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SAFEguarding Antimicrobials

“We need to think about how we’re going to create mechanisms which protect the global pool of effective antimicrobials for generations to come.”

-Julianne Piper

In this episode of Unpacking AMR we explore the principles behind the SAFE AMR Governance Partnership. As the UN General Assembly’s High-level Meeting on antimicrobial resistance approaches, our host, Daniela Corno Link and guests dive into the importance of sustainability, acceptability, fairness, and effectiveness in developing global strategies to mitigate AMR.  

Join us in a conversation with Julianne Piper, Carly Ching, Isaac Weldon, and Jeremy Grimshaw while they highlight how a collaborative, One Health approach can help safeguard our global pool of antimicrobials for future generations.  


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Isaac Weldon Link : Isaac Weldon is a Senior Research Associate at Cambridge University’s Center for Law, Medicine and Life Sciences. Isaac is also an investigator at York University’s Global Strategy Lab in Toronto. His work integrates legal and medical sciences to shape international strategies and policies addressing complex societal challenges. 


Julianne Piper Link : Julianne Piper is a Research Fellow with the Pacific Institute on Pathogens, Pandemics and Society (PIPPS), in the in the Faculty of Health Sciences at Simon Fraser University. Her research interests include global health governance, health security and development.  


Carly Ching Link : Carly Ching is a Postdoctoral Researcher at Boston University. With a background in microbiology, Carly now investigates antimicrobial resistance (AMR) through a multidisciplinary lens, integrating diverse perspectives to tackle critical healthcare challenges. 


Jeremy Grimshaw Link : Jeremy Grimshaw is a Senior Scientist at the Clinical Epidemiology Program, Ottawa Hospital Research Institute, and a Full Professor in the Department of Medicine, University of Ottawa. Jeremy’s work focuses on addressing critical global challenges such as antimicrobial resistance.

Daniela Corno 

My name is Daniela Corno and I work for the Global Strategy Lab.  
 
Welcome to another episode of Unpacking AMR. As we approach the UN General Assembly’s high-level meeting on antimicrobial resistance this September, it’s crucial to consider the goals needed to safeguard effective antimicrobials and successfully manage AMR. This meeting, only the second of its kind, is a huge opportunity for world leaders to collectively address this growing threat that AMR poses to human, animal, and environmental health.  

On today’s episode, we’ll dive into the foundational principles that drive the SAFE AMR Governance Partnership, an international research project developing guidance for governments on how to manage the existing global pool of antimicrobials in a way that is sustainable, acceptable, fair, and effective, what we call SAFE governance. Let’s start with the first part of our acronym, sustainable. What exactly does sustainability mean in the context of safeguarding antimicrobials, and how does it relate to our research? To better answer these questions, I brought some of our partners into today’s episode to dive into the acronym with me. 

Isaac Weldon  

I’m Isaac Weldon. I’m a senior research associate with the Center for Law, Medicine, and Life Sciences at the Faculty of Law at Cambridge University, and I’m also an investigator with the Global Strategy Lab at York University in Toronto. Essentially, sustainability means that we can’t use more of this precious resource than we have or at a faster rate than we can resupply it, and so antimicrobial effectiveness is this precious resource that we all share. In that way, it’s quite similar to the climate, where individual actions have the potential to have global consequences through antimicrobial use, because the more we use these medicines, the more likely it is that resistance will occur in the future. 

Daniela Corno 

It’s so important to understand that antimicrobials are indeed a shared resource, much like our environment. Just as we must protect our climate and biodiversity, we need to ensure that antimicrobials remain effective for future generations, but we also need to think of sustainability from a governance perspective. It’s not just about conserving resources; it’s about creating long term strategies and policies that ensure the continuous availability and effectiveness of these resources. 

Julianne Piper 

My name is Julianne Piper. I’m a research fellow at the Pacific Institute on Pathogens, Pandemics and Society or PIPPS. Coming out of the COVID-19 pandemic, one of the sort of remarkable moments was when the government, or member states of the World Health Organization, agreed that they should negotiate a new pandemic instrument, so a new agreement that sort of helps govern for years or decades into the future how different governments will respond when there’s a global or planetary health risk or threat. 

Daniela Corno 

The COVID-19 pandemic drew the world’s attention to critical issues in global health governance and government commitments in the face of challenging political and financial interests. And while the pandemic instrument negotiations continue to be challenging, they do signal the understanding that we need long term strategies to equitably protect health around the world now and for future generations to come. 

Julianne Piper 

Even after the sort of global devastation of the COVID-19 pandemic, there’s sort of concerns that are increasingly present around whether the commitments that governments are willing to make in those governance instruments will be enough. So, I think that’s really applicable to AMR or when you think about other potential planetary health risks where we really need sustained action. We need people to be thinking beyond, you know, the next four years or the next two years, what’s happening in the world. We need to think about how we’re going to create mechanisms which protect the global pool of effective antimicrobials. You know, for generations to come. 

Daniela Corno 

Here’s the key point of sustainability. We have to think sustainably to ensure that we’re not only protecting access to antimicrobials now, but also for the future. It’s not just the responsibility of individuals. Governments need to be held accountable for staying committed to strategies designed to preserve and optimally use this resource, and this is where another essential aspect comes into the ongoing maintenance of these strategies. Carly Ching delves into this topic, explaining how we can ensure long-term effectiveness of our efforts. 

Carly Ching 

So, my name is Carly Ching, and I’m a postdoctoral researcher at Boston University. So, sustainability to us means being able to maintain the intervention or policy over time. Our team is specifically researching strategies and methodologies to measure and report antibiotic consumption and use in animals, which is referred to as surveillance. And surveillance is critical to know how big a problem we’re really dealing with, and if progress is being made, and then by collecting that data year after year, we can see if the problem is getting better or worse, and that allows us to compare trends and benchmark policies over time. By critically evaluating different strategies, we can start to identify key policy mechanisms and differences in resources and investments that contribute to sustainability of a surveillance program. 

Daniela Corno 

Overall, surveillance ensures we stay ahead of the problem by making informed decisions to protect both individuals and populations from the threat of antimicrobial resistance. But can we achieve sustainable use of antimicrobials for all without acceptability?  

Isaac Weldon 

So, let’s imagine for a second that we said that sustainability is the only goal. Well, the easiest way to sustain any resource is just to not use it, but for antimicrobials and for a lot of other resources that would be totally unacceptable and counterintuitive and completely contradictory to the goals of public health and humanity. And so, we need to balance several tensions between access and excess, between those who have and those who don’t have, rural and urban, human health and agriculture.  

Daniela Corno 

Isaac has highlighted an essential point about the need for balance in our approach to sustainability. It’s not just about conserving resources but making sure they are accessible and beneficial to everyone, but we also need to consider how to make these strategies more accessible and balanced in practice. 

Carly Ching 

So, when we think of solutions, we have to think about things like more balanced interpretations, standardized guidelines on data use, ways to champion that data is not being overinterpreted, and then, more broadly speaking, building public or end user, in this case, for farmers or livestock workers, support to reduce antibiotic use in animals will increase acceptability overall, as there is going to be pressure for politicians and governments to follow what has the most public support. 

Daniela Corno 

In the past, AMR was often viewed solely as a human health issue, but it’s now understood to be a One Health challenge, which requires collaborative and coordinated actions across multiple sectors. Because of this, a group called the Quadripartite Joint Secretariat on AMR was formed. This group includes UN agencies focused on human health, animal health, food security, and the environment. They work together to create strategies to protect jobs, stop microbes from spreading between farms, and promote biodiversity.  

Carly Ching 

This could be approached from multiple different angles, from messaging to the public to increase scientific evidence that provides more support for evidence-based policies. And then ultimately, if a strategy is not acceptable, especially politically, it will likely not see fruition.  

Daniela Corno 

Drug resistant infections know no borders. One country can’t solve the problem of AMR all by itself. It’s really important for countries to work together to deal with AMR. We’ve learned that it is a complicated issue that needs everyone to work together worldwide. Fairness and equity are really important when it comes to trying to solve this problem, especially when we think about who benefits from the solutions and who might be harmed. 

Julianne Piper  

Fairness is at the heart, the crux, of global health governance as a field. I think about equity, for me, it means thinking about and integrating how benefits and harms are distributed within and across populations and in the AMR space this is incredibly complex. 

Carly Ching 

Fairness for our research involves thinking about whether it’s fair to ask of certain strategies across the board when there are often inequalities between different locations or context. As we’re thinking about antibiotic use in livestock practices, one question that comes up is, is it fair to ask of farmers to stop using antibiotics when it can lead to food production and economic loss and threaten their livelihood? And then furthermore, is it fair to expect the same conduct between farmers and livestock workers from high-income countries compared to low-income countries, when there may be different markets for spending on products produced without antibiotics, so any potential solutions like incentive structures or grants have to be structured based on the local context and the local economy.  

Daniela Corno 

And that’s really what we have to consider when thinking about fairness, expecting the same behaviors and rules across all regions without considering local economies and market dynamics would not be fair or practical. We need to design structures and solutions that are tailored to the specific needs and context of each community. Balancing these considerations will be crucial in promoting fairness and ensuring the effectiveness of our efforts in mitigating AMR. 

Isaac Weldon 

We think about the way that resources and access to resources are distributed in the present and how they have been distributed in the past, it’s extremely unjust. And so, when we look about moving forward, we have to also think about how we rectify these injustices.  

And I think this is a really interesting comparison to the Sustainable Development debates, the Green Debates in the 1980s and 1990s around the time when the Montreal Protocol and the Kyoto Protocol were being negotiated, where we had several rich countries come to the negotiations. We knew that emissions were bad, we knew that we had to cut emissions. But then, you know, Canada, the US and the UK came to the table and said, well, no one can industrialize the same way that we did. But you know, the North, the Global North, was largely responsible for most of the emissions because of the ways that we industrialized, the way that we underwent this process of development. And then so we came to the table, and it was extremely unfair. And there’s quite a bit of reaction from lower and middle-income countries, from stakeholders that have been unfairly marginalized or sidelined in the benefits of industrialization.  

And so, we see it from that, you know, there’s this, this tendency, or there has been this tendency, to think about kicking away the ladder and preventing everyone from enjoying the benefits of industrialization. For antimicrobials, we’re kind of seeing a similar pattern. It falls along these colonial histories where some groups have had access for a long time and have used it, have used antimicrobials quite freely. 

Julianne Piper 

There’s a need to center and create space for different perspectives coming from different contexts, other than what’s been traditionally dominated by Northern or Western academic institutions and international organizations. And if we’re going to move towards that sort of fair solutions, where we not only acknowledge but integrate considerations for making the distribution of benefits more equal and minimizing harms on populations that potentially are already more vulnerable or disadvantaged. 

Daniela Corno 

We can’t consider a successful global AMR solution without recognizing and including different perspectives, especially those that have traditionally been underrepresented. This is vital for creating truly fair and inclusive solutions. We’ve explored the importance of Sustainability, Acceptability and Fairness in tackling AMR, but now let’s turn our attention to the final pillar of the SAFE acronym, Effectiveness. Because why does it matter for doing all this work without making sure that it’s actually doing what it said it would? 

Jeremy Grimshaw 

My name is Jeremy Grimshaw. I’m a senior scientist at the Ottawa Hospital Research Institute and professor at the University of Ottawa, and I’m very pleased to be involved in this initiative. What societies and governments need are information about which policies and programs are most likely to be able to achieve reductions in antimicrobial use, reductions in antimicrobial resistance, whilst being acceptable within the kind of resources and context and other constraints those societies face. 

These policies or programs, even if they are, even if we have programs that are highly effective, they aren’t enacted in a vacuum. So, they are likely to have other knock-on effects beyond the AMR space. So, if we’re thinking about programs that may reduce antibiotic use in animals, and that may have an impact on the food chain. And if governments are trying to make decisions about which programs are going to be useful, they not only need to know what you know is it, will this lead to reduced AMR? But also, what are the other knock-on consequences so we can make a judgment about, well, what’s best for us here, and which are the ones we can use. And that’s where the SAF of SAFE, I think, comes into this. But during the census, we’ll also be trying to gather this information about, well, what else happens? What are the knock-on effects for that. And then the final challenge is that the evidence is constantly evolving and constantly changing.  

Daniela Corno 

Effective AMR policies will not only reduce antimicrobial use and resistance, but also consider the broader impact. As you’ve heard a one-size-fits all approach doesn’t work. The policies need to be adaptable to different contexts and resources, much like how Jeremy mentioned the importance of government commitment and long-term thinking, 

Carly Ching 

Effectiveness is research leading to meaningful change. So a policy or intervention may be adopted, but ultimately, we want it to lead to a reduction in AMR and what we’re working on directly feeds into measuring effectiveness as accurate and sustained data collection will ultimately allow us to determine if programs and strategies to reduce antibiotic use in AMR are producing the desired outcome. So again, tying it back, surveillance that is sustainable is critical to evaluating if change is happening and contributes to measuring effectiveness. 

Daniela Corno 

Sustainable surveillance is essential for evaluating whether our strategies are working and leading to meaningful change. By continuously collecting and analyzing data, we can ensure that our efforts to reduce antimicrobial use and mitigate AMR are truly effective.  

Isaac Weldon 

Yeah, I think effectiveness is probably the easiest of the pillars to understand. Of course, you know, if we’re going to implement strategies to address AMR globally. They have to work. And so, they need to curb antimicrobial resistance from happening. They need to improve health and well-being. They need to actually have an impact that’s positive. Crucially, this means that we need to measure, I think there’s a great opportunity now, as we start to think about what we’re going to do as we roll out strategies to also co-produce science at the same time, to have a nice integrated process between policy making and measurement and monitoring. 

Daniela Corno 

Effectiveness is crucial. But it doesn’t stand alone. Of course, while we adjust all these moving pieces of Sustainability, Acceptability, Fairness, and Effectiveness, we have to consider One Health at the center of it all. 

Julianne Piper 

Instead of focusing on like which actors are involved in AMR thinking instead about the relationships between them and one of the things that I think is quite relevant or potentially overlapping with this project, and this the SAFE acronym is the concept of One Health and the idea that in order to be effective with AMR governance, you need to really come up with solutions that address human, animal, and environmental health. 

Isaac Weldon 

In so many narratives, we try to think of humans as exceptional, and, you know, we’re also animals, right? And so really the question and the way that I think about antimicrobial resistance and the way that I think about climate change and biodiversity losses is what it really comes down to is the way that we’ve organized ourselves in relation to each other, but then also in relation to the planet and towards nature.  

And when we look at it this way, you know, it allows us to see the co-evolution of humans and microbes, kind of in a really long history. And antimicrobials are crucial in enabling us to do things that we never used to be able to do. So, everything is really interconnected when you think about the history and the way that we use antimicrobials to transform our relationship with microbes, but then also how that has allowed us to transform our relationship with the rest of the world. That’s why I think a One Health approach is super crucial. But then my only addition to the One Health approach is to also look specifically at the way that we’ve related to microbes. So not just the way that microbes transfer around these different domains between human health, animal health, and environmental health, but also the way that our relationship to microbes has changed because of antimicrobials, that has also resulted in a great and profound shift in our relationship to other animals and our relationship to the environment as well. 

Daniela Corno 

It’s clear that addressing AMR requires a multifaceted approach that includes sustainability, acceptability, fairness and effectiveness, but we have to consider these pillars in the context of One Health. This way we can better navigate the complexities of AMR governance and strive towards a collective goal of safeguarding our global pool of antimicrobials. A big thank you to all of our guests today, Carly Ching, Isaac Weldon, Julianne Piper, and Jeremy Grimshaw for sharing your insights with us. You can learn more about the SAFE AMR Governance Partnership or listen to more Unpacking AMR episodes by visiting www.globalstrategylab.org/unpackingAMR Link join us next time for another episode, and remember AMR is more than drugs and bugs. 

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