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NYT Syndicate
An extraordinary gathering at the United Nations in September may have permanently changed how the world deals with antibiotic resistance, which is believed to kill 700,000 people around the world each year.
During the UN meeting, the entire assembly signed on to a political declaration that calls antibiotic resistance"the greatest and most urgent global risk." But it is what they do next that will determine whether the threat can really be contained.
Meanwhile, a multinational research team announced that they have identified a new strain of the drug-resistant staph bacterium MRSA that appears to be travelling on poultry meat.
SHADOW SIDE
The UN meeting, formally the High Level Meeting on Antimicrobial Resistance, marked only the fourth time that the world body has acted on a health issue. (The last time was the Ebola emergency in 2014.) Leaders signalled from the start that they considered the day important.
"Antimicrobial resistance poses a fundamental long-term threat to human health, sustainable food production and development," UN Secretary-General Ban Ki-moon said in a speech opening the meeting."In all parts of the world, in developing and developed countries, in rural and urban areas, in hospitals, on farms and in communities, we are losing our ability to protect both people and animals from life-threatening infections."
His assessment of the dire situation was backed up by the World Health Organisation's executive director, Margaret Chan."Antimicrobial resistance poses a fundamental threat to human health, development and security," she said as the meeting opened."The commitments made today must now be translated into swift, effective, lifesaving actions across the human, animal and environmental health sectors. We are running out of time."
The agreement made by the world governments, which will be formally voted in before the General Assembly ends, commits them to creating national plans for combating antibiotic resistance in medicine, agriculture and the environment, and to reporting back to the General Assembly in 2018 on their progress.
It also commits the UN and its partner agencies ” the World Health Organization, the Food and Agriculture Organization and the World Organization for Animal Health ” to creating an"ad hoc interagency coordination group" that will be led by David Nabarro, a physician who works within the secretary-general's office and has led UN efforts on Ebola, pandemic flu and the Haitian cholera epidemic.
"This is day zero, which means we now have to start figuring what happens next: what this coordinating mechanism does, what its mandate is. How does progress get measured?" said Ramanan Laxminarayan, director of the nonprofit Center for Disease Dynamics, Economics and Policy.
"This is a multi-sector problem, which means the UN has to quickly make friends outside of governments. We've got to get doctors, the whole medical practice community, the pharmacists, manufacturing, the whole agricultural sector. It's not amenable to control-type regulation."
CONSUMER VOICE
The UN's decision to take up the cause of antibiotic resistance created an intense few days of gatherings on the east side of Manhattan.
There was the high-level meeting itself, which took place in two immense side-by-side auditoriums at UN headquarters. In one auditorium, experts on the topic gave presentations about challenging issues with controlling antibiotic resistance, such as stimulating development of drugs and devices and finding alternative means of producing lots of animal protein for the expanding economies of the developing world.
In another, representatives of 70 governments gave statements that supported the UN's move, but also raised their individual concerns about financing change in their health care systems, protecting exports of their agricultural products and, for the smaller countries, being allowed to find their own path to the issue instead of having to live up to the standards of the industrialized West.
Thomas Frieden, director of the CDC, spoke at several of the side meetings. He said after one of his speeches,"This is not an easy problem to fix. Preventing drug resistance really requires that you have a functioning health system. It requires that doctors prescribe appropriately, that governments regulate appropriately, that laboratories work. And it requires innovations, better ways to diagnose as well as treat."
There were several significant developments that seemed to be putting momentum behind the UN declaration. Defra, the British government's farming and food agency, announced that it would require farms in the United Kingdom to cut antibiotic use by one-fifth.
At the same time, 13 of the world's largest antibiotic makers committed to a"road map" for reducing overuse. It not only commits them to reining in their marketing but also accepts responsibility, for the first time, for water pollution from antibiotic manufacturing waste.
And a coalition of five nonprofits that work on food safety announced that, in the United States, fast-food and chain restaurants are rapidly scaling up the amount of meat they buy that is raised without routine antibiotic use. Their report, co-written by the Center for Food Safety, Food Animal Concerns Trust, Friends of the Earth, Natural Resources Defense Council and Consumers Union (which publishes the magazine Consumer Reports), said that nine of the 25 largest chains in the US have adopted sourcing policies that demand antibiotic-free meat, twice what existed a year earlier.
Consumer pressure led to those developments, and it is likely to push forward much of the change that is needed in farm antibiotic use, David George Velde, a board member of the World Farmers' Organization, said during the meeting.
"Producers respond to market stimulus," he said in an onstage colloquy."One of the dramatic shifts that has occurred is the awakening of public awareness of health issues, in terms of where does their food come from, how is it produced, how is it processed. The growing interest by consumers in knowing the answers to those questions is having a huge effect in the marketplace."
LAST DEFENCE
At the same time, new challenges are emerging in the fight against antibiotic resistance on a global scale.
In September, a multinational research team led by microbiologists Lance Price in Washington, DC, and Robert Skov in Copenhagen announced a new strain of drug-resistant staph in the journal Clinical Infectious Diseases.
The researchers found the novel strain, a variant of"livestock-associated MRSA," in city dwellers who had no contact with farm animals. Denmark has very strict controls on antibiotic use in livestock, and the strain has never been recorded there, raising the possibility that it might have travelled into the country via imported meat.
In truth, not even the most optimistic representative at the UN meeting expects antibiotic resistance to go away entirely. The goal of the declaration that governments agreed to is to slow down resistance by ceasing the misuse and overuse that force bacteria to evolve.
Still, as the meeting ended, it was clear that they felt the cause had been handed an extraordinary opportunity that could make a real difference in the health of the world ” an opportunity that will occur only once.
"We only get one crack at this," Laxminarayan said."If we fail to do this, the world will only have checked off a box that says, 'We have dealt with antimicrobial resistance, it went to the UN, it is done.'"
