Governing Global Antimicrobial Resistance: 6 Key Lessons From the Paris Climate Agreement

Isaac Weldon, MSc; Susan Rogers Van Katwyk, PhD; Gian Luca Burci; Dr Giur; Thana C. de Campos, DPhil; Mark Eccleston-Turner, PhD; Helen R. Fryer, DPhil; Alberto Giubilini, PhD; Thomas Hale, PhD; Mark Harrison, DPhil; Stephanie Johnson, PhD; Claas Kirchhelle, DPhil; Kelley Lee, DPhil; Kathleen Liddell, DPhil; Marc Mendelson, PhD; Gorik Ooms, PhD; James Orbinski, MD, MSc, MA; Laura J. V. Piddock, PhD; John-Arne Røttingen, MD, PhD; Julian Savulescu, PhD; Andrew C. Singer, PhD; A. M. Viens, PhD; Clare Wenham, PhD; Mary E. Wiktorowicz, PhD, MSc; Shehla Zaidi, MD, PhD; Steven J. Hoffman, JD, PhD, LLD

Disclosures

Am J Public Health. 2022;112(4):553-557.

Abstract and Introduction

Introduction

Antimicrobial resistance (AMR) is among the most urgent global health challenges of our time. AMR can develop with each use of an antimicrobial, regardless of the setting. The ongoing use of the same antimicrobials across sectors and the ability of microbes to transfer among people, animals, food, and environments; spread across borders through global trade and travel; and bring entire economies to a halt means that every antimicrobial consumed has global implications. Some microbes have already developed resistance to all known antimicrobials, meaning previously curable diseases have become untreatable. If immediate action is not taken, the effectiveness of these vital medicines will continue to diminish, further undermining modern medicine's ability to treat infectious diseases and perform essential medical procedures.^[1]

The global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants that cause COVID-19 has sparked new discussions on the need for an international pandemic treaty,^[2]presenting a unique opportunity to reflect on AMR as one pathway through which new cross-border global health threats emerge. Similar to zoonoses such as COVID-19, AMR can lead to untreatable infectious diseases in humans with the potential to become deadly pandemics. AMR diminishes the global common pool of antimicrobial effectiveness—a nonexcludable but rivalrous resource—meaning that maintaining the viability of antimicrobial therapy is a global common-pool resource challenge.

Table 1. Comparing the Paris Climate Agreement With Existing Global AMR Efforts
Essential Elements	Paris Climate Agreement	Current Global AMR Efforts
1. Collective global goal	Keep global temperature rise below 1.5°C above preindustrial levels or at least well below 2°C	No consensus on what a collective global goal could look like
2. A focus on social and economic transformation	Implementation of the Paris Agreement requires social and economic transformation to decarbonize national economies.	AMR discourse has historically emphasized individual behavior instead of social and economic transformation.
3. Nationally determined contributions pledged, reviewed, and ratcheted every 5 years	All parties must communicate their nationally determined contributions every 5 years and, during revisions, aim for maximally ambitious goals. Nationally determined contributions are reviewed to ensure the distribution of responsibilities is fair and that countries are ambitious in their goals. All parties must regularly provide information on activities and outcomes using methods that are articulated by the Intergovernmental Panel on Climate Change.	All WHO member states committed to having national action plans for AMR. Even though this commitment is not legally binding, more than 100 countries have published plans, and many are under development. However, there are no specified review, intensification, or accountability mechanisms, and little financial, technical, and infrastructural support is provided for achieving necessary policies. WHO, FAO, and OIE conduct self-assessment surveys on national AMR activities, but there is no regular reporting or standard methodology for reporting outcomes.
4. Annual multistakeholder forum	The annual Conference of the Parties to the UNFCCC serves as a multistakeholder meeting place for advancing the Paris Agreement.	AMR is normally discussed every 3 years at the World Health Assembly, but there is no formal or regular meeting focused on AMR and no permanent forum for multistakeholder discussions on AMR across sectors.
5. Global scientific stock taking every 5 years	Requirement to assess the best available science every 5 years; this stock-taking exercise will help ensure that the Paris Agreement's ongoing efforts are in line with scientific best practices.	No relevant comparison
6. International legal framework	The Paris Agreement is a legally binding instrument of the UNFCCC. The UNFCCC provides a broader legal framework for the Paris Agreement.	No international legal framework, although the constituting instruments of the WHO, FAO, OIE, or UN could serve as the broader legal framework for a legally binding AMR agreement

Note. AMR = antimicrobial resistance; FAO = Food and Agriculture Organization of the United Nations; OIE = World Organization for Animal Health; UN = United Nations; UNFCCC = United Nations Framework Convention on Climate Change; WHO = World Health Organization.
Source. Rogers Van Katwyk et al.¹⁵

Authors and Disclosures

Isaac Weldon, MSc, Susan Rogers Van Katwyk, PhD, Gian Luca Burci, Dr Giur, Thana C. de Campos, DPhil, Mark Eccleston-Turner, PhD, Helen R. Fryer, DPhil, Alberto Giubilini, PhD, Thomas Hale, PhD, Mark Harrison, DPhil, Stephanie Johnson, PhD, Claas Kirchhelle, DPhil, Kelley Lee, DPhil, Kathleen Liddell, DPhil, Marc Mendelson, PhD, Gorik Ooms, PhD, James Orbinski, MD, MSc, MA, Laura J. V. Piddock, PhD, John-Arne Røttingen, MD, PhD, Julian Savulescu, PhD, Andrew C. Singer, PhD, A. M. Viens, PhD, Clare Wenham, PhD, Mary E. Wiktorowicz, PhD, MSc, Shehla Zaidi, MD, PhD and Steven J. Hoffman, JD, PhD, LLD

Isaac Weldon, Susan Rogers Van Katwyk, A.M. Viens, and Steven J. Hoffman are with the Global Strategy Lab, York University, Toronto, Ontario, Canada. Gian Luca Burci is with the Graduate Institute of International and Development Studies, Geneva, Switzerland. Thana C. de Campos is with the School of Government, Pontificia Universidad Catolica de Chile, Santiago, Chile. Mark Eccleston-Turner is with the Department of Global Health and Social Medicine, King's College London, United Kingdom. Helen R. Fryer is with the Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom. Alberto Giubilini and Julian Savulescu are with the Oxford Martin School and the Uehiro Centre for Practical Ethics, University of Oxford. Thomas Hale is with the Blavatnik School of Government, University of Oxford. Mark Harrison is with the Faculty of History and Oxford Martin School, University of Oxford. Stephanie Johnson is with the Wellcome Centre for Ethics and Humanities and Ethox Centre, University of Oxford. Claas Kirchhelle is with the School of History, University College Dublin, Dublin, Ireland. Kelley Lee is with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Kathleen Liddell is with the Centre for Law, Medicine and Life Sciences, Faculty of Law, University of Cambridge, Cambridge, United Kingdom. Marc Mendelson is with the Division of Infectious Diseases & HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. Gorik Ooms is with the Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. James Orbinski and Mary E. Wiktorowicz are with the Dahdaleh Institute for Global Health Research, York University. Laura J. V. Piddock is with the Global Antibiotic Research and Development Partnership, Geneva, Switzerland. John-Arne Røttingen is with the Ministry of Foreign Affairs, Oslo, Norway. Andrew C. Singer is with the UK Centre for Ecology & Hydrology, Wallingford, United Kingdom. Clare Wenham is with the Department of Health Policy, London School of Economics and Political Science, London. Shehla Zaidi is with the Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.

Correspondence should be sent to
Steven J. Hoffman, JD, PhD, LLD, Global Strategy Lab, York University, Dahdaleh Building, Suite 2120, 4700 Keele St, Toronto, ON, Canada, M3J 1P3 (e-mail: steven.hoffman@globalstrategylab.org).

Contributors
The ideas and arguments in this analysis were generated at an expert dialogue attended by all authors at the Oxford Martin School, University of Oxford, in May 2019. The workshop was co-organized by A. Giubilini, M. Harrison, S. J. Hoffman, C. Kirchhelle, A. McLean, S. Rogers Van Katwyk, J. Savulescu, and I. Weldon as part of a larger research project on collective responsibility for infectious disease. I. Weldon wrote the first draft of this editorial with the workshop co-organizers. All authors provided critical edits and approved the final version.

Conflicts of Interest
S. J. Hoffman is Scientific Director of the CIHR's Institute of Population and Public Health and is CIHR's Scientific Lead for Global Health. The views expressed in this article are those of the authors and do not necessarily reflect those of the Canadian Institutes of Health Research (CIHR) or the Government of Canada. The other authors have no conflicts of interest to disclose.