A GLOBAL and local public health threat, antimicrobial resistance is also a development challenge. AMR occurs when bacteria, parasites, viruses and fungi become resistant to antimicrobial medicines that are used to treat infections. As a result, antibiotics become ineffective and infections increasingly difficult to treat.

AMR in Pakistan is driven by the indiscriminate use of antimicrobials in humans and animals. One study shows an increase of 65 per cent from 2000 and 2010 in the use of antibiotics. The Covid pandemic also saw an upsurge in the use of antimicrobial drugs for treating related syndromes.

AMR caused at least 1.27 million deaths globally in 2019. It has been on the global policy agenda since 2009. However, efforts to accelerate action on AMR got underway in earnest with the publication of the WHO-led global action plans in 2015. In line with the global action plan, states framed their own national action plans. Sadly, progress on the implementation of these plans has been glacial.

Implementation efforts were further set back by the pandemic, which not only diluted the focus on AMR but also diverted scarce health funds to the Covid response in low-income countries.

Antimicrobial resistance caused at least 1.27m deaths globally in 2019.

Yet, in recent years, a series of policy actions have brought back the focus on AMR, as observable in AMR figuring in the G7 and G20 summits. As part of the renewed focus, a UN General Assembly high-level meeting on AMR is being convened on Sept 24, with a view to speeding up coordinated and concerted AMR-related work. In the run-up to the meeting, a zero draft was prepared in May 2024, which has been in circulation for member states’ response.

The political declaration, as embodied in the zero draft, notes with grave concern that AMR could incur a trillion dollars in additional healthcare costs by 2050; GDP losses could range between $1tr to $3.4tr by 2030, with productivity losses as high as $443 billion. More crucially, treating resistant bacterial infections alone could cost up to $412bn annually. These economic and health costs necessitate urgent and sustained action by states.

In view of these multiple threats, the political declaration seeks to scale up national and global actions in proportion to the increase in the AMR threat. The overarching target set out in the zero draft is a reduction in global deaths by 10pc by 2030. This target is to be achieved by stimulating a multifaceted strategy and response.

Furthermore, the political declaration, while acknowledging that 178 countries have developed multi-sectoral national action plans, notes that only 52pc of countries have functioning multi-sectoral coordinating mechanisms. The declaration also expresses the ambition of revising and updating national action plans through the prism of the ‘one health and whole of society’ approach. These updated national plans should be framed in accordance with national contexts.

The declaration also enjoins upon the member states to put in place prioritised, fully costed and funded national plans. Currently, only 11pc of the member states have produced these plans, with dedicated financing earmarked in national budgets. The target is for 60pc of the countries to have fully costed and financed plans by 2030.

The declaration puts a lot of stress on infection prevention and control, as well as an antimicrobial stewardship infrastructure to be raised and maintained with adequate funding and a supportive legislative and policy framework. Vaccination, water and sanitation and hygiene form an essential part of the multi-track response.

The declaration acknowledges the lack of regulation of over-the-counter sales of antibiotics, over-prescription of anti-

biotics as well as lack of evidence-

based standard treatment gui-delines and af­­f­ordable diagnostic tests as the main drivers of AMR. Given the multi-strand nature of the AMR crisis, reversing the situation would require a strong and sustained political commitment at the highest level. The high-level UN meeting on AMR offers an ideal opportunity to engage actively and reaffirm Pakistan’s political commitment to the local and global effort to tackle the threat of AMR head-on. As Pakistan’s national action plan on AMR is being revised and reframed, the political leadership should prioritise the AMR agenda and set aside the required resources for the revised plan.

More importantly, by sending a high-powered delegation to the UN meeting and signing on all commitments enshrined in the zero draft, Pakistan’s senior leadership would be signalling its serious intent to confront AMR as a top national and global priority.

The writer, a public health and development consultant, is the author of Patient Pakistan: Reforming and Fixing Healthcare for All in the 21st Century.

drarifazad@gmail.com

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Published in Dawn, July 27th, 2024