A Political Declaration on AMR: What’s next?

Daniela Corno  

‘At the UN World leaders are negotiating the biggest health issue you’ve never heard of.‘ That’s the headline of GSL Director Mathieu Poirier’s latest piece in The Conversation. And he’s right. The recent high-level meeting held in New York on September 26 has been a key moment for setting the global agenda to tackle one of the biggest, leading global health threats, antimicrobial resistance for AMR. My name is Daniela Corno and welcome to another episode of unpacking AMR. 

The latest projections on AMR estimate that between 2025 and 2050, 39.1 million people will die from AMR if more is not done. Despite calls for an international legal instrument to address it, the latest efforts to adopt a pandemic treaty have not resulted in agreement on how to manage this growing global health threat. But this year, at the high-level meeting, a major political declaration was approved committing world leaders to a set of clear targets and actions.

Two of our team members, Director of Global Engagement, Julia Bishop, and Global Strategy Lab Director Mathieu Poirier, were able to attend this historical meeting and witnessed this declaration firsthand. But now we’re left with some questions. What happens next? Is this political commitment enough? Are there gaps in the plan, or is more action needed?

In today’s episode, we get to hear from them. The wins, the losses, what was done well and what might have been done better at the UN General Assembly high level meeting on AMR. So what actually happens at a high-level meeting? We often hear this term being thrown around, but what does it mean?  

Julia Bishop 

High-level meeting means high level individuals that are taking part in those proceedings, heads of state, ministers are all in the room, and each country has an opportunity to make an intervention, to share what their country feels about the political declaration and kind of their priorities around AMR. So, it was a fantastic opportunity to just be present in the room and in the space, and also to hear what countries were prioritizing, because they’re only given three minutes to speak.  

Daniela Corno 

It’s interesting and a little surprising to think that such a major declaration could be adopted so quickly at the meeting. I imagine there must have been a huge amount of groundwork behind the scenes to make that happen.  

Mathieu Poirier 

Yeah, it’s kind of funny being there when the actual political declaration was adopted, because there was a panel of five very high level speakers who gave some rather brief remarks about why this was an important moment in the history of AMR, and then it was immediately adopted, probably within the first 15 minutes, and that was by design, but it’s because so much work had gone into the negotiation design behind the scenes for months upon months, well before the the high level leaders were brought together for this meeting. So, it just goes to show that this has been a long time in the making.

That there was a lot of disagreements that had to be overcome, and we found many points of agreement and cooperation that we can really build on moving forward, and that was all done in a long series of meetings over the months before the actual high-level declaration was adopted.  

Daniela Corno 

In the months leading up, GSL’s AMR Policy Accelerator has been doing a lot of work to advise the conversation surrounding this meeting. In April 2024, a group of global health researchers, policy makers and civil society representatives came together in a meeting at the Bellagio Center in Italy. In this meeting, they developed a proposal for unifying goals for AMR. These goals aim to:

1. One, unite perspectives from all countries and sectors into one clear, memorable idea that’s easy to communicate;
2. two, provide a framework that can be used to track global progress and help build a roadmap with specific action driven goals for each sector, and;
3. three provide leaders like heads of government and ministers with tools to better communicate with citizens and the media about why we need to collectively act on AMR.  

Mathieu Poirier 

So, we as a lab were really hoping again that there would be two main things that would be highlighted in this declaration, and we were hoping there would be a politically oriented unifying goal that would really unite countries’ efforts. We hope that it would be a barometer for global progress across all countries and also all sectors, that being human, animal, agricultural, environmental sectors, and uniting these usually technical perspectives into a concept that’s easily communicated, that gives moments of success that politicians can point to, and it can be usable by heads of state. And I think unfortunately, we got some really high quality scientific targets. And. But we didn’t necessarily get that high level political unifying goal in this declaration. That’s not to say it won’t come in future meetings, but there wasn’t necessarily an easily communicated, politically oriented target that we were hoping for.  

Daniela Corno 

Unlike other serious global challenges requiring ongoing, coordinated global action, unifying goals have yet to be identified to address AMR. Without global goals to rally public and political support, past efforts to address AMR have lacked the necessary level of ambition and coordination needed to create meaningful change. Until now, AMR has taken a complex technical approach to goal setting, but unfortunately, this fails to properly underline the urgency of the problem to politicians and the public.  

Julia Bishop 

I think Mathieu has captured the unifying goals piece and kind of the importance of that, and it is, I would say, disappointing that that wasn’t in the declaration itself, but I think there’s still space to advocate for unifying goals on AMR outside of the political declaration, so I don’t think it’s a lost cause, and certainly hearing people, including Dame Sally Davies, talk about the need for a Southern Star or a North Star, depending on where your celestial navigation leads you, is still really, really important.  

Daniela Corno 

One of the priorities the AMR Policy Accelerator has been advocating for leading up to the high-level meeting was the push for a scientific panel, an independent body to guide evidence-based action on AMR. Its inclusion in the declaration felt like a huge step forward.  

Julia Bishop 

The second thing that we hope to see in the declaration, we’re very pleased to see there was the the establishment of an independent panel. I think the fact that there was a little bit of detail also provided to how it would be established, what the timeline would be, was helpful.  

Mathieu Poirier 

We need to establish an independent panel for evidence against AMR by the end of 2025 and when it comes to establishing an international scientific panel like this, that’s light speed, which leaves us very little time to have a broad consultation process for the Quadripartite to lead its establishment, to understand what its design principles will be, and as the AMR Policy Accelerator, we’re hoping that we can inform that process to allow it to be essentially a global public good, an institution that benefits low and middle income countries, marginalized populations, people who lack access to effective antimicrobials. And to do that, we think that it’s first of all going to be a cost effective evidence synthesis body that will benefit all countries, regardless of whether it they put funding into it or are in charge of directing its priorities. It will hopefully identify evidence-based interventions to address health inequities specifically, but inequities in access and even meeting alone is going to encourage international collaboration and raise the profile of AMR on the global scale, and hopefully bring civil society into that process as well.  

Daniela Corno 

Now that the declaration is in place, we wanted to dive into the aspects that both Julia and Mathieu felt really stood out. What were some of the wins in the final document?  

Mathieu Poirier 

I think one of the big positives was the framing of the declaration itself, which was one health focused and also highlighted access and prevention, which is definitely the way that we think about addressing AMR with the Global Strategy Lab, highlighting the fact that water, sanitation, hygiene can prevent more than 750,000 deaths every year, the need for equitable and timely access to effective antimicrobials, diagnostics and the need for more vaccine coverage, Both in humans and animals, and that prevention and access focus, I think, is the thing that is going to actually make this into an issue that we can cooperate on globally. Because it was just about conservation, limiting access, we’re never going to get there. So, I really appreciated that overall framing.  

Julia Bishop 

I think another big positive is just the fact that it was agreed to in the first place, frankly, because there’s a lot of geopolitical tensions when it comes to global health, and we’re seeing this play out with the pandemic treaty. And just to have a document that all the countries came together and agreed to and that has some really important guidance on the path forward, I think, is an achievement in and of itself. I think the fact that there are targets, maybe they’re not as ambitious as we would have liked, maybe there’s not as many as we would have liked.

There’s no sort of quantifiable targets in the animal health sector and the environment sector. But the fact that there are some targets in there distinguishes it from the 2016 political declaration and the number, the sheer number of commitments, maybe that’s both a positive and maybe a little bit of a negative, in the sense of, a negative, in the sense of, I don’t know how they’re going to be able to achieve all of that, but if you look back at the 2016 political declaration, there was only five commitments made in that declaration, and there were no targets. So to have some targets and to have a much broader array of commitments, I think, is. Demonstration of progress and some form of sort of global unity and agreeing to the to the declaration. 

Daniela Corno 

It’s true, despite some of the challenges, there were meaningful victories in this declaration that our team could appreciate. The declarations focus on a One Health approach, encompassing human, animal and environmental health was a big win. Aligning closely with the work our policy accelerator does, and having multiple countries come together to approve a document that includes concrete targets, even if not as ambitious as hoped, is an accomplishment in itself for human health.

The declaration aims for at least 70% of antibiotics used globally to come from the WHO Access Group. These are antibiotics that are generally safer and less likely to drive AMR.

In agriculture and animal health, it commits to significantly reduce Antimicrobial Use in agri-food systems by the year 2030. The plan includes funding and prioritizing infection prevention measures while simultaneously promoting responsible, evidence-based use of antibiotics in animal health.

The declaration also addresses the impact that AMR has on the environment, emphasizing action towards pollution caused by excessive discharge of antimicrobials in the environment.

So, overall, this declaration gives us some important commitments across human, animal and environmental health, but there’s always more that can be done.  

Julia Bishop 

I think, from my perspective, one of the things that isn’t in the declaration, apart from unifying goals is a strong financial commitment. And I think that that’s something that is also been highlighted amongst other stakeholders who work in this field. But the the financial target of 100 million towards National Action Plans, and to have 60% of countries have financed national action plans is just completely, completely insufficient. The World Bank estimates many billions of dollars would be required annually in order to be able to really make progress on this front. So, 100 million is really a drop in the ocean. So I think that that’s something that that is really missing. And then, as I alluded to earlier, having targets around animal health and the environment is also something that that’s that’s absent.  

Daniela Corno 

It’s always interesting to reflect on how these global processes evolve, especially when initial drafts raise expectations and the final outcomes can feel a bit different the sense of wins, but also that more can be done is tangible with this current declaration.  

Julia Bishop 

I think the general sentiment was one of happiness that it was agreed to, as we’ve kind of discussed, but also a feeling that it wasn’t necessarily ambitious enough, and that we needed to calibrate our expectations a little bit. I think that when the earlier drafts of the political declaration were released, there was quite a high level of of expectation raised because the earlier drafts of the declaration were more ambitious and a little bit more far reaching, and pushed countries a little bit further, and then as we saw the process play out over the course of the summer months, it became a little bit less ambitious.

And that’s understandable, and I think probably expected, for those who have gone through a process like this before, but for those of us who this was the first time, kind of seeing the whole process play out, it did seem like the end point wasn’t quite as ambitious as the starting point, but I think a general sense that we’re happy that it’s there. There are some really positive things that come out of it. It gives some really clear guidance as to what the priority should be. And now it’s up to civil society and other stakeholders, as well as, of course, governments and policy makers to move the declaration through to implementation and to make sure that the promises aren’t just promises, but that there’s actually action that comes behind it.  

Daniela Corno 

Absolutely, it feels like this declaration is just the beginning of a longer journey, one where we need to keep our eyes on the big picture as these incremental steps take hold, even if this declaration didn’t reach the heights we might have initially hoped for, it set a foundation that civil society researchers, policy makers and governments can build on.  

Mathieu Poirier 

I couldn’t agree more that the political declaration was never going to be the be all, end, all of how we address AMR. It was always one step in the process. But for me, what really matters is that we have increasingly institutions in place that can deal with this issue on a more sustainable basis. So, from even the academic end, having research, big research institutions that are focused on generating evidence for AMR, we saw the gram study at the Institute for Health Metrics and Evaluation, putting out global estimates for the burden of disease of AMR that allowed us to understand that this is also a global equity issue. We have institutions that are focused on bringing new technologies to market and out to patients that need it. So, we have all of these pieces coming together, and while none will solve AMR in and of themselves, we are, I think, making progress in creating an ecosystem of groups of voices, of processes that will soon start to address the issue of AMR on a more sustainable basis in the decades to come.  

Daniela Corno 

But in order to see this declaration come into effect, we also need to plan for accountability mechanisms. Previous research by the Global Strategy Lab on international treaties has shown that without clear and strong accountability measures, it leaves the door open for pledges without the pressure to deliver.  

Mathieu Poirier 

When people think of declarations coming out of the UN the assumption is sometimes that these are automatically international laws that will be enforced, and there’s some way to make sure that countries comply with the things that they agreed to. But in these kinds of political declarations that are referred to as soft law, that’s not the case. They are real mechanisms for countries to actually come together at a table, discuss an issue, come to a mutual understanding, and make commitments to each other that will not be enforced. But by making those commitments, by talking about this issue, it raises the profile of AMR within their own countries.

Every country, almost in the world, came to this meeting prepared with a three to five minute speech on how they’re going to address AMR, both within their countries and globally, and that really matters. But if we don’t meet a 10% reduction in AMR attributable deaths, that’s there’s going to be no consequence. There’s no enforcement mechanism for meeting that, or even the steps leading up to it, but that’s really what should happen at the national level. It’s not necessarily appropriate to enforce these things at the international level, because really that could actually prevent countries from coming to the table, because they might fear that there could be consequences for doing so. So, it has a different purpose than many people assume, but it’s still a really useful, constructive way to get countries that cooperate on this massive global issue. 

Daniela Corno 

By gathering nearly every country around the table to acknowledge AMR, we’re already shifting its visibility and importance. This kind of consensus building allows each country to set its own course of action while agreeing on a shared goal, and while it may lack direct consequences for unmet targets, the value is in creating an ongoing commitment and a global agenda for collective action. AMR is not a problem that can be tackled by one individual or one country alone. It’s a problem that affects all of us collectively, therefore needing to be addressed together.  

Mathieu Poirier 

I think there are some opportunities coming up in the level of international law. One is, like I said earlier, we haven’t yet agreed to a pandemic treaty. It’s still being negotiated, and hopefully we can start to cooperate in a meaningful way. And there’s been in various versions, a protocol focused on one health and a One Health protocol could help to accelerate action against antimicrobial resistance across human, animal, agri food, environmental sectors. So that’s one opportunity that’s coming up over the next six months.  

Julia Bishop 

There’s also going to be an opportunity alongside that, for there to be a multi stakeholder partnership platform plenary meeting where a group of different stakeholders from research and academia, from industry, from governments and from a number of different sectors will come together and also think about what role we as stakeholders have to play in that process. And that’s something that the AMR policy accelerator and GSL have been involved with Inception last year and really looking forward to seeing how we can use that as a platform to move the process forward.  

Daniela Corno 

So, as we’ve heard, while the political declaration may be a foundational step, it’s just the beginning of a much larger body of work. The real work of bringing declaration actions to life now lies ahead as advocates, researchers, policy makers and citizens. Our role now is to keep the pressure on, push for accountability, and remind those making the decisions that these are commitments we all need to see through. It’s an exciting, hopeful time, and we’ll be watching closely to see how these efforts unfold over the months and years to come.

That was GSL Director Mathieu Poirier and Director of Global Engagement. Julia Bishop, thanks for tuning in to another episode of Unpacking AMR. To find more resources about the topic we discussed today, visit our podcast page at www.globalstrategylab.org/unpackingAMR and remember AMR is more than drugs and bugs.