The 2024 political declaration on antimicrobial resistance needs bold targets

Antimicrobial resistance (AMR) poses a major threat to human health and economies. In 2019, there were 4.95 million global deaths associated with bacterial AMR, including 1.27 million deaths directly attributable to it, with the Africa Region bearing the highest mortality burden.1 The economic and health burden is far reaching—a recent study showed that, at the current level of action, overall healthcare systems are expected to spend up to around US$412 billion per year due to bacterial AMR and there would be an average loss of 1.8 years of life expectancy globally.2 The United Nations 2024 Political Declaration of the High-level Meeting on Antimicrobial Resistance, due to be adopted in September 2024, needs bold targets, measurable indicators, and sufficient funding to tackle AMR across human, animal, and environment sectors through a One Health approach.

Numerous global commitments have been made in response to AMR threats. These include a global action plan and resolutions from the World Health Assembly which were endorsed by the political declaration of the high-level meeting of the 2016 UN General Assembly on AMR3 and at the 77th World Health Assembly. These commitments called for accelerating national and global responses.4

Despite this, progress has been slow. Although 178 WHO member states had developed multi-sectoral national action plans, the 2022 self assessment survey shows that only 27% of member states had implemented their plans effectively. While 11% had allocated national budgets for implementation, others relied on fragmented donor funding. There are no targets and indicators to track progress in the global action plan and the 2016 political declaration, and only some in national action plans. Additionally, the strategic objectives and interventions of these plans are not aligned with the global action plan.5678 This means that commitments for responding to AMR are not guided by targets and funding support. In contrast, work against HIV/AIDS demonstrates that global and national targets, supported by adequate funding, are effective for driving implementation and achieving measurable outcomes.910

At the UN high-level meeting on AMR in September 2024, a political declaration will be adopted to accelerate implementation to tackle challenges posed by AMR. We have reviewed the zero draft of the declaration11 and the first draft after negotiation with its proposed 47 substantive commitments with nine targets and indicators.12 However, substantial gaps remain—important commitments lack corresponding targets, including those for international funding sources; financing for research and development; infection prevention and control; water, sanitation, and hygiene; and vaccination.

There is no target or indicator on tackling AMR in the environmental sector despite waste and environmental transmission being important and overlooked drivers of AMR.13 Effective regulation of waste discharge into the environment is essential to prevent the dissemination of AMR pathogens. Increased public awareness and community engagement are essential to drive behaviour change.

We propose two additional indicators to the ongoing negotiation. Firstly, by 2030 all countries should have established a plan for stepwise regulation of antimicrobial waste discharge to the environment, and 80% of the public should be aware that use of antibiotics contributes to resistance. Secondly, we need standardisation of measurement to ensure temporal and cross-country comparisons.

We support the proposal to establish an independent panel on evidence for action against AMR by 2025 to identify gaps and provide member states with regular guidance on the sciences and cross sectoral evidence. The panel can guide evidence based policy options for global AMR responses.

Tackling antimicrobial resistance at the human, animal, and environmental interface requires a One Health approach with collaborative, responsive, and accountable governance at national and global levels. Governance is what translates political commitments into tangible outcomes. This means we need national action plans, developed through multi-sectoral engagement and co-creation, with national targets and indicators aligned with global commitments. High level political commitment, the incentives for competition versus collaboration between partners, and a common understanding and shared goals across actors about AMR are three factors that contribute to successful multi-sectoral governance.14

Substantial global and domestic funding, along with strengthened implementation capacity at the country level, are essential for translating the 2024 political declaration into reality. A UN high-level meeting on AMR is proposed to be convened again in 2029 in New York. By then, we need to have made crucial progress.