Impact of the AMR Review
The Review made an impact well before the publication of its final report in May 2016. The estimates of deaths and economic costs in its first report in December 2014 have since been widely used to justify urgent action to tackle AMR. While the estimates have been queried, the number of times the figures have been quoted is a testament to the large advocacy impact the Review has achieved. For example, a Google search for ‘10 million deaths globally 2050 drug-resistant’ on 30 September 2019 produced 5.92 million results. In its major report on the economic impact of AMR in 2017, the World Bank described the Review’s report and background papers as ‘remarkable’.4
The Review, and the lobbying efforts of the UK and other governments, certainly played a role in raising the international political profile of AMR and in stimulating a number of initiatives, even before the report was completed. One example is the launch of the UK’s Fleming Fund in 2015.5 The declaration on AMR from G7 health ministers in October 2015 specifically referred to the Review’s estimate of 700,000 deaths annually from AMR6 and the G20 made its first reference to AMR in the Antalya summit communique in November 2015.7 The Review probably also made a material contribution to the passing of the UN Political Declaration on AMR in September 2016.8 The declaration reflected many of the themes identified in the Review including, for instance, ‘the importance of delinking the cost of investment in research and development on antimicrobial resistance from the price and volume of sales’ and the need to mobilize predictable and sustainable funding to address all aspects of AMR.
As host of the 2017 G20 meeting, Germany made AMR one of its priorities and undertook substantial preparatory work to seek agreement on the appropriate use of antibiotics as well as to coordinate on incentives for improved research and development (R&D). One major input was a report by the Boston Consulting Group (BCG) that made proposals for new incentives and financing for R&D, drawing heavily on many of the proposals in the Review.9 A second was a report from the Organisation for Economic Co-operation and Development (OECD) and the Tripartite agencies – the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (OIE) and the World Health Organization (WHO) – on tackling AMR and ensuring sustainable R&D. This also drew substantially on the analysis in the AMR Review and the BCG report.10
However, compared with all this comprehensive preparatory work, the G20 leaders’ declaration in July 2017 in Hamburg was decidedly muted. The one concrete proposal was to call for the establishment of an international R&D Collaboration Hub but when it came to the detailed proposals put forward by BCG and the OECD/Tripartite for stimulating R&D, the declaration simply said, ‘we will further examine practical market incentive options’.11 The outcome of the 2017 G20 summit seems to have marked a turning point in the global political commitment to take concrete action on AMR. To the extent that statements made by the G7 and G20 are important in moving the global agenda forward, and the Review certainly thought they were, these peaked in 2017 when it became clear there was a political impediment in moving from ‘examining practical market incentives’ to proposing concrete steps to make these a reality.
This lack of forward momentum contrasts with the political impetus that resulted in the G7 summit in Okinawa in 2000 setting in motion steps that led to the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria.12 The Global Fund to date has disbursed more than $40 billion, which is the amount the Review estimated would be needed over a decade to address AMR.13 Current political and economic circumstances are very different from those that prevailed in 2000 but it is apparent that the pressure arising from civil society, key governments, individuals and WHO, allied with the obvious severity of the AIDS pandemic and millions of lives immediately at risk, resulted in effective action at the level of the G7 in 2000 and the mobilization of large-scale financial resources.14 While many of these elements are present in the case of AMR, they have so far failed to generate financial commitments on the scale that the Review and many others believe is required. It appears that the threat, in spite of many warnings, is not perceived to be sufficient to merit the exceptional policy action many consider necessary.
4 World Bank (2017), Drug-Resistant Infections: A Threat to Our Economic Future, Washington DC: World Bank, http://documents.worldbank.org/curated/en/323311493396993758/pdf/final-report.pdf.
5 The Fleming Fund (n.d.), ‘About the Fleming Fund’, https://www.flemingfund.org/about-us/.
6 G7 (2015), ‘Declaration of the G7 Health Ministers’, 8–9 October 2015, Berlin, http://www.g8.utoronto.ca/healthG8/2015-berlin.pdf.
7 G20 (2015), ‘G20 Leaders’ Communiqué Antalya’, 16 November 2015, http://www.g20.utoronto.ca/2015/151116-communique.html#annex.
8 United Nations (2016), ‘Political Declaration of the High-Level Meeting of the General Assembly on Antimicrobial Resistance’, A/71/L.2, 22 September 2016, https://digitallibrary.un.org/record/842813?ln=en.
9 Boston Consulting Group (2017), Breaking through the Wall: A Call for Concerted Action on Antibiotics Research and Development, Berlin: BCG/ Federal Ministry of Health, https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikationen/Gesundheit/Berichte/GUARD_Follow_Up_Report_Full_Report_final.pdf.
10 OECD, WHO, FAO, OIE (2017), Tackling antimicrobial resistance: Ensuring sustainable R&D, Final note prepared by OECD, WHO, FAO and OIE, 29 June 2017, https://www.oecd.org/els/health-systems/G20-AMR-Final-Paper-2017.pdf.
11 G20 (2017), ‘G20 Leaders´ Declaration. Shaping an interconnected world’, 7–8 July 2017, https://www.oecd.org/els/health-systems/G20-leaders-declaration.pdf.
12 Global Fund (2017), ‘Japan and the Global Fund’, Geneva: Global Fund, https://www.theglobalfund.org/media/1493/donor_japan_report_en.pdf?u=636918787320000000.
13 The Global Fund (n.d.), ‘Financials’, https://www.theglobalfund.org/en/financials/.
14 Liden, J. (2013), The Grand Decade for Global Health: 1998–2008, Working Group on Governance, Paper 2, London: The Royal Institute of International Affairs, https://www.chathamhouse.org/sites/default/files/public/Research/Global%20Health/0413_who.pdf.