Researchers share goals of using a One Health-approach, to save 10 million lives and aim for 100 per cent sustainable access to effective antimicrobials in new policy paper

TORONTO, September 18, 2024 – Antimicrobial resistance (AMR) contributes to millions of deaths annually, a problem that only becomes more pressing and will be a focus of a United Nations high-level meeting in New 91��ɫ later this month. Ahead of this key meeting, 91��ɫ researchers with the (GSL) and a group of international collaborators that emphasize an all-in approach where antibiotics and other antimicrobials are available to everyone, especially those who need them the most, and millions of lives are saved.

GSL’s co-director and Faculty of Health Assistant Professor , who was a key player in drafting the proposal, says that the goals, while ambitious, are also wholly achievable.

“Similar to climate change, AMR poses a threat to human and animal health, food security and economic wellbeing globally, so tackling the problem successfully requires a One Health approach that takes all of these factors into account,” says Poirier. “Low- and middle- income countries face even greater challenges with less access to life-saving antimicrobials, fewer resources and a higher burden of AMR, and children under 5 are particularly affected.”

Poirier and other GSL colleagues had also convened a meeting earlier this year in Italy with other global health and policy experts, and the resulting discussion led to the creation of the 1-10-100 goals, outlined in a in the journal Globalization and Health.

The goals look at three key areas:

• One health: The interconnections between people, animals, agrifood systems, and environment means a collaborative approach involving multiple sectors is fundamental
• 10 million lives saved: The researchers say 10 million lives could be saved by 2040 through efforts to prevent and properly treat infections while preserving antimicrobial effectiveness. This would include enhanced vaccination programs, improved water, sanitation, and hygiene infrastructure and improvements to infection prevention and control
• 100 per cent sustainable access: Antimicrobials must be available and affordable for all, used only when needed, and new antimicrobials must be developed for future use

Since that meeting, other goals and targets have been presented, including a 10 per cent reduction in mortality from AMR, a one-fifth reduction in inappropriate human antibiotic use, and reducing unnecessary animal antibiotic use by 30 per cent.

While AMR is the result of a natural process where bacteria, viruses and other microbes evolve to develop resistance to the drugs used to combat illness, the rapid proliferation of drug-resistant infections is a huge threat globally.

Poirier will be in New 91��ɫ at the time of the UN high-level meeting on AMR Sept. 26, and says that regardless of the meeting’s outcome, it’s crucial that UN member states do not take a merely technical approach to setting targets.

“This is a historic opportunity for member states to introduce unifying goals that rally public and political support to accelerate policy action to mitigate AMR,” says Poirier, also 91��ɫ Research Chair in Global Health Equity. “The stakes are huge; there’s literally millions of lives at stake. While AMR does affect some countries disproportionately, none of us are immune.”  In a , Poirier further elaborates on the topic.

About 91��ɫ

91��ɫ is a modern, multi-campus, urban university located in Toronto, Ontario. Backed by a diverse group of students, faculty, staff, alumni and partners, we bring a uniquely global perspective to help solve societal challenges, drive positive change, and prepare our students for success. 91��ɫ’s fully bilingual Glendon Campus is home to Southern Ontario’s Centre of Excellence for French Language and Bilingual Postsecondary Education. 91��ɫ’s campuses in Costa Rica and India offer students exceptional transnational learning opportunities and innovative programs. Together, we can make things right for our communities, our planet, and our future.

Media Contact: Gloria Suhasini, 91��ɫ Media Relations and External Communications, 647-463-4354, suhasini@yorku.ca

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New paper from Global Strategy Lab calls for antimicrobial resistance to be reframed as a sustainability issue

TORONTO, Jan 9, 2024 – From a wartime spread of antimicrobial resistant disease in Ukraine, to superbugs in China causing “white lung” pneumonia in children, 2023 brought no shortage of new evidence that antimicrobial resistance (AMR) continues to be a pressing problem globally, and this pattern shows no sign of abating in 2024 unless a radical shift occurs. 

To truly tackle the issue of AMR, 91��ɫ researchers with the Global Strategy Lab (GSL) argue it needs to be understood as a socio-ecological challenge that accepts AMR as a phenomenon stemming from natural evolutionary processes. In other words, the war on bugs can’t be won; what’s needed is a major change in how people live with it. 

“For the past hundred years, we’ve tried to address AMR like a medical problem. But we haven't really made much progress in actually mitigating the deeper drivers of the issue,” says, a recent 91��ɫ PhD political science graduate and lead author of in the prestigious Perspectives on Politics journal. “We argue that there's a lot of potential to make progress by instead looking at it as a problem with our relationship with the microbial world and sustainability.” 

AMR stems from both the natural tendency of bacteria, viruses and fungi to evolve as well as the acceleration of that process through human interventions such as an over-reliance or misuse of antibiotics in medical settings, to the routine use of antimicrobials in the livestock industry. Global data from 2019 showed more than a million deaths a year directly related to AMR, and the COVID-19 pandemic seems to have accelerated this process.

Last year, GSL set up the AMR Policy Accelerator with $8.7 million from Wellcome Trust to deal with this urgent threat. While Weldon acknowledges that medical and technological innovation will be a crucial component in managing the issue, new antimicrobial drugs alone will not be the solution.

“What we’re currently doing is treating the symptoms and not the causes of AMR,” says Weldon, also an investigator with GSL. “Without addressing the underlying social relationships that drive our use, innovation would have to operate at an unsustainable speed as these microbes evolve faster than we can make new drugs.”

Weldon and co-author Steven J. Hoffman, director of GSL and Dahdaleh Distinguished Chair in Global Governance & Legal Epidemiology with 91��ɫ’s Faculty of Health and Osgoode Hall Law School, outline major problems with the current governance approach to AMR. They introduce five principles for designing institutions for a better ecological fit of human-microbial ecosystems to minimize drug resistance: 

1. There’s no silver bullet. Recognizing that there is no easy fit or one-fits all solution for AMR means problem-solving must always be tailored to specific ecological situations and health challenges of diverse populations.
2. Create institutions that can adapt over time. Future proofing doesn’t mean creating institutions that are strong enough to withstand change, but ones flexible enough to evolve with the changing nature of AMR and our relationship to it.
3. Diversify practices. As the best way to tackle AMR is still unknown,  diversifying practices can help us discover what works, when, and where. 
4. Create records. As practices are diversified, records need to be kept of what works to enable learning and adjustments in policy. 
5. Involve stakeholders. This involves everyone from the public at large, to government and decision makers. 

“What we are proposing is a completely different way of looking at the issue,” says Hoffman. “We are hoping this journal article will be a foundational piece that will inspire further AMR research in this direction.”

of Weldon explain the research.

GSL is hosting the live online webinar Is “Co-existing” with Microbes the Key to Addressing AMR? on Feb. 1 at 9 a.m. featuring Weldon, Hoffman, and Clare Chandler from the London Tropical School of Hygiene & Tropical Medicine. For details and registration information,. 

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The emerging pandemic of antimicrobial resistance (AMR) and challenges to addressing it have parallels with climate change, said experts at a recent online , hosted by 91��ɫ’s (GSL), as part of World Antimicrobial Resistance Awareness Week.

Similar to climate change, AMR is frequently talked about as a problem where the responsibility is downloaded to individuals, but actual solutions need to be collective ones tackled at the systems level,” says 91��ɫ School of Global Health Professor Susan Rogers Van Katwyk, who is also the managing director of the GSL.

“For many years, I think we really thought of antimicrobial resistance as a problem that was limited to the health-care setting and so it was siloed off to be managed individually between physicians and their patients as a medical problem,” says Rogers Van Katwyk. “What's changed recently is more of a recognition that antimicrobial resistance … has very far-reaching consequences that go beyond human health — that go into animal health, that go into agriculture, food systems, the environment.”

“As Canada’s third-largest university, 91��ɫ is committed to tackling the world’s most pressing issues of our time. Climate change and AMR are among those that highlight the importance of embracing a more sustainable way of living,” says Rhonda Lenton, President and Vice Chancellor. “As a mother and grandmother, I think often about the future that we are creating and the urgency of taking the necessary steps to address these global threats now. We are proud of the GSL’s work aimed at driving positive change in AMR for the benefit of all.”

Timothy Jinks, head of infectious disease interventions at global health charity Wellcome Trust, who was also part of the panel, points out that the global ramifications of AMR are felt unevenly.

“The impact and consequences of Antimicrobial Resistance is felt greatest by people in sub-Saharan Africa, South Asia and Asia.”

Wellcome has granted the GSL $8.7 million for the AMR Policy Accelerator, a unique initiative that will provide vital research and services to support evidence-based policymaking and the development of effective AMR national action plans.

Rogers Van Katwyk says one thing the climate change space has done very well is using targets as a communications tool, something the AMR space could learn from.

“You see these news articles that come out on a regular basis that assess whether the world is on track to meet those goals and if they're not, then we have an entire conversation on a regular basis about what needs to change.”

GSL director Steven Hoffman, who is also a professor at 91��ɫ’s Faculty of Health and Osgoode Hall Law School, moderated the panel.

“A lot of the conversation around climate change, just like a lot of the conversation and antimicrobial resistance, is often around benefits and of action and burden sharing, and mitigating causes, but also recognizing that the historical contribution to the development of a problem is not equally shared across countries,” Hoffman notes.  

For decades, the overuse and misuse of antimicrobial drugs for human health, agriculture, and the environment have resulted in bacteria, fungi, and other microbes that are increasingly resistant to essential life-saving medicines. As a result, even simple infections are now more complicated — and sometimes impossible — to treat.

“The AMR policy accelerator is really designed to help governments address the policy challenges that we've been working through in this space,” says Rogers Van Katwyk. “Our platform has really been designed to help bridge the scientific evidence to that policy space.”

Other participants included Raheelah Ahmad, knowledge mobilization & policy lead with the System for Enteric Disease Response, Investigation, and Coordination, and Arshnee Moodley, AMR team leader with the International Livestock Research Institute in Kenya.

Ahmad says it is important not to flatten the issue.

“I can think of excellent examples in Kerala, India, at the Amrita Institute, who have excellent IT systems within their hospital, which I have not found in some parts of high-income countries,” she said during the panel.

Similarly, even high-income countries have settings that are lower resourced.

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New policy accelerator aims to bridge science and politics with $8.7 million backing from Wellcome Trust

TORONTO, Nov. 22, 2022 – While recent health-care attention remains on the ‘triple threat’ of COVID-19, influenza and respiratory syncytial virus, we cannot overlook the emerging pandemic of antimicrobial resistance — an already critical problem with the potential to become so dire that a small cut could lead to death, as without reliable antibiotics, some infections could be untreatable, say researchers from the 91��ɫ-based Global Strategy Lab (GSL). 

Creating solutions to antimicrobial resistance (AMR) will be made possible with a unique project initiated by 91��ɫ’s GSL and an $8.7-million grant from , a global charitable foundation that supports science to solve urgent health challenges.

Antimicrobial drugs are increasingly falling short in their ability to tackle infectious bugs due to overuse, and this has only intensified since COVID-19 began. It has gotten to the point where we might see basic health-care standards compromised within a generation, GSL experts say. The , an ambitious initiative by GSL, will act as a critical antidote to this global threat by intersecting scientific research and evidence-based policy to urge governments to act.

“It's not one bug and one drug that we're worried about — it's the whole ecosystem,” says GSL’s, a leading epidemiologist who acts as managing director of the new project. “People around the world, and Canadians in particular, expect when they go to the doctor’s office that there's going to be a drug that's going to be able to treat their infection. We're increasingly looking at a situation where that won’t be possible unless we change course.”

The Accelerator is not a typical research project. While some of its output will be academic papers, it will also provide customized research and advisory services to governments and civil-society organizations — especially in low and middle-income countries — in response to requests for evidence on AMR policy, implementation, and evaluation.

"The AMR Policy Accelerator will leverage the Global Strategy Lab’s proven track record of using evidence to advise the world’s governments. These much needed research-based solutions for policymakers will result in more equitable and effective AMR policies and action plans worldwide,” says GSL director, who is also a professor at 91��ɫ’s Faculty of Health and Osgoode Hall Law School.

The initiative is led by Hoffman and Rogers Van Katwyk, with support from 91��ɫ researchers,  and and University of Ottawa’s. Wellcome supports discovery research into life, health and well-being, and works to take on mental health, infectious disease and climate and health, pledging to spend £16 billion over the next 10 years. 

The GSL team will look at AMR from its three main points of spread and how these intersect: human, animal and environmental. They will work with governments to not only give them the best research information, but also tailor solutions for local challenges, a message they are emphasizing this World Antimicrobial Awareness Week and will tackle in more detail during a panel discussion on equity and AMR happening this Thursday. 

“We know that what works in a high-income country like Canada isn't necessarily going to be what works in a low-income country that struggles to get clean water in their rural hospitals,” says Rogers Van Katwyk.

The researchers say because of AMR, longer hospital stays, drug-resistant strains of pneumonia, tuberculosis and staph, untreatable gonorrhea, and infections leading to amputations are already a reality. In the next 20 to 30 years, the situation could become dire. Women would be at high risk for deadly infections when giving birth via c-section, because without reliable antibiotics, the risk of surgery leading to serious infection would be too great. 

While some experts have flagged AMR as the next potential pandemic, the researchers say it could already be described as one.

“We already know it's spreading rapidly around the world,” Rogers Van Katwyk says.

 from 2019 showed more than a million deaths a year directly related to AMR. The COVID-19 pandemic seems to have accelerated this process, with research from the Centers for Disease Control and Prevention showing a 15 per cent increase in both AMR resistance and AMR-related deaths in U.S. patients hospitalized with COVID-19 in the first year of the pandemic.

“With COVID-19, with that many people in hospital — intubated and experiencing secondary bacterial infections — that’s created massive opportunities for more antimicrobial resistance to develop,” Hoffman says. “If decision-makers don’t implement sound policy based on evidence, we may be facing the next crisis without these vital treatments.”

While overreliance in medical settings is a major source of AMR, it is not the only one. Animals receive the same antibiotics humans do, and while some use is responding to infectious disease, a lot is done pre-emptively or as a growth promoter, especially with livestock in industrialized food settings, the researchers say. Resistance can then develop in the animals themselves and in the environment through waste. 

Governments need to tackle all of these sources and how they interact. 

“We can't bring antibiotic use down to zero, but we can bring it down to a sustainable level where we conserve the drugs’ effectiveness,” Rogers Van Katwyk says. “So we can keep using antibiotics now and in the future for our kids, and we don’t lose what is ultimately an incredibly precious resource.”

To register and submit questions to global experts as part of the Importance of Equity in AMR Policy Making panel happening Thursday, Nov. 24 at 10 a.m. EST/3 p.m. GMT, .

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Media Contact: Emina Gamulin, 91��ɫ Media Relations, 437-217-6362, egamulin@yorku.ca

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