Greenpeace activists campaign against the excessive use of antibiotics in livestock farming John Macdougall/Getty Images

Tackling AMR With the IMF

The world has made significant and relatively fast progress in the fight against antimicrobial resistance. But to ensure continued success, more effective mechanisms are needed to hold governments to their increasingly lofty promises.

LONDON – This month is the first anniversary of the United Nations High-Level Meeting on Antimicrobial Resistance, which the United Kingdom’s independent Review on AMR helped to bring about. That moment last year was very gratifying for me, as the chairman of the Review, as well as for my team and the UK’s Chief Medical Officer, Sally Davies.

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Last year’s High-Level Meeting resolved that member-state delegates are to reconvene for a progress assessment after two years – so, in September 2018. The meeting also called for the establishment of an Interagency Coordination Group to guide efforts in the fight against AMR during that two-year period. From what I have gathered, the group is being led by deeply committed individuals. And, more broadly, policymakers at the national and international levels have begun to pay more attention to the threat of AMR.

In fact, since the UN High-Level Meeting, the G20 has also made notable commitments in the battle against AMR. At the G20 summit in Hamburg, Germany, in July, governments agreed to establish an “R&D Collaboration Hub,” and to begin to phase out antibiotics in agriculture, where producers use them to promote animal growth.

The UK Review recommended that an additional $2 billion be earmarked for early-stage research into AMR, so the creation of an R&D hub is very welcome. But the agreement to limit the use of antibiotics in agriculture was even more significant. In the past, key G20 member states have resisted such commitments. And in the texts that served as a foundation for the UN High-Level Meeting, agriculture wasn’t even mentioned, owing to fear that it would render any eventual agreement dead on arrival.

The steps that the UN and the G20 have taken are encouraging. But the fight against AMR is hardly over, and has probably only just begun. Looking forward, one of the biggest challenges will be holding to account individual countries and multilateral organizations, such as the UN itself. How will we confirm that governments and institutions have followed through on their lofty declarations?

For starters, we can look at the intersection of economics and public health. There are many ways that international institutions can use economic-policy levers to reduce significantly the probability of infectious-disease outbreaks, and to increase vulnerable countries’ resilience to such risks.

To my mind, the International Monetary Fund should take the lead. As Peter Sands and his colleagues show in a May 2016 study in The Lancet, infectious-disease outbreaks have far-reaching economic costs, and yet they are rarely, if ever, factored into assessments of macroeconomic risk. The IMF already conducts regular reviews of countries’ economic health, and financial markets give significant weight to its analyses. For the sake of economic as well as public health, the Fund would do well to start tracking countries’ progress in the fight against AMR as well.

The European Union declared more than ten years ago that it would fully phase out the use of antibiotics for animal growth promotion. But who, other than the occasional investigative journalist, has ever actually delved into EU member states’ progress toward that goal?

In the UK, my Review colleagues and I were quite impressed by the government’s formal policy response to our recommendations, especially with respect to reducing antibiotic prescriptions, preventing hospital-acquired infections, and limiting the use of antibiotics in farming to 50 milligrams per kilogram of livestock.

Over the past year, I have given public talks at some of the British universities that are actively working on the AMR threat. I have been encouraged to see more academic researchers pursuing this topic than in the past. But when I have quizzed my audiences, I have come to realize that hardly anyone knows about the government’s policy response. This could mean that my audiences are simply uninformed; but I doubt that. What is more likely is that the government has not yet followed through on its commitments.

The IMF is ideally suited to get to the bottom of this question as a part of its routine economic assessments. And its analyses would be even more valuable to less wealthy countries, where preventing outbreaks of infectious diseases could directly boost long-term economic growth.

One last concern that I have on this first anniversary of the UN High-Level Meeting is that policymakers still need to agree on a source of funding for the market-entry rewards intended to encourage the development of new drugs and diagnostics. Such innovations will be crucial for preventing and detecting AMR, and an incentive mechanism to stimulate them is increasingly regarded as the right way to go. That, too, is a topic on which the IMF could provide invaluable advice.

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