Conference Report (7 Dec, 2017):
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On 21 September 2016, the UN General Assembly (UNGA) convened a high-level meeting of Heads of States and national delegations to discuss an issue of increasing concern to national public health authorities around the world:  the rise of antimicrobial resistance (AMR).  As an indication of the urgency and magnitude of the problem, this was only the fourth time that a health topic had been raised for discussion by the General Assembly.  A draft political declaration was issued in the wake of the meeting endorsing the Global Action Plan on Antimicrobial Resistance formulated by the World Health Organization in collaboration with the UN Food and Agriculture Organization and the World Organization for Animal Health.

The scale of the threat posed by AMR, and its current and potential toll in terms of deaths, human suffering and economic loss is immense.  Current conservative estimates are that 700,000 people die from resistant infections each year.  Of these, 200,000 people die from tuberculosis alone, as commonly-used antibiotics begin to lose to their efficacy because of AMR.  Beyond the direct cost in human lives, it is estimated that more than 2 million infections a year are caused by resistant bacteria, which imposes an additional burden of US$20 billion on the US health care system alone.  The human cost in countries that cannot afford such extra spending on healthcare is incalculable.  Inappropriate use of antibiotics in livestock farming have accelerated the pace of the development of AMR, at once reducing the efficacy of critical antibiotics and leaking residual drugs into the environment and the food chain.  It is estimated that over 70% by weight of the most important antibiotics are used on animals – and mostly for purposes other than for treating sick animals.  The grim projection is that by 2050, the direct toll of human lives lost to AMR could rise to 10 million with a corresponding cumulative cost to global economic output of US$100 trillion (all data from O’Neill et al, Tackling Drug-Resistant Infections Globally:  Final Report and Recommendations, 2016:  The Wellcome Trust / HM Government).

Themes: This conference sets out in the first session (‘The Challenge’) to present a survey of the present global scale and impact of AMR, and the implications for the future in human, clinical and economic costs if current trends in AMR is not reversed or contained. Current international efforts in building a concerted global response towards the containment of AMR will be examined, with especially reference to efforts by international agencies such as the World Health Organization.

The conference will then address next in its second session (‘Emergent Threats – The Experience’) specific shortcomings and problem areas such as public and professional awareness; in public and environmental health (public sanitation and access to safe water); and in clinical practice in both developed and developing countries (short or inappropriate courses of antibiotics, resistant nosocomial infections in hospital settings, the problem of counterfeit antibiotics). We also look into recent developments in relevant technologies, such as in pathogen genomics.

In the third session (‘The Community Context’) the conference will address specific situations in which AMR is already a grave and urgent threat (tuberculosis, malaria, MRSA and other resistant nosocomial infections), and examine accounts of current public health responses to the challenges of AMR for these specific situations, and consider recommendations for the future management of these conditions (including the incentivization of research, the development of new antibiotics and the prioritizing of resources to public health efforts at the control of these infections).  The legal and ethical implications of some public health challenges are examined.  The inappropriate use of antibiotics in animal agriculture is considered, as well as on its impact on the environment and the food chain, as well as recommended responses.

In the final and fourth session (‘Making It Work’), the conference will focus on public health and national responses recommended by expert bodies such as the WHO in its global action plan on AMR, and the O’Neill Report.  How much will it take to stem the tide of AMR?  What will be the corresponding financial cost of failure?  What should the relative distribution of burdens and responsibilities between better-off and poorer nations, and how can communities in the latter be helped?