[NEW YORK] World leaders meeting in New York have backed a new set of goals and pledged to find US$100 million in funding to address the problem of drug-resistant bacteria, a global crisis that is all the more acute in the poorest countries.

The issue was taken to the UN General Assembly for the first time since 2016 because the world’s arsenal of effective drugs is rapidly running out.

Bacteria are constantly evolving and many have now developed resistance to existing medications, while it has been almost 40 years since the last new class of antibiotic was launched.

According to analysis published in The Lancet, 4.95 million deaths a year result from or are linked to infections resistant to the antibiotics available to treat them—a phenomenon known as antimicrobial resistance. And there are huge gaps in development of and access to new medicines.

The political declaration adopted by governments has set a target of reducing deaths from antimicrobial resistance by 10 per cent by 2030.

“That might sound modest, but it’s a good start in terms of being able to establish the political ambition,” said Jeremy Knox, head of policy for infectious disease at the UK-based health research foundation Wellcome.

The declaration calls on countries collectively to deliver US$100 million in funding to kick-start progress, as well as ongoing national financing to help at least 60 per cent of countries fund national action plans to tackle the problem by 2030.

It includes a commitment to establishing an independent scientific panel to provide evidence on antimicrobial resistance, such as the one for climate change.

Low- and middle-income countries are disproportionately affected by drug-resistant infections, partly because they also have the highest prevalence of infectious diseases.

But, “there’s not a single country in the world that does not have this problem”, says Ramanan Laxminarayan, director of the One Health Trust, a global health research organisation based in the US and India.

“This is not like tuberculosis or diarrhea, or something. Every country has a problem,” said Laxminarayan, who was a key contributor to The Lancet series and involved in negotiating the draft political declaration.

One problem is that the remaining few effective drugs are overused, giving bacteria more opportunities to develop resistance.

Laxminarayan, along with other global health specialists, wants countries also to commit to cutting inappropriate human antibiotic use by 20 per cent and inappropriate animal antibiotic use by 30 per cent by 2030.

Antibiotics “are effectively sold as chocolates”, said Sania Nishtar, CEO of Gavi, the Vaccine Alliance, at a symposium on the problem in New York on Sunday (22 September).

Another part of the problem is the conditions that lead to infections, such as poor access to safe water and sanitation. In 2022, according to the WHO, at least 1.7 billion people were using a drinking water source contaminated with faeces.

One of the most effective tools to tackle growing drug resistance is to vaccinate people against disease before they get it, according to Nishtar.

Mia Amor Mottley, the Barbados prime minister and chair of the Global Leaders Group on Antimicrobial Resistance, hopes it will wake up the world to the “slow-motion, silent pandemic”.

“There are already too many people dying, but if this is going to be the number one killer of people by 2050, then we have a moral obligation to start now,” she told the symposium.

Annual global funding for antibiotics research and development has increased by 25 per cent since 2017 to US$1·68 billion, according to the Lancet series. But it says many new antibiotics can’t be registered and are unaffordable to poorer countries.

Trevor Mundel, president of global health at the Bill & Melinda Gates Foundation, believes artificial intelligence could help address the barriers to developing new antibiotics.

“I’m really confident that if you look at the drug discovery process in three to five years’ time, it’ll be completely changed from what it is now,” he told the symposium.

“It’ll be changed in terms of the time it takes to develop a drug, it’ll be changed in terms of the types of actors and parties, stakeholders that can actually participate.”

In the meantime, small drug companies need help to keep going, says Laxminarayan. Eighty per cent of new drug development is happening in small biotech companies but these are “on the verge of becoming bankrupt”, he told SciDev.Net.

However, Laxminarayan is confident that the solutions are achievable.

“We have the money for prevention,” he said.

“We have the money for improving access to treatment. We have the money for figuring out ways in which you can develop new antibiotics.

“So, I think this stuff just needs to be done now and we’ve got to stop bellyaching about it being a difficult problem.”

This piece was produced by SciDev.Net’s Global desk.