September 23, 2016

Strength in numbers: The value of a global coalition approach to combating antimicrobial resistance

Written by Jaak Peeters, Jens Bitsch Norhave, Jami Taylor, Adrian Thomas

Recent years have seen a tremendous increase in attention to the threat of antimicrobial resistance (AMR).  That attention has generated a welcome stream of multi-government and multi-stakeholder declarations acknowledging the need to bolster defenses against the risks AMR pose.  Among these are the US-EU Summit Declaration on AMR1 (2009), the Jaipur Declaration (2011), the Chennai Declaration2 (2013), the Berlin Declaration (2015), and the so-called “Davos” or “Industry Declaration”3 (2016).  Several of these have given rise to important new initiatives: The US-EU Summit Declaration, for example, launched the US-EU Transatlantic Task Force on Antimicrobial Resistance (TATFAR)4 to improve cooperation between the US and EU in areas of antibiotic stewardship, prevention of healthcare acquired infections, and innovation.

These regional and bilateral efforts have proven important steps forward in the fight against AMR.  The scope of their respective actions is and has been limited, however.

Last year, more sweeping recognition of the AMR challenge came through in the World Health Assembly (WHA) Resolution on this topic5.  The Resolution reflects “a global consensus” on the risks AMR presents, and emphasizes the importance of urgent action toward globally coordinated AMR control.

The United Nations High Level Meeting on Antimicrobial Resistance, held in September 2016, marks a pivotal moment in this trajectory, and an important opportunity for relevant actors to organize further, on a global basis.  Recent proposals to this end include the establishment of a global, multi-stakeholder coalition to advance the fight against AMR.  We applaud the idea and encourage its realization.  As we and others have argued, success in the fight against AMR will necessarily require a holistic approach.  A coalition that is truly inclusive of stakeholders worldwide can help to chart the course toward comprehensive solutions to the AMR crisis.

The value of a global coalition to drive action against AMR lies in at least three dimensions: (1) improved global coordination and policy coherence; (2) knowledge management, including best-practice sharing; and (3) mutual accountability.

  1. Improved coordination and policy coherence6

Fundamentally, a coalition serves the purpose of facilitating improved coordination among its members.  In the case of AMR, improved global coordination is not only desirable, it is critical.  The WHA Resolution on AMR calls upon all countries to establish and execute national action plans based on the Global Action Plan on AMR.7  In recent months, government leaders in China, Japan, Vietnam, Austria and elsewhere have unveiled national plans to bolster the AMR fight within their respective borders.  These add to the nearly two dozen other countries that have released national plans to date.

As national plans on AMR continue to proliferate, a coalition structure can help to ensure policy coherence across all of them.  Furthermore, the inclusion of a diverse range of members in the coalition—including private-sector corporations; foundations, think tanks and universities; and civil society organizations8—can help enhance national plans as they are constructed and presented.

As national plans move toward execution, a coalition structure can help to drive across-the-board success.  Knowledge management, including best-practice sharing, is a core coalition function and will be vital to the achievement of success at scale.

  1. Knowledge management, including best practice sharing

The work of a global AMR coalition can include AMR knowledge management, including best-practice sharing.  Such work could build upon the library of AMR information that WHO has begun to assemble, adding to it valuable case studies in AMR control.9

Importantly, best practices can emerge from lesser-known initiatives that may present potential for replication and scaling.  The Hospital Pharmacy Initiative10 in the UK from 2003 to 2006, for example, produced clinical, economic and other benefits vis-à-vis AMR control that may merit attention from global leaders.  A coalition context enables global leaders to access such examples in an efficient manner.

In addition, knowledge management within a coalition context can enable key learnings to surface from one sector for the benefit of all sectors.  From private industry, for example, the Novartis Malaria Initiative has worked in innovative ways to address risks of antimalarial drug resistance.   At Johnson & Johnson, our own experience in developing Sirturo™ for multidrug-resistant tuberculosis (MDR-TB) offers important lessons worthy of sharing and study in a global coalition setting.

Along these lines, the sharing of ideas and models for unlocking greater investment in AMR-related R&D should be a key priority for coalition members.  Dissemination of data11 which identifies areas of greatest public health need in AMR can help shape incentive models and investment decisions.  Dissemination of best practices in stewardship can help to ensure the efficacy of antibiotics currently available, and those that may become available in the future.

Of course, the sharing of useful information among a broad set of stakeholders is of relatively little value unless that information translates into action.  A coalition structure helps to ensure this translation of knowledge to action through the accountability it intrinsically imposes.  This accountability is critical to securing the long-term legitimacy of national AMR plans, and to securing the long-term success of the world’s fight against AMR.

  1. Mutual accountability12

Since the WHO policy package to combat AMR was first unveiled five years ago, its architects have pressed for a global accountability framework13 to guide progress.  To date, accountability measures and mechanisms have remained elusive.  As AMR-related threats and costs rise, however, a lack of mutual accountability across nations will prove untenable.  A global coalition for AMR, established in the near term, can lay the groundwork for accountability on AMR over the long term.

Conclusion

As the world gathers at the UN High Level Meeting on AMR, and as ministers and heads of state prepare to deliver their respective commitments in this area, we encourage those commitments to include active participation in global coalition efforts against AMR-related threats.  A coalition structure and the benefits it offers—improved coordination and policy coherence, knowledge management, and accountability—can make possible the institution of AMR control efforts at the scale necessary for ultimate success.


1 See http://www.cdc.gov/drugresistance/tatfar/about.html2 Ghafur, A., et al. “The Chennai Declaration: a roadmap to tackle the challenge of antimicrobial resistance.” Indian journal of cancer 50.1 (2013): 71.

3 See http://amr-review.org/sites/default/files/Declaration_of_Support_for_Combating_AMR_Jan_2016.pdf

4 See http://www.cdc.gov/drugresistance/tatfar/.

5 WHA 68.7

6 Santos-Paulino, Amelia U. Enhancing development through policy coherence. United Nations University, 2010.

7 See http://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_eng.pdf

8 An AMR coalition can include global networks working against AMR, e.g., The World Alliance Against Antibiotic Resistance, a stewardship-focused group that includes 145 medical societies; the Antibiotic Resistance Coalition, a collection of civil society advocates working in the AMR space; and the Antimalarial Resistance Network.

9 http://www.who.int/drugresistance/events/UNGA-meeting-amr-sept2016/en/

10 Cooke, Jonathan, et al. “Improving practice—working together to improve the use of antimicrobials.” Journal of antimicrobial chemotherapy 60.4 (2007): 712-714.

11 Such as data collected by the Center for Disease Dynamics, Economics and Policy (CDDEP).  See http://www.cddep.org/

12 Droop, James, Paul Isenman, and Baki Mlalazi. “Paris Declaration on Aid Effectiveness: Study of Existing Mechanisms to Promote Mutual Accountability (MA) between Donors and Partner Countries at the International Level: A Study Report.” Oxford, United Kingdom: Oxford Policy Management. Retrieved from http://www. oecd. org/dataoecd/47/33/43163465. pdf Accessed 22 (2008): 12.

13 See http://www.scielosp.org/pdf/bwho/v89n5/v89n5a16.pdf