What we need to tackle antimicrobial resistance

Antimicrobial resistance (AMR) is not a disease for which we should expect ultimately to develop a cure. Instead, it is a concept, a global concept, involving multiple disciplines – working locally, nationally, and globally – to attain optimal health for people, animals, and the environment. It is something that undermines the treatment of many diseases and therefore health systems. AMR is not something that you can identify easily, such as malaria or HIV.

AMR is part of a larger phenomenon and is thus not amenable to easy technical interventions. AMR is a natural phenomenon that occurs as microbes evolve and all prescribed antibiotics can contribute to the spread of AMR, so the exact role of antibiotics in human health or animal health in driving the spread of resistance in the ecosystem must be properly understood and addressed. Moreover, a vast majority of bacteria are essential for life and the health of humans, animals, and the ecosystem and only a very small percentage of them cause disease. This implies that the treatment of infectious diseases should be optimized in a way that they do not make the cure worse than the disease.

AMR poses a global challenge. No single country, however effective it is at containing resistance within its boundaries, can protect itself from the spreading of resistant bacteria through contact between humans, animals, and the environment, via travel and trade. The global nature of AMR calls for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody is exempt from the problem, nor from playing a role in the solution. Responding to outbreaks of drug-resistant infections involves the coordination of efforts across national boundaries, varied health systems, and involving international agencies.

AMR has been often wrongfully depicted as purely a medical problem, presumably because of the direct and devastating consequences that patients with multi-drug-resistant infections may experience. Such a narrow perspective prevents the issue from being recognized as a systems failure and from getting the global attention that it requires.

There is no single ‘silver bullet’ to address AMR.

What we need to tackle the AMR problem is an adaptive, multipronged approach involving many stakeholders – working locally, nationally, and globally – to attain optimal health for people, animals, and the environment.

What we need is a multidisciplinary approach, considering also the great diversity of social, economic, political, and cultural contexts in which AMR emerges or spreads.

What we need are strategies to increase awareness about AMR in order to implement more effective interventions.

Finally, what we need is a comprehensive and solidaristic model as the only solution for a problem that knows no borders.

To tackle AMR, antimicrobial effectiveness needs to be recognized as a fundamentally important global public good and governed accordingly.AMR is a challenge to global development. Antimicrobial effectiveness must be looked upon as a limited global public good on the verge of becoming scarce, and the world has a collective responsibility to preserve it in order to avoid countless future victims of drug-resistant infections.

The COVID-19 pandemic has shown the devastating impact of hard-to-treat infections, and the ease with which infections can spread and threaten global health security.

The COVID-19 pandemic has highlighted the need for resilient health systems and has resulted in an unprecedented rate of collaboration in scientific, medical, social, and political dimensions. The pandemic has also created a renewed awareness of the importance of infectious diseases and is a substantial entry point for reigniting the momentum towards containing the silent pandemic of AMR.