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Speaking at the high-level meeting on antimicrobial resistance (AMR), Sunita Narain, director-general, Centre for Science and Environment, a Delhi-based think tank, highlighted the need to rethink and reinvent the way agriculture is done and environment is managed in order to minimise the impact of the silent pandemic of AMR, particularly in low- and middle-income countries (LMIC).
Narain was speaking at the second panel of the meeting, which concluded on September 26, 2024 at the United Nations General Assembly (UNGA) in New York. The theme of the meeting was ‘investing in the present and securing our future together: accelerating multisectoral global, regional and national actions to address antimicrobial resistance’.
The panel was aimed at understanding the role of integrated surveillance, capacity-building, sustainable resources, financing and investment in addressing AMR in human health, animal health and welfare, agrifood systems and protecting the environment.
She stressed that priorities for developing world with respect to AMR is different as this part of the world cannot afford the cost of treatment if live-saving medicines like antibiotics become ineffective, particularly when access to healthcare for all is a concern. It is also true that the developing world cannot afford the cost of cleaning up after polluting.
The key priorities for the developing world, she said, lie in conserving antimicrobials for human health (conservation agenda), focusing on livelihood and development (development agenda), ensuring circularity of waste that is AMR-safe (environmental agenda) and most importantly, ensuring that disease is prevented by measures like biosecurity, good animal husbandry, use of alternatives (prevention agenda).
“The prevention agenda is most important because for us, affordability is important and affordability only comes when cost of action is low and inclusive,” said Narain, highlighting India's initiative of using ethnoveterinary medicines to effectively treat diseases in Indian dairy sector at low cost and less antibiotic dependence.
In her intervention, Narain also brought together larger agendas like access to clean water, food agenda for nutrition and climate crisis, which all link to the way food is grown and environment is managed.
Narain expressed happiness that the political agenda recognises these issues but also highlighted that it is time to move from declaration to action. “The political declaration that the governments have come up with is a huge step ahead. It shows political leadership and global leadership for an issue that will need global cooperation for action,” she stated.
Nobody is safe until everybody is safe. This is what underpins the political declaration that we have been part of and now need to act on it.
Sunita Narain
In addition, this panel also discussed key issues such as surveillance of AMR and antimicrobial use, access to old and new antimicrobials, the existing fragile pipeline of new antibiotics and the AMR linkages in small animals. The panelists reflected on what needs to be done to manage these issues and how the political declaration serves as a stepping stone to these suggested solutions.
Overall emphasis was laid on importance of money, political will, collaboration, prevention of diseases, new antibiotic resource and development, ensuring access of old and new antimicrobials as well as data sharing, transparency and monitoring.
Prior to this, panel 1 of this high-level meeting focused on addressing the urgent global risk of antimicrobial resistance across the human, animal, plant and environmental sectors through equity, access, building awareness and innovation.
Panelists reflected on country-level initiatives to contain AMR, inter-sectoral coordination mechanisms not only among human, animal and environment sectors, but also among government agencies responsible for trade, research, development, cooperation and preparedness.
Other aspects highlighted were need for incentivising and accelerating the pipeline of new antibiotics with help of greater leadership and collaboration, preventing infections in human health by scaling up existing prevention mechanisms like vaccination, WASH, IPC measures, addressing AMR in agrifood systems in low resource settings through preventive measures like vaccination, biosecurity, use of herbal alternatives, adherence to environmental guidelines for managing manufacturing waste.
There was recognition of the fact that identifying national goals and setting targets for achieving them is the most important effective way to leverage resources and accelerate action on the ground, and hoped for more progress in this direction in the coming years.