The annual World Health Assembly took place last week, the meeting of health minsters from 194 countries that serves as the decision-making body for the World Health Organization. In the week-long conclave, the representatives set policy on a number of global health issues—malnutrition, immunization, polio eradication, emergency response to outbreaks such as Ebola— and for the first time, the global crisis of antibiotic resistance.
It remains to be seen whether the actions taken by the assembly will make a difference, but that the delegates committed unanimously to tackling the issue is an advance from just a few years ago, when antibiotic resistance seemed an invisible problem.
The tone for the vote was set at the opening of the assembly, when WHO Director-General Dr. Margaret Chan told the delegates in her welcome speech: “This is a unique time in history where economic progress is actually increasing threats to health instead of reducing them… As the century progressed, more and more first- and second-line antimicrobials failed. The pipeline of replacement products ran dry, raising the spectre of a post-antibiotic era in which common infections will once again kill. A draft global action plan on antimicrobial resistance is on your agenda. I urge you to adopt it.”
The plan has five closely related components:
- “Improve awareness and understanding,” which the WHO said means including instruction on resistance in school curricula and in professional training for healthcare, veterinary and agricultural personnel;
- “Strengthen… surveillance and research” by rapidly gathering environmental and diagnostic data on resistant organisms and supporting studies of costs of resistance and alternatives to antibiotics;
- “Reduce the incidence of infection” by improving hygiene in healthcare and by increasing the use of vaccines to prevent infections;
- “Optimize the use of antimicrobial medicines” by reducing over-prescription and uncontrolled over-the-counter sales, and improving rapid-result diagnostic tests that make sure the correct drugs are prescribed;
- “Develop the economic case for sustainable investment,” persuading pharmaceutical companies to return to making antibiotics and guaranteeing that low-income countries will have adequate access to drugs.
Laudably—and, frankly, in contrast to the United States—the plan persistently emphasizes the need to curb antibiotic overuse in agriculture as well as in human medicine: “Reducing antimicrobial resistance will require the political will to adopt new policies, including controlling the use of antimicrobial medicines in human health and animal and food production.” (Emphasis WHO.)
By voting in the plan, the delegates also committed their countries to producing individual, national versions of the global plan by the time the assembly meets in 2017. In a table within the global plan, the WHO recommends specific actions that a government might take to support each of the objectives; for instance, for “Improve awareness,” include resistant bacteria on a national registry of reportable diseases, and for “Strengthen surveillance,” add antibiotic-sensitivity testing to any laboratory analyses of foodborne illnesses. Each of the national actions is matched by supportive ones that could be taken at the same time by the WHO and by other international health agencies such as the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (known by its acronym in French, OIE).
The possible hitch in these grand plans is the same as in the proposal to increase antibiotic production that I discussed over the weekend: Who pays for them? In documents from last winter, summing up action taken since the 2014 delegates’ vote in favor of coming up with the plan this year, WHO acknowledges that there is little room in its current budget for any line items addressing resistance. Itprojects that in its current budget cycle, which extends to 2016, it can break loose only $15 million. (For context, the White House’s 2016 budget asks for $1.2 billion to tackle resistance just in the United States.)
Without funding assistance, it is not clear how much countries can do—especially since some of the worst offenders on antibiotic overuse are emerging economies with little income to spare. Still, I think we can take it as a positive sign that health ministers from everywhere in the world acknowledged the seriousness of the problem. Now we just have to see whether they act.