World leaders have committed US$790m to fighting superbugs. These are infectious diseases that don’t respond to treatment using antibiotics – an essential defence against infections after surgery.
They are also essential in complex treatment programmes, such as chemotherapy. But antibiotics are being misused. They are often wrongly prescribed for viral diseases, such as the flu, and they are increasingly used in livestock to encourage growth. This abuse of antibiotics is leading to strains of bacteria that are resistant to all antibiotics. Without urgent action, it is estimated that antimicrobial resistance will result in 10m deaths annually by 2050.
The global commitment by all 193 members of the UN was not only timely but extraordinary. It was only the fourth time in the history of the organisation that the general assembly had met to discuss a health issue. While there has been a lot of excitement about the agreement, I can’t help feeling underwhelmed. First, the sum of money earmarked to tackle the problem is wholly inadequate. Second, the plan relies on domestic surveillance systems to identify new forms of resistance, even though these systems are substandard in many developing countries. Third, despite this agreement, there is scant incentive for pharmaceutical companies to produce new antibiotics.
Not nearly enough
The things the plan needs to succeed – better surveillance systems, new drugs, and awareness campaigns about the dangers of misusing antibiotics – will need enormous resources. The O’Neill review was commissioned by the UK government in 2014 to analyse the problem of antimicrobial resistance. Led by Jim O'Neill, an economist, the report estimated that it would cost at least US$40 billion to fix the problem. By comparison, US$790m is almost risible.
Both parties agree that money should be spent on better surveillance systems and sanitation in developing countries; better regulatory systems; public health awareness campaigns; better pay for infectious disease doctors; and technological improvements, such as innovative diagnostic equipment and money to fund the development of vaccines.
While the O'Neill and UN plans broadly agree on the interventions needed, the UN allocated far less money and did not include proposals on incentives for pharmaceuticals companies. The O'Neill report proposed fines for pharmaceuticals firms that don’t cooperate with governments in order to produce new antibiotics. Also, the O'Neill report proposed that countries set targets to curb the over-use of antibiotics.
The global surveillance system relies on countries sharing information on cases of suspected antibiotic resistance and rates of domestic antibiotics use with the World Health Organisation (WHO) which then monitors the global situation and identifies new global trends of resistance as well as geographical variations. A good surveillance system helps the WHO to regularly update diagnostic and treatment guidelines based on strong scientific evidence.