Ensuring progress on sustainable access to effective antibiotics at the 2024 UN General Assembly: a target-based approach.

Publisher: Elsevier Country of Publication: England NLM ID: 2985213R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1474-547X (Electronic) Linking ISSN: 01406736 NLM ISO Abbreviation: Lancet Subsets: MEDLINE

Publication: 2004- : London : Elsevier
Original Publication: London : J. Onwhyn

Anti-Bacterial Agents*/therapeutic use ; Global Health* ; United Nations*; Humans ; Health Services Accessibility ; Drug Resistance, Microbial

Rising antimicrobial resistance (AMR) is a global health crisis for countries of all economic levels, alongside the broader challenge of access to antibiotics. As a result, development goals for child survival, healthy ageing, poverty reduction, and food security are at risk. Preserving antimicrobial effectiveness, a global public good, requires political will, targets, accountability frameworks, and funding. The upcoming second high-level meeting on AMR at the UN General Assembly (UNGA) in September, 2024, is evidence of political interest in addressing the problem of AMR, but action on targets, accountability, and funding, absent from the 2016 UNGA resolution, is needed. We propose ambitious yet achievable global targets for 2030 (relative to a prepandemic 2019 baseline): a 10% reduction in mortality from AMR; a 20% reduction in inappropriate human antibiotic use; and a 30% reduction in inappropriate animal antibiotic use. Given national variation in current levels of antibiotic use, these goals (termed the 10-20-30 by 2030) should be met within a framework of universal access to effective antibiotics. The WHO Access, Watch, Reserve (AWARE) system can be used to define, monitor, and evaluate appropriate levels of antibiotic use and access. Some countries should increase access to narrow-spectrum, safe, and affordable (Access) antibiotics, whereas others should discourage the inappropriate use of broader-spectrum (Watch) and last-resort (Reserve) antibiotics; AWARE targets should use a risk-based, burden-adjusted approach. Improved infection prevention and control, access to clean water and sanitation, and vaccination coverage can offset the selection effects of increased antibiotic use in low-income settings. To ensure accountability and global scientific guidance and consensus, we call for the establishment of the Independent Panel on Antimicrobial Access and Resistance and the support of leaders from low-income and middle-income countries.
Competing Interests: Declaration of interests A meeting held to coordinate this Series paper was supported by the Bill & Melinda Gates Foundation (INV-055356 to RL) and the Africa Centres for Disease Control and Prevention (to all authors). Neither funder had any role in the design, writing, or decision to submit this paper for publication. RL has received grant funding from the National Science Foundation (CCF1918628). WA is an employee of the Africa Centres for Disease Control and Prevention but authored this Series paper in her individual capacity as an expert. JSW has received consulting fees from Mars Veterinary Health, VetMedux, and the Veterinary Information Network; has received payment for lectures from Merck Canada, Vetoquinol, Hills Pet Nutrition, Royal Canin, Zoetis, the Canadian Veterinary Medical Association, and the Ontario Dental Association; and has received payment for expert testimony from the British Columbia Veterinary Medical Association. MS has received academic grant funding from the Global Antibiotic Research and Development Partnership (GARDP) for the design and conduct of clinical studies in the GARDP programme and the European and Developing Countries Clinical Trials Partnership (the NeoSep1 study); had an unpaid leadership position on the WHO Essential Medicine List Antibiotics Working Group; and has been the chief investigator of clinical trials in children, where generic antibiotics have been donated by Sandoz, InfectoPharm, and Shionogi. KBP has received grant funding from the Wellcome Trust, Ineos Oxford Institute for Antimicrobial Resistance Research, Coalition for Epidemic Preparedness and Innovations, UK Health Security Agency, National Institute for Health and Care Research, Medical Research Foundation, Waltham Foundation, and EU-H2020 IMI-2 (jointly funded by IMI-2 and the European Federation of Pharmaceutical Industries and Associations). AC, KBP, and MS also report funding as part of the ADILA Project sponsored by the Wellcome Trust (222051/Z/20/Z). MMe receives funding support from the Wellcome Trust (226690/Z/22/Z). All other authors declare no competing interests.
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0 (Anti-Bacterial Agents)

Date Created: 20240526 Date Completed: 20240608 Latest Revision: 20240711

20240711

10.1016/S0140-6736(24)01019-5

38797179