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Building an Antibiotic Resistance Toolkit

11 Oct 2017
By Anna George
Foreign Minister Julie Bishop at the launch of the Indo-Pacific Centre for Health Security

With the launch of the new Indo-Pacific Health Security Initiative, Australia is taking antimicrobial resistance seriously as it seeks to strengthen the region against disease outbreak.

Australia is investing in a new and clever initiative to tackle health security risks affecting the region. Significantly, it includes the creation of a Health Security Corps that will place Australian health professionals in the region, drawing upon the health expertise of Australian governments, universities, civil society and the private sector. Portfolio responsibility lies with the Department of Foreign Affairs and Trade and includes funding of $300 million over five years.

This important collaborative initiative, the Indo-Pacific Centre for Health Security, will support efforts to prevent and contain disease outbreaks with potential to cause “large scale economic impacts on a national, regional or global scale”.

The timing of this initiative coincides with heightened global concerns about dealing with the dangerous spread of antimicrobial resistance (AMR). AMR represents a complex and pernicious problem, especially when multidrug resistance threatens to undermine progress made addressing malaria and TB within the region.

AMR political debate

The 2016 UN political declaration on the dangers posed by AMR provided the political momentum to expose these dangers and draw in some of the key global players, including significant multibillion-dollar global industries: pharmaceutical, healthcare and food producers. These industries also monitor AMR developments and often actively participate alongside the many global forums attempting to build a policy/regulatory consensus framework.

The UK has made a significant intellectual contribution and the US, EU and Australia, among others, actively contribute to developing the beginnings of a global approach. The UN agencies are also substantially engaged, including providing clever tools to explain the scope of the problem.

As in all multilateral negotiations that hold significant economic, development and security consequences, and intrude on existing practice with the capacity to alter the balance of interests, the AMR dialogue is likely to become more politically contentious.

For instance, important political markers are likely to be laid down in some key international negotiations. And while much of the dialogue may appear to be technical and esoteric it would be a mistake not to recognise the conflicts of interest and political undercurrents that will run through these debates.

These various deliberations should be closely monitored as they will influence future healthcare, food safety and development opportunities for developed and developing nations, so mainstream media, academics, public health experts and politicians should take note. Ultimately, governments are responsible for food safety.

Three important meetings that should be followed closely—in Australia, Berlin and the Republic of Korea—have the capacity to address some fundamental elements not yet fully integrated into AMR policies.

The WHO’s international health regulations

The World Health Organization’s (WHO) Regional Committee for the Western Pacific is being held in Brisbane on 9-13 October and is chaired by Australia. Prior to the opening, Australia announced the capacity of its hospital system to deal with pandemics and public heath emergencies would be rigorously examined by the WHO. This complies with existing WHO international health regulations and underpins a state’s capacity to manage pandemics and AMR; a key objective for all Western Pacific states.

Filling in the AMR evidence-based gaps

The meeting being held in Berlin on 12-13 October typifies the diplomatic ‘second track’ framework designed to garner consensus in advance of formal multilateral negotiations. Organised by the UK Welcome Trust, it is supporting the work of the UN’s AMR Inter-Agency Coordination Group (IACG) and includes governments, civil society, research and philanthropic groups. The most critical gaps in tackling AMR will be discussed. One significant evidence-based gap is linked to the transfer of AMR through the international food chain.

AMR transmission through the food chain

The Republic of Korea will host the Taskforce on AMR between 27 November and 1 December to examine AMR’s transmission through the food chain. The mandate for this work evolved from the lesser known but important international food safety and standard setting agency, Codex Alimentarius Commission. Codex’s current advice on AMR is now 10 years old so its risk management and code of conduct guidance will also be updated.

Politically and economically, Codex food standards can have far-reaching implications, for food exporters and also in resolving trade disputes. A World Trade Organization (WTO) member can apply stricter food safety measures than those set by Codex, but may be required to justify these measures scientifically. Given the significance of global trade in food, this AMR Taskforce will also be carefully monitored by non-state entities such as national food export industries, global food producers, pharmaceutical companies and consumer groups.

Codex deliberations aim to be technically focused and based on science and expert input. But developing ‘scientifically supported evidence’ on AMR transmission through the food chain may be hard to deliver given that impartial evidence-based data has not been collected. Few, if any, countries systematically test food for AMR at their borders.

Although Codex is not expected to finalise its work until 2020, the November meeting will influence the technical and political parameters of future negotiated outcomes. Reaching consensus on guidance and standards that will influence national policy or regulatory measures to address AMR in the food chain is likely to be more politically difficult than any resistance experienced by reducing the use of antibiotics in humans.

But leaving aside the prospects for achieving consensus in Codex, AMR research is growing exponentially making information on AMR transmission through the food chain more accessible, including from an influential international alliance of researchers. Consequently, governments may come under pressure from consumers to act nationally in advance of any political consensus reached through Codex.

Anna George is currently an adjunct professor with Murdoch University and an associate fellow with the Chatham House Centre for Global Health Security.  She is a former Australian ambassador and former vice-president of the AIIA for WA.

This article is published under a Creative Commons Licence and may be republished with attribution.