Introduction
The Review on Antimicrobial Resistance (AMR Review), chaired by Lord Jim O’Neill, was commissioned in July 2014 by the then UK Prime Minister David Cameron. The establishment of the Review reflected a renewed concern at the highest political levels in the UK about antimicrobial resistance (AMR), catalysed by the sustained advocacy of Dame Sally Davies, England’s chief medical officer. The choice of Jim O’Neill, an economist without a health or scientific background who had spent much of his career at Goldman Sachs, was surprising to some. However, it reflected the view that tackling the AMR crisis was not just a scientific and medical challenge but an economic and social one too. Moreover, a key factor was the feeling that Jim O’Neill could be instrumental in building connections with emerging economies, which were perceived to be critical players in addressing AMR on a global scale. This perspective is reflected in the Review’s emphasis on the potential leadership role of the G20 group of countries, alongside that of the UN and the G7.1
Box 1: AMR Review recommendations
- A massive global public awareness campaign;
- Improve hygiene and prevent the spread of infection;
- Reduce unnecessary use of antimicrobials in agriculture and their dissemination in the environment;
- Improve global surveillance of drug resistance in humans and animals;
- Promote new, rapid diagnostics to cut unnecessary use of antibiotics;
- Promote the development and use of vaccines and alternatives;
- Improve the numbers, pay and recognition of people working in infectious disease;
- Establish a Global Innovation Fund for early-stage and non-commercial research;
- Better incentives to promote investment for new drugs and existing ones; and
- Build a global coalition for real action – via the G20 and the UN.
The final report of the Review was published in May 2016. The Review set out why AMR is such a huge threat as antimicrobial drugs become less effective and too few new ones are developed. It found that not enough was being done to reduce unnecessary use of antimicrobials in human healthcare and in agriculture, nor to curb their presence in the environment. The Review estimated that if no action is taken AMR could cause the deaths of 10 million people worldwide every year by 2050, with a cumulative economic impact of around $100 trillion lost from global GDP.2
The Review made proposals covering the 10 main areas in which action was required to address the imminent threat posed by AMR (see Box 1). In total it made 29 specific sub-recommendations across those 10 areas. In the run up to the final report, the Review published eight separate reports in 2014–16 on different aspects of tackling the AMR crisis. These reports were informed by many supporting documents commissioned by the Review.3
The purpose of this research paper is to assess progress on AMR against the recommendations of the Review to identify opportunities for further action and key obstacles that need to be overcome. The analysis is based on a review of available literature and other materials documenting developments in the AMR field, particularly since 2016. This is supplemented by the insights of participants in a Chatham House expert roundtable held in May 2019 and by interviews with other stakeholders.
1 O’Neill, J. (2018), ‘Two years on: an update on achievement towards the recommendations of the antimicrobial resistance report’, Journal of Applied Microbiology, 125(2), pp. 308–312, https://doi.org/10.1111/jam.13933 (Note: All URLs accessed 10 Sep. 2019).
2 AMR Review (2016), Tackling Drug-Resistant Infections Globally: final report and recommendations, London: AMR Review, https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf.
3 AMR Review (n.d.), ‘Publications’, https://amr-review.org/Publications.html.