Unpacking the Independent Panel on Evidence for Action Against AMR

Demetria Tsoutouras 

Welcome to another episode of Unpacking AMR, the podcast that unpacks the latest AMR policy research. My name is Demetria Tsoutouras and I’m excited to be joining as a new co-host. On future episodes, you’ll hear me alternating episodes with my wonderful co-host, Daniela Corno. I can’t wait to introduce today’s topic, so let’s dive right in. In 2024, country representatives at the UN General Assembly called for the creation of an Independent Panel on Evidence for Action Against AMR or IPEA, for short. It’s expected that the scientific panel will provide countries with the best possible evidence and clear guidance on how to effectively address AMR. This could be a huge step forward in addressing AMR. On today’s episode, we’ll hear from two AMR experts that we had the opportunity to interview in June, on the design and development of the IPEA. We’ll explore what the process of establishing a scientific panel entails and what IPEA’s establishment might mean for countries around the world. 

Iruka Okeke 

Hello, I’m Iruka Okeke. I am a professor at the University of Ibadan in Nigeria. My group conducts research on antimicrobial resistance and other aspects of bacterial infections. 

Anthony McDonnell 

Hi, thank you very much for having me. I’m Anthony McDonnell, a policy fellow at the Center for Global Development and an economist by background, and I lead most of our work on antimicrobial resistance. 

Demetria Tsoutouras 

The 2024 political declaration on AMR commits to the establishment of the IPEA by the end of 2025. The Quadripartite is leading this process, ensuring that country representatives get a seat at the decision-making table and that existing resources are used effectively. Let’s pause there to unpack this a bit further. The Quadripartite organizations comprise four key entities, the Food and Agriculture Organization, the United Nations Environment Programme, the World Health Organization, and the World Organisation for Animal Health. Their goals include preserving the effectiveness of antimicrobials, and promoting their responsible, sustainable, and equitable use across the full spectrum of health, spanning people, animals, plants, and the environments we all share. This One Health approach recognizes human, animal, and environmental health are all deeply interconnected. The Quadripartite’s efforts to address AMR also support progress towards the Sustainable Development Goals and the continued implementation of the Global Action Plan on AMR. But what is the desired outcome of the IPEA? What do we hope to achieve by developing it? Let’s hear from Anthony, 

Anthony McDonnell 

What I would like to see is that we generate the evidence that different groups need, whether that’s better understanding of the problem and better understanding of the solutions. There’s a lot of evidence that exists already, but it often is only tailored towards high income countries, because that’s where most of the research takes place, or is only available in certain environments. How do we discuss and synthesize that evidence to see what is available in other places? And you know, it could — I’m from Ireland, so we’re a high-income country, but we’re very small. So what evidence is useful in the world that is benefit to Ireland? But also, where are there gaps for broader countries? And then, and then, hopefully encouraging the filling of those gaps so that we get the evidence that we need to address this problem 

Demetria Tsoutouras 

It’s crucial for this panel to generate evidence that addresses the real needs of countries, ensuring that no one is left behind. In the political declaration, article 30 talks about how IPEA will quote, “facilitate the generation and use of multi sectoral scientific evidence to support member states and efforts to tackle antimicrobial resistance.” But the panel will also have to consider long standing challenges faced by people living in lower resource settings, such as limited access to health care, safe water and sanitation, and the lasting impacts of colonialism and global inequity. AMR doesn’t stop at borders, which means solutions must be tailored to local realities, priorities, and systems. 

Iruka Okeke 

Article 30 that came out of the UN General Assembly declaration, a key word there is the word support. Evidence is actually supportive. And I mean everybody who really understands what antimicrobial resistance is and the threat that it poses wants to do something. And there are limited resources worldwide, but especially in lower-income settings, and so we want to make sure that the action that we take is actually cost effective. You know, I think it was a Tadataka Yamada many years ago in the context of malaria control, but very, very applicable in the context of antimicrobial resistance, that said, if you’re not keeping a score, you’re just practicing like tennis. So you know, we need the evidence to be able to keep score, to know where we’re starting from, see how things are going, and know when we have we’ve made progress, so that we can pat ourselves on the back, but also leverage it for further progress. 

Demetria Tsoutouras 

Dr. Okeke put it so clearly, evidence is actually supportive. It’s not just about collecting data. Evidence is a tool for accountability and informed decision-making by showing what works and what doesn’t; evidence guides better policies to tackle AMR. It helps countries weigh tradeoffs, allocate scarce resources and shape policies and investments that reflect local needs, especially in settings with limited resources. But the window to establish the IPEA is tight. The political declaration calls for it to be up and running by the end of 2025. What will it take to make that happen? 

Anthony McDonnell 

The Quadripartite just launched a consultation which will run through the summer, and they’re planning to take all of the results of this consultation and the analysis that they’ve did, and they’ve said that they will launch in December. The most likely place that they’re going to launch is on the sidelines of the UN Development as a UN Environmental Assembly, which is the in the 8th to 10th of December, at an event in those sidelines, but that is not yet fully confirmed. 

Demetria Tsoutouras 

Earlier this year, a workshop brought together research and policy experts in Lagos, Nigeria to discuss the development of this panel. Why was this event such a key item in the road towards the development of an IPEA, and why was it so important that it was hosted in Nigeria? 

Iruka Okeke 

The path to establish this panel was going to be run pretty quickly, and it was very, very important for us that all stakeholders from all over have the opportunity to weigh in. So we saw this as a way to help the consultation, to bring many voices to the table, to have an in person conversation about what the panel should look like, and not only to have this conversation with AMR stakeholders, obviously, they were important to have at the table, but also to talk to people who had a lot of familiarity with other global panels that have done this kind of work for other common use problems. It was important for us to have this in an African country, because that way would make it easier for other African stakeholders to attend. This was one meeting I went to where there were very few issues with visas. So, it was nice to know that, you know, everybody who needed to be there could be there. And also, the way we conducted the meeting, it was largely participatory, so we did have some plenary sessions, but the talks were short. Most of what we did was done in breakout sessions, where everybody had a voice around the table 

Demetria Tsoutouras 

A panel like the IPEA should use an equity-based approach to enhance global coordination, build a real-time evidence base, and monitor global progress in addressing AMR. IPEA will have to balance independence with influence, representation with focus, and be built to withstand political pressure. The workshop gave participants a chance to think through what those tradeoffs might look like. 

Anthony McDonnell 

Yeah, so I think there was a lot of discussion around how different functions work and don’t work in other areas that can be learned from so Global Strategy Labs presented some really useful work that they did looking at climate and an independent panel there, and taking kind of lessons from the literature and applying it and put forward a model that they saw as kind of ensuring independence, or you saw I should say, ensuring independence from the independent panel but also creating a safe space for open dialog by us embedding it in the international architecture and ensuring that it, you know, has the support and buy in to be properly funded. And I guess the kind of, the broader takeaway is that there’s kind of, there’s many different ways that we can bring together an independent panel, but there was a broad consensus that this panel should be independent. It should be able to speak to the Quadripartite and hold them to account, as much as holding nation member states to account, so that it can be kind of a fair assessment of what’s happened and that there does need to be proper systems in place to make sure that people across the world are represented. And as I said, this was in Africa, and it was, you know, the first meeting I’ve ever been to where the most represented conferences were tend to be from the global south and not the global north. 

Demetria Tsoutouras 

The Global Strategy Labs, AMR Policy Accelerator team, had the privilege of attending this important event and contributing new research to the discussion. In a nutshell, our research found that for science to inform policy effectively, it needs to be relevant, credible, and legitimate. Achieving all three will require careful design decisions. The workshop highlighted the importance of the process, putting emphasis on inclusion, participation, and access. And as Anthony and Iruka said, it was a huge win that this meeting took place in a country that allowed multiple representatives from the global south to attend without the burden of visa barriers. But how do these insights actually shape the panel? How will the outcomes from Lagos feed into the formal consultation process now underway? 

Iruka Okeke 

Well, first and foremost, the Quadripartite was actually at the meeting. So, you know, they had the direct opportunity to listen to what people were saying, provide some informal comments, but they were really there as listeners. So that’s the first thing. The second thing is that everybody at the workshop was invited to feed into the Quadripartite consultative process. This is something that is actually open to people broadly, but which many of the attendees may not have been aware of if they did not receive a direct invitation. So, by attending the meeting, they were invited to weigh in. Thirdly, we are actually disseminating some of the findings at the panel. Before the workshop took place, we had actually commissioned seven papers, so everyone came to the workshop well informed about the status quo. It’s important that the Quadripartite hears this, because obviously they are the ones taking the decision. But I think it’s also important that broader stakeholders become aware of this discussion and how it may shape what the Quadripartite eventually comes up with. 

Demetria Tsoutouras 

One of the papers commissioned ahead of the Lagos meeting came from the Center for Global Development, co-authored with researchers from the University of Ibadan. This paper explored what representatives across different countries, sectors, and disciplines want from the IPEA. 

Anthony McDonnell 

We, as part of this, interviewed 60 different people, either as part of roundtables or in one-to-one interviews to understand what different stakeholders, both geographically and sectorally representative groups, wanted from this independent panel. In many ways, there were a lot of consensuses. There was broad consensus that there needed to be a lot of different groups represented in the independent panel. There’s essentially three ways you could run a panel like this one is to have it be solely independent of government. But different analysts kind of felt that in that instance, it might become unimportant or ignored. In contrast, you could have something like the IPCC, which is an intergovernmental panel, and their governments, play much more of a role deciding who the authors are selecting the agenda, but such a process can lead to small numbers of countries vetoing progress or certain issues not being discussed. And so instead, it was a lot of buy in for kind of a hybrid model where countries are involved, but not to the same extent they would be at an intergovernmental panel, but at the same time, this isn’t just an independent entity that is, you know, out there in the wilderness, writing papers that nobody needs, or that are answering questions that aren’t the questions that governments think are useful for them in tacking this problem. There was a lot of emphasis on the need for transparency. People need to know how these decisions are being made, how different people are being appointed, but also what is the evidence that is leading to any synthesis or conclusion. 

Demetria Tsoutouras 

It’s essential for the IPEA to have global representation, and a wide range of expertise, including microbiologists, clinicians, social scientists, economists, policy makers, and communication specialists. Each of these groups brings different kinds of evidence that are essential for tackling antimicrobial resistance. For example, microbiologists contribute laboratory-based data on resistance patterns. Clinicians bring insights from real world prescribing practices and patient care, while social scientists help us understand behaviors, systems, and community level drivers. Communications experts help us translate this evidence into messages that resonate with decision makers and the public. Together, these perspectives help create a more complete picture of what’s happening, and what’s needed to address AMR. The foundation of IPEA will require involving the right stakeholders from the onset and ensuring ongoing support to maintain momentum. We’ve talked a lot about what an effective IPEA could look like and what it needs to succeed, but of course, none of that is possible without resources. Sustained funding will be critical to IPEA’s long-term impact. I asked our guests what challenges they foresaw in securing that kind of reliable funding, especially given today’s global funding climate. 

Anthony McDonnell 

We’ve seen many European countries and the United States vastly cut their contributions to multinational organizations and international development more generally, which will reduce the amount of funding in the global health system. It is also more difficult for any of the individual members of the Quadripartite to fund this, the who are having huge funding problems at the moment. And so, there are lots of challenges to this. I think the one hope I would have is that if you look at the IPCC, it’s not actually very much money in terms of the whole scale of things. I think these 7, 8 million Euro a year is what it costs to sustain the IPCC, which is an awful lot of money for an individual, but if you compare it to the 10s of billions of dollars that are spent by various global health institutions, or the, you know, 10s of 10 ish trillion dollars that we spend on health care across the world. It’s actually a very small sum. 

Demetria Tsoutouras 

Recent cuts to global health funding include the UK Government cutting funding to the Fleming Fund, which has provided vital support to AMR initiatives in low- and middle-income countries, and cuts to the World Health Organization. Recently, The Lancet published an open letter highlighting the urgent need to protect the WHO’s leadership capacity during health crises, and the importance of maintaining the WHO’s international cross border coordination. Can we really afford not to invest in global efforts to address AMR? The World Bank estimates that AMR could result in 1 trillion US dollars in additional health care costs, by 2050 and one to $3.4 trillion dollars of GDP losses per year by 2030. If funding the IPEA costs close to the approximate 8 million euros needed annually to fund IPCC, it’s a drop in the ocean compared to global health spending and projected costs AMR’s impact will have if we don’t do more. AMR is a crisis we can’t afford to ignore. 

Iruka Okeke 

I think it’s really important that this panel be inclusive and trusted. Otherwise, it’s just going to be doing stuff in a corner. It really needs to be able to bring evidence to action. And so, I think transparency and inclusiveness are going to be really important so that, so that individuals and countries can trust the panel. 

Anthony McDonnell 

There needs to be high quality research that countries and researchers believe and trust coming out of this, and ultimately, sustaining power from this panel will be in them being able to demonstrate that there is a value to it. Antimicrobial resistance has been around for a long time. It will be around for a long time. And while there are real reasons why we need to take decisive actions to deal with this, collecting evidence is not always the quickest thing it takes a long time to build surveillance systems, it takes a long time to run clinical trials; it takes a long time to do large literature reviews and collate evidence. And so, whether or not this gets up and running in December of 2025 shouldn’t be this, whether it succeeds and where we are in 2026 or 27 probably isn’t also the marker of success. What we want is something that in the medium term, can churn out lots of papers, and are high quality. It’s more about quality and quantity papers and studies that both answer the questions about how bad this problem is that help us better understand what is driving this problem. Because actually we know, in kind of broad terms, what is causing antimicrobial resistance, but the what the individual drivers and what to what extent say, is antibiotic use and agriculture driving resistance over antibiotic over the counter sales versus hospital use is poorly understood, and so a better understanding of those things. And then I think most importantly, you know what, what are the things we can do to stop this? And if, by the end of this decade, we’re getting a much better quality effort and much more evidence, particularly in the parts of the world where there is less evidence at the moment and which also unfortunately tend to be the parts of the world where the need is greatest, then I think this, this will be a success, and hopefully it will manage to to sustain itself and to keep taking things forward. 

Demetria Tsoutouras 

Thank you to our guests for joining us on this episode, Anthony McDonnell and Iruka Okeke. I’d also like to thank our behind-the-scenes crew for their support on this episode, Sofía Gutiérrez, Sahar Khan, Kayla Strong, Daniela Corno, Deni Dryanovska, and Lisa Freire. And thanks to you for tuning in for another episode of Unpacking AMR.  

To find our resources about the topic we discussed today, visit our podcast page at www.globalstartegylab.org/unpackingamr. Until next time, remember, AMR is more than drugs and bugs.