other side events throughout UNGA week hosted by partners and key stakeholders in global AMR mitigation.
The Lifeline AMR Gala
On Saturday evening, September 21, the OHT team attended a gala with a special showing of the Scottish musical, Lifeline, hosted by Dame Sally Davies, the United Kingdom Special Envoy on AMR. The show was preceded by a special panel on AMR. The panel covered issues promoting a nuanced One Health approach to understanding and addressing AMR with panelists from the human, animal, and environmental health sectors. Joining the expert voices was the writer of the musical score, Robin Hiley. The play, which intertwined the biography of Sir Alexander Flemming with stories of love and profound loss due to AMR, portrayed multiple perspectives of this ever-growing crisis. It depicted the excitement and promise of antibiotic discovery along with the human tragedy that trails their declining effectiveness. As the curtains closed, scientists, clinicians, and others on the front line delivered strong messages on how they are working to tackle AMR, simultaneously bringing hope that together we are stronger and can alter course.
Advancing Together: Securing the Global AMR Agenda by Harnessing the Collective Strength of Multi-Sector Partnerships
On the morning of September 24, our team attended the event hosted by bioMérieux, The Wellcome Trust, The American Society of Microbiology, the Republic of Malawi, and the French Ministry for Labour, Health and Solidarities. The speakers discussed creating a collaborative ecosystem for sustainable solutions in the AMR landscape, covering diagnosis, treatment, surveillance, and action plans across the health of humans, animals, and the environment. They emphasized that achieving the UN Declaration’s goals requires collective action from all stakeholders, as no single sector has the necessary resources or expertise. As health and finance sectors move from awareness to action, exploring collaboration and leveraging shared strengths is essential for driving country-level changes to meet global targets.
From People to Leaders – Side event & exhibition
Hosted by ReAct and partners, the event in the early evening on September 24 aimed to amplify community and civil society voices globally. It served as a platform to share testimonies, convey key messages to global leaders, and present the “Call for Global Action” to the President of the 79th UN General Assembly and the co-facilitators of the Political Declaration negotiations. The event began with testimonies from communities and civil society representatives on the impact of AMR, followed by a showcase of the role of communities and civil society in the global response and a special ceremony for a call to global action. The discussion closed with remarks from the founder of the ReAct Network, Dr. Otto Cars, in which he touched on how far we have come in the fight to control AMR and the vital work that we all, as stakeholders in global health, have ahead to fight to mitigate AMR. The discussions were followed by an art exhibition filled with art installations about AMR by Visual Communications students at Beckmans College of Design in Stockholm, Sweden.
From Policy to Action: Successful Implementation of Multisectoral AMR Programs in LMICs
Hosted by the World Medical Association (WMA) and the International Centre for Antimicrobial Resistance Solutions (ICARS) on the evening of September 24, the event’s main panel included Dr. Youk Sambath, Secretary of Health of Cambodia; Dr. Juliana Corrêa of Fundação Getulio Vargas; Dr. Ronnia Gavilan, Director of the National AMR committee in Peru; and Dr. Lata Kapoor, Director and Head of the AMR Programme Unit for the Ministry of Health and Family Welfare of India. Speakers reflected on AMR success stories and lessons learned from National Action Plan implementation in their countries. Speakers emphasized the unique opportunity UNGA Week presents for AMR advocates to share insights and contribute valuable evidence to future planning and action.
The Future Can’t Wait – Shaping tomorrow, today
OHT’s Dr. Ramanan Laxminarayan spoke on the panel “Confronting an emerging global health threat: Strategies for defeating antimicrobial resistance” with Dr. Anand Anandkumar of Bugworks Research Inc. and Dame Sally Davies at the Devex Summit at UNGA 79: The Future Can’t Wait on the afternoon of September 25. Dr. Laxminarayan emphasized three things that are needed to curb the AMR crisis, “First, there’s a need for stronger infection prevention efforts in low- and middle-income countries, such as clean water and adequate sanitation. Second, there’s a need to expand access to antibiotics to settings where people are dying without the needed drugs. Third, there’s a need for a new pipeline of antibiotics.”
Elevating African Voices on Antimicrobial Resistance
The event hosted by Africa CDC and partners was held on the afternoon of September 25. It began with a call to action from the Director-General of the Africa CDC, H.E Dr. Jean Kaseya. Dr. Kaseya noted that it is predicted that four million people will die due to AMR in Africa between 2025 and 2050. He stated that the stakes are high for Africa as the continent’s GDP could reduce by 3.8 percent without improved AMR mitigation. Speakers called for a commitment to local manufacturing of antibiotics for less reliance on the Global North and better local protocols to ensure drug safety and effectiveness. The Minister of State for Environment of Uganda, the Honorable Beatrice Atim Odwong Anywar called for global targets to be set as recommended in the Lancet Series on AMR, a 10 percent reduction in deaths from AMR, achieved in part by a 20 percent reduction in inappropriate antibiotic use in humans and a 30 percent reduction in inappropriate antibiotic use in animals by 2030. Speakers also discussed the launch of an Africa Union landmark report on AMR, Voicing African Priorities on the Active Pandemic – Accelerating the Continental Response to Antimicrobial Resistance (AMR).
Addressing the Global Health Challenge of AMR Through Innovative Solutions and Global Cooperation
The last event we attended on the evening of September 25 before the UNGA high-level meeting on AMR was co-hosted by Novo Nordisk Foundation and Healthcare Denmark. The reception gathered a diverse range of experts to discuss the impact of AMR and effective mitigation strategies. Topics included surveillance; innovative approaches to developing new vaccines, diagnostics, and antimicrobials; financial mechanisms to support these efforts; and the significance of a multi-sectoral approach. Importantly, the meeting brought in the patient’s voice as Vanessa Carter, Executive Director of The AMR Narrative, spoke about her experience as an AMR survivor and the life–changing impact of hard–to–treat infections. Recognizing the wide–ranging implications of AMR, Dr. Sonali Johnson, Head of Knowledge, Advocacy, and Policy at the Union for International Cancer Control highlighted the devastating impact of ineffective antibiotics on cancer patients.
The 79th United Nations General Assembly High-level Meeting on Antimicrobial Resistance
The One Health Trust was privileged to have a delegation at the UNGA High-level Meeting on antimicrobial resistance including: President, Dr. Ramanan Laxminarayan; Director of Partnerships and Research Fellow, Dr. Erta Kalanxhi; Research Analyst, Isabella Impalli; and Associate Director of Science Communications, Dr. Samantha Serrano. The day’s agenda began with an opening plenary, including addresses from distinguished speakers such as Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and the Honorable Ms. Mia Amor Mottley, Prime Minister of Barbados. The opening plenary was followed by Multi-stakeholder Panel 1, “Addressing the urgent global risk of antimicrobial resistance across the human, animal, plant and environmental sectors through equity, access, building awareness and innovation.” As a panelist in the section, Dr. Laxminarayan highlighted that AMR is not a silent pandemic but a neglected one. He reiterated the recommendations and evidence for the need for action provided in the Lancet Series on AMR, published in May 2024. Further, he called attention to the fact that more people die from a lack of access to antibiotics than antimicrobial-resistant infections, so promoting access to antibiotics whenever they are needed must be a priority within AMR control policies.
During the second multi-stakeholder panel, “Addressing human health, animal health, agrifood systems and protecting the environment to tackle antimicrobial resistance, through surveillance, capacity-building, sustainable resources, financing, and investment,” it was heartening to see partners, colleagues, and policymakers come together to discuss this crisis that member states unanimously agreed should be prioritized for action in the coming years. All 193 member states later approved the UN declaration on AMR. While the text does not cover the multitude of actions and commitments needed to address AMR, it is a vast improvement to the previous 2016 declaration. Important targets include:
- Establishing an independent panel for evidence for action against antimicrobial resistance in 2025
- Reducing the global deaths associated with bacterial antimicrobial resistance by 10 percent by 2030
- Facilitating sustainable funding of US$ 100 million by 2030 for national action plan implementation
- Expanding the use of WHO Access group antibiotics to achieve at least 70 percent overall human antibiotic use globally by 2030
At the One Health Trust, we will harness the energy and momentum from UNGA week to advance our work to move the needle in the fight to control AMR. We will continue to collaborate with our partners and to spread awareness in our communities with the knowledge that this work can and does make a difference.
