Antimicrobial resistance (AMR) causes close to 1.3 million deaths annually and contributes to millions more. Due to growing levels of AMR, anyone–anywhere is at risk of acquiring a life-threatening drug-resistant infection, but existing resource inequities mean those living in the Global South are at a higher risk of AMR-related death or disability.
AMR also increases economic and food security risks. In addition to the health care costs associated with AMR, the World Bank has estimated AMR will reduce global animal production by up to 7.5% by 2050, resulting in economic losses of up to one trillion dollars and undermining decades of progress in food security and nutrition worldwide. These far-reaching impacts on people, animals, food systems, and the environment means a One Health approach is vital to effectively address AMR.
Key Takeaways
- AMR is a significant threat to decades of progress on global health and development.
- Addressing AMR requires a coordinated global approach that brings together actors from all health sectors (human, animal, agri-food, and environmental health).
- Unifying goals – such as the 2° target of the Paris Climate Accord – can spur action by setting the agenda, defining success, and uniting collective efforts.
- The United Nations General Assembly High-level Meeting on AMR, being held in September 2024, is a key opportunity to introduce ambitious goals to mobilize action on AMR.
Ensuring that life-saving antimicrobials remain available as effective treatment options will require a coordinated global effort. This process would be greatly accelerated by adopting unifying goals that unite all countries and sectors in their collective efforts to address AMR.
The United Nations General Assembly (UNGA) High-level Meeting on AMR provides a critical opportunity to adopt unifying goals for meaningful action on AMR. Examples of other unifying goals include the Paris Agreement’s objective to keep global warming well below 2° Celsius compared to pre-industrial levels, the Sustainable Development Goals (SDGs), and UNAIDS’ 90-90-90 goal.
Antimicrobials & AMR
Antimicrobial drugs are essential for many medical procedures, including cancer treatment and most surgeries. Antimicrobials also play an important role in animal health and infection prevention and control in modern farming.
Antimicrobial resistance occurs when infection-causing microbes (bacteria, fungi, viruses, and parasites) evolve over time and become resistant to antimicrobial drugs. When this happens, infections become drug-resistant and very hard or impossible to treat.
While AMR is a natural process, it has been unnecessarily sped up through the overuse and misuse of antibiotics. AMR cannot be stopped but it can be slowed and managed. It is critical that steps be taken now to safeguard a future with effective antimicrobial treatments.
Unifying Goals on AMR
Unlike other serious global challenges requiring ongoing coordinated global action, unifying goals have yet to be identified to address AMR. Without global goals to rally public and political support, past efforts to address AMR have lacked the necessary level of ambition and coordination needed to create meaningful change.
Goal setting is an inherently political challenge: goals are a tool of global governance that act as vehicles for global norms, to direct attention and effort towards relevant activities, and to serve an energizing function to motivate action over an extended period of time.
To raise awareness, attract investment, and catalyze action, the primary audience for unifying goals must be politicians and the public. This is an important consideration in the AMR context: AMR has traditionally taken a complex technical approach to goal setting, adopting siloed and highly technical targets which are not widely understood. While this approach to goal setting may be intended to avoid making AMR a politicized issue, it fails to convince politicians and the public that AMR is an urgent challenge that requires significant investment. Technical targets are frequently less ambitious because they often lack whole-of-government commitment and dedicated budgets.
The 1-10-100 Unifying Goals
In April 2024, the Bellagio Group for Accelerating AMR Action, made up of global health researchers, policymakers, and civil society representatives met to identify unifying goals for AMR which could:
1) Unite technical perspectives across all countries and sectors into a memorable concept that is easily communicated;
2) Act as a barometer of global progress by providing a framework into which an action-oriented roadmap can be crafted with concrete and sector-specific targets; and
3) Be useable by heads of government and ministers when communicating with citizens and journalists about the importance of action on AMR while providing identifiable moments of success.
The resulting 1-10-100 unifying goals are an ambitious but achievable vision for AMR action by 2040.
| Goals | Potential Progress Measures/ Indicators |
|---|---|
| 1 Health: We must unite the world through a One Health approach to safeguard human health, animal welfare, agri-food systems, and the environment from the emergence and spread of drug-resistant microbes and infections. | • More secure livelihoods (e.g., percent reduction in pathogen introduction and spread between farms; percent reduction in people forced into extreme poverty by AMR) • Sustained biodiversity (e.g., percent of land and ocean designated as protected). |
| 10 million lives saved: Using 2025 as a baseline, 10 million lives can be saved by 2040 through concerted efforts to prevent and appropriately treat infections while preserving the vital systems and services that depend on sustained antimicrobial effectiveness. | • Enhanced vaccination programs (e.g., percent vaccination coverage for humans and animals) • Improved water, sanitation, and hygiene (WASH) infrastructure (e.g., percent access to clean water and sanitation) • Improvements to infection prevention and control (IPC) measures (e.g., percent compliance to IPC and biosecurity measures) • As a result of these actions, preventing loss in economic productivity (e.g., percent GDP loss averted). |
| 100% sustainable access: We must commit to ensuring that antimicrobials are available and affordable for all, used prudently, and secured for the future through innovation. | • Greater access (e.g., percent access to quality-assured antimicrobials, diagnostics, and health services for humans and animals) • Enhanced conservation (e.g., percent of antimicrobials used that meet treatment guidelines; percent reduction of non-veterinary and non-phytosanitary use of antimicrobials in the agri-food system) • Innovations (e.g., number of new antimicrobials, vaccines, diagnostics, and social innovations). |
Advantages of the 1-10-100 Unifying Goals
The 1-10-100 unifying goals could be used as an umbrella to structure more technical objectives that have been put forward by the Global Leaders Group on AMR (GLG), in the Lancet Series on Antimicrobial Resistance, and others. Advantages of the 1-10-100 unifying goals proposed by the Bellagio Group for Accelerating AMR Action, include:
- A focus on prevention: We call for investments in effective interventions such as vaccinations and WASH infrastructure. Achieving these unifying goals is possible because some of the most cost-effective and impactful interventions to sustain antimicrobial effectiveness are the same interventions that are urgently needed to protect lives and livelihoods from preventable infectious diseases.
- Integration with existing SDGs: The unifying goals align with SDGs across One Health sectors related to universal health coverage, access to WASH, food security, and maternal and child health, thereby leveraging existing investments to effectively address AMR within a shorter timeframe.
- Promotion of health equity: By expanding access to effective antimicrobials while investing in prevention-focused interventions, these unifying goals will most benefit LMICs, newborns and children, and marginalized communities, where the burden of infectious disease is highest, access to effective antimicrobials is the lowest, and health and agri-food systems are least prepared to respond.
- Multisectoral action and collaboration: The unifying goals put One Health first and fully integrate the health of humans, animals, plants, agri-food systems, and the environment in the achievement of every target. They are not achievable by any single country or any single sector, which will allow for context-specific approaches to attain them and many opportunities for political ‘wins’ along the way.
- Recognizes the need for innovation: To secure a future where effective antimicrobials and alternative treatments are available to all when needed, the 1-10-100 unifying goals underscore the need to develop new equity-promoting diagnostics, vaccines, and social innovations.
This work is openly licensed via CC BY 4.0. Please address inquiries about this brief to the AMR Policy Accelerator team: policy@globalstrategylab.org.
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