People have a poor track record of preventing global disasters. But for antimicrobial resistance, an unlikely group of allies is making big promises. Last month, a massive group of business leaders and health officials gathered for one of the biggest events in the fight against antimicrobial resistance. Almost 350 parties showed up to pledge support for the AMR Challenge, a program whose goal is to make countries and corporations get serious about a major threat facing humanity: the gradual but catastrophic loss of drugs that can treat life-threatening infections, which leads to an estimated 700,000 deaths each year. By the standards of the public policy world, the New York event was an enormous success. Those executives and officials didnt just state their support, they made surprisingly detailed commitments. And the boldest moves came from a perhaps unlikely source: the business world. Dozens of hospital networks, both giant and small, pledged to reduce the prescriptions they write in-house, to keep from encouraging resistance. Huge retailers committed to tracking animal antibiotic use; Walmart, for instance, agreed to set guidelines for the suppliers that funnel meat to its more than 5,000 stores. Pharmaceutical manufacturers including Merck, one of the few US-based companies still making antibiotics, laid out a plan to invest more in basic research on new compounds. Fifty-five pharma and biotech companies promised to develop better rapid tests, which prevent unnecessary prescriptions, including Accelerate Diagnostics, based in Arizona, which committed a $100 million program. Two manufacturers of veterinary vaccines announced they would educate veterinarians on alternatives to using antibiotics in farm animals. At a time when global challenges can seem paralysing in their complexity, the New York convocation offers a ray of hope, an indication of how worldwide alliances can in fact take root. The AMR Challenge is the brainchild of staff at the US Centres for Disease Control and Prevention, who worked for 18 months to wrangle all those companies and entities into one room. In other settings, many of them might have considered each other competitors. But at least on this topic, they aligned themselves with a higher priority than profits at all costs. It should have happened a lot sooner. Three years ago, the United Nations held a landmark meeting to discuss antibiotic resistance. It was only the fourth time the UN had ever assembled to consider a health problem; the last such meeting had been over the international epidemic of Ebola in 2014. At the gathering, the UNs secretary general called antimicrobial resistance a fundamental long-term threat to human health, sustainable food production, and development, and the director-general of the World Health Organization urged that we are running out of time. At the end, representatives of all 193 states that make up the UN signed a resolution that committed their governments to developing national plans for reducing antibiotic overuse and misuse. But those words did not yield much action. So, officials at the CDC decided to step things up. Under the Obama administration, they had masterminded a meeting of health care and business leaders at the White House that produced hard commitments, along with a national action plan and an executive order. They figured that event could perhaps serve as a model for the rest of the world, says Michael Craig, the CDCs senior adviser for antibiotic resistance. We thought wed try to revisit the framework of the White House summit, in which people came ready to make commitments, but do it on a bigger scale. They got what they asked for. The commitments made at the September gathering reached across the spectrum of what causes antibiotic resistance, from cleaning dirty drinking water that transmits pathogens in communities, to preventing the infections occurring in long-term care facilities that prevent patients from going home and restricting the overmedication of the pets. The commitments also stretched across the planet, including a New York City operator of urgent care clinics and medical groups in India, Australia, and Tanzania. The range of the entities and companies underscores how complex a problem antibiotic resistance is. Its complexity is second only to climate change, says Dame Sally Davies, who spoke at the New York event and who has worked for years to draw attention to resistance as the outspoken chief medical officer of the United Kingdom. (Davies stepped down from that post on September 30 to become the first female master of Trinity College, Cambridge.) But that means theres room for every country to find a different way of tackling this. The challenge of course is the follow-through. The key thing is, what are the next steps; what will be the measures of accountability? says Matt Wellington, the antibiotics program director of US PIRG, a coalition of public-interest research groups, which committed to getting the six largest US restaurant chains to forgo meat raised with routine antibiotic use. To make this mean something, every one of them is going to have to commit to hard goals. Accountability is difficult when there are no regulations on the horizon and no hints of enforcement to come. In the US, the Trump administration is unlikely to crack down on antibiotic use. And looking globally, the countries that use antibiotics the most are in the developing world and have other priorities for national action. But theres a positive spin too. Overwhelmingly, the commitments made in the CDCs challenge represented commercial interests taking responsibility for their own actions: using antibiotics more conservatively, making them more carefully, relying more on vaccines to make them less necessary. Attacking antibiotic overuse through commerce has already produced results: The year after the Obama administration tightened its rules, sales of antibiotics for use in farm animals dropped significantly. The reason it worked is that consumers made it clear to those companies they were ready for change. After all, administrations come and go; farming, pharma and health care are here for the long haul. If they can choose to change practicesand even, as they did in New York, be eager to show off what theyve donethey may be more likely to stick with the changes for good.
Wired, 31 October 2019