Onwards and Upwards: Strengthening Global Cooperation to Address Antimicrobial Resistance

Given the hurricane of news around immediate crises in the past few months, it’s not surprising that warnings about antimicrobial resistance (AMR)—often called a slow moving tsunami—are getting lost. Without global action, by 2050 there could be as many as 10 million AMR-related deaths each year, which would entail a high cost for the global economy as well. An important—and often overlooked—part of the problem is the overuse of antibiotics in farm animals. (For more on how antibiotic use in livestock is contributing to the spread of antibiotic-resistant superbugs, be sure to check out Kim Elliott's new book Global Agriculture and the American Farmer.) Without action, antibiotic use will grow rapidly in middle-income countries where meat consumption and the intensification of livestock industries are expanding. CGD recently convened a roundtable discussion with technical experts to discuss possible ways to strengthen global cooperation to address livestock’s contribution to AMR. Drawing on that productive discussion, we outline steps that could help make inroads into the problem.

Earlier this year we outlined key elements of a global treaty to reduce antibiotic use in farm animals in this CGD policy paper. This (admittedly ambitious) global treaty—modelled on the Montreal Protocol on Substances that Deplete the Ozone Layer—would support much-needed research, surveillance, and data collection; establish a framework for binding commitments and targets that would evolve over time; and create a mechanism to encourage participation from low- and middle-income countries. A couple of weeks ago, we convened a roundtable discussion with technical experts to build on this idea and assess how a treaty could contribute to global efforts to address AMR. Here’s a rundown of what we learned (without any attribution since the discussion took place under Chatham House rules).

The time is right

There was unanimous agreement that global momentum around the AMR issue is building. The issue was in the spotlight at last September’s United Nations General Assembly, which culminated in a landmark resolution calling for national action with international oversight. The recent creation of a UN Interagency Coordination Group (as set forth in the resolution) is a sign of initial progress toward this effort. Moreover, 90 percent of the world’s population now lives in a country that has developed or is of developing a multi-sectoral national action plan to tackle AMR. Efforts are also ongoing to establish a global database on antibiotic use in farm animals at the World Organization for Animal Health (OIE). Against this background, a global treaty could help fill an existing gap by providing the legal framework to consider important policy and trade issues related to antimicrobial use in farm animals as countries roll-out their national action plans.

Setting up a flexible framework is key

A key question in our discussion was whether such a treaty should focus on livestock, or be comprehensive and consider antimicrobial use in humans as well. Everyone agreed that any treaty should be in the context of the overall One Health approach led by the tripartite collaboration between the World Health Organization (WHO), Food and Agriculture Organization (FAO), and OIE. But many felt a treaty focused on antibiotic use in livestock would be more feasible and realistic. To us, this debate underscored the importance of designing a mechanism for addressing the livestock problem that could stand on its own, or could be slotted into a broader global treaty on AMR.

The need for flexibility was also relevant to the discussion on possible targets for “prudent use.” A treaty framework could include targets focused on multiple dimensions—i.e., for certain animal species (with poultry producers perhaps leading the way); for specific drug classes (per WHO’s list of Critically Important Antimicrobials); or for different practices (growth promotion, prevention, etc.). But considering the extent of knowledge and data gaps in this space, participants argued against setting targets for use in livestock before more information is available. Thus, flexibility would need to be a key feature of the treaty framework so that targets and commitments could be adapted as additional evidence becomes available.

What about a global voluntary industry partnership?

Increased consumer awareness and concerns about food safety and quality are already driving change on the supply-side of the market. In the United States, for example, many fast-food chains are committing to serve meat raised without antibiotics and large meat producers are following suit by voluntarily phasing out antibiotics on the farm. A June 2016 study reported that one-third of the US poultry industry had eliminated or pledged to eliminate routine use of medically-important antibiotics. For example, Perdue—the fourth largest US poultry producer—now uses natural herbs like oregano and thyme, in addition to vaccines and probiotics to keep their chickens healthy. Reflecting on these positive developments, we discussed the potential role industry could play in paving the way forward, especially in light of the current political climate. A global treaty could therefore serve as the stick—spurring industry to keep making progress in anticipation of regulations coming down the pike. The carrot would come in the form of business opportunities for developing antibiotic alternatives. An industry-led partnership could have powerful reinforcing impacts.

As we at CGD continue to chip away at the problem, we’ll seek to broaden our engagement with key stakeholders: researchers and policymakers in low- and middle-income countries; the livestock and pharmaceutical industries; international organizations such as WHO, FAO, and OIE; the wider global health community; and financial industry experts.

Watch this space as we continue to rethink, refine, and adapt our policy proposals. And we’d love to hear additional ideas and feedback in the comments section below.