AMR already kills millions. Global action is urgently needed.

The figures are staggering, as is the scale of the problem. Antibiotics are a mainstay of modern medicine: over the decades, they have turned once-deadly infections into curable conditions. Increased resistance now threatens to undermine a century of advances in health care. 

The dilemma we face is so stark that we have no choice. If we do not act today, there will be no cures tomorrow.  This is why we must all applaud the landmark political declaration signed by 193 Member States during the 79th United Nations General Assembly (UNGA) High-Level Meeting on Antimicrobial Resistance. 

With the declaration, world leaders committed to reducing deaths linked to bacterial AMR by 10%—against the 2019 baseline of 4.95 million deaths—before the end of the decade. It calls for scaled-up action across multiple sectors—including farming, pharmaceutical manufacture, environmental protection and health care—as well as sustainable national financing and $ 100mn in catalytic funding to help achieve the target of at least 60% of countries having funded national action plans to address AMR, using the One Health approach, by 2030. 

Recognising that "while antimicrobial resistance affects people of all ages, knows no borders and is present in all countries", the declaration acknowledges that "the burden is largely and disproportionately borne by developing countries and those in vulnerable situations, requiring global solidarity, joint efforts and international cooperation."

In its quest to leave no one behind, it singles out "people living in conflict-affected states and humanitarian settings, including those impacted by climate change and natural disasters, refugees, internally displaced persons and migrants" and "those living in poverty and extreme poverty."  

Colossal stakes

That the impact of AMR is asymmetric raises the already colossally high stakes in an area such as WHO's Eastern Mediterranean region where eight of 22 countries and territories are on the World Bank's 2024 List of Fragile and Conflict-affected Situations, and which hosts more than 55% of the world's population of refugees and displaced persons. 

So yes, adopting the political declaration is a major step forward. But now we must get down to implementing the concrete actions necessary to address AMR across all sectors. The challenges are formidable, but they must be overcome. 

Inappropriate use of antibiotics is one of the most common drivers of AMR. The Eastern Mediterranean has the highest— and fastest rising—level of antibiotic consumption of any WHO region. There is an urgent need for better antimicrobial stewardship. 

In some countries, people struggle to access what the World Health Organisation terms 'access antibiotics'—older types in pill form that have fewer side effects and are less likely to drive AMR. We need incentives for local manufacturers to produce these essential antibiotics. One of the goals of our new regional flagship initiative is to support countries to strengthen supply chains. By pooling procurement and stockpiling, the initiative aims to ensure equitable, uninterrupted access to drugs, diagnostics and lab consumables.  

Simple hygiene measures can make a huge difference in stopping infections in the first place. Yet 78 million people in our region lack access to safe drinking water, 138 million lack access to basic sanitation services, and 222 million have little or no access to basic hygiene facilities. In 2022, just 36% of healthcare facilities reported basic sanitation and waste management systems. 

Investments are urgently needed to address this situation. Dedicating financing for AMR is an enormous burden on low-income countries, especially fragile, vulnerable, and conflict-affected states, where health systems are already severely depleted and face a plethora of competing priorities. Support is desperately needed. 

War raises risk

That wars and conflicts increase the risk of AMR was underlined by the emergence of specific resistant bacteria following the Iraq war. And now, ongoing conflicts in Gaza and Sudan threaten a repeat and further complicate efforts to ensure full vaccination coverage to prevent new infections. To address the challenges, we need peace. And we need it now. 

The 4th Ministerial Summit on AMR, hosted by Saudi Arabia on 15–16 November in Jeddah, presented an opportunity to translate the political declaration into concrete action. Ministers of health, agriculture and the environment, particularly from lower-income countries, used the meeting to unite their voices and advocate for the actions that are so desperately needed.

AMR respects no borders. To contain it, we must act in unison. We are running out of time. The world cannot wait.