Saskia Popescu, MPH, MA, CIC – PhD Candidate, Biodefense George Mason University -USA
The infectious disease threats that jeopardize global health security are vast and evolve as technology becomes more sophisticated, populations grow, and the world gets a bit smaller. Efforts to reduce these vulnerabilities to infectious diseases have to be just as diverse and resilient. Despite strategies at the international, national, and local level, outbreaks continue to stress critical infrastructure. The Global Health Security Agenda (GHSA) seeks to address these vulnerabilities and gaps to help strengthen national capabilities in preparing for, detecting, and responding to infectious disease threats. The GHSA is an especially unique approach to address biological threats as it utilizes multisectoral partners and reaches far beyond the scope of government, non-governmental organizations (NGOs), and academia. In truth, to address the unique predicament of infectious disease, a new strategy was needed and the GHSA is just that. The 5thMinisterial Meeting of the GHSA was recently held in Bali, Indonesia, to address the most pressing issues facing global health security, assess our current state, and look towards the future with the release of the 2024 Framework.
While the DRC battles an outbreak of Ebola virus disease and influenza hits the Northern Hemisphere, one might think that antimicrobial resistance would be an afterthought at this meeting. The GHSA and those invested in its future are used to putting out fires and still battling the slow burning threats, like antimicrobial resistance, which means that this topic was a frequent point of discussion. Throughout the presentations and sessions, the topic of antimicrobial resistance was frequently brought up, especially in the context of One Health. In the U.S. alone, 23,000 people die a year as a result of resistance infections. The latest WHO reportsreveal a global issue in which the most common infections are increasingly becoming drug resistant. From the agricultural sector to healthcare and the environment, combatting antimicrobial resistance is extremely challenging and many at the meeting vocalized their concerns with such a chimeric dilemma.
On the second day, during the third session focused on achieving the 2024 overarching targets, Nick Adkin, Deputy Director of Global Health Security, Department of Health and Social Care in the United Kingdom, spoke on antimicrobial resistance. Adkin’s sentiments, even to this antimicrobial resistance enthusiast, were deeply profound and thought invoking. He highlighted that in a future of increased resistance, medical treatments like chemotherapy and standard hip arthroplasty would be too risky, meaning that as resistance grows, our medical capabilities diminish. Antimicrobial resistance is a complex, multisector issue, impacting trade, health systems, and food safety, he noted. During his talk he heavily emphasized the importance of these collaborative efforts, like the GHSA, and the tripartite that is between the WHO, the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE) that was established to combat antimicrobial resistance. Perhaps one of the topics most reiterated was Adkin’s focus on revising the Action Package surrounding antimicrobial resistance and putting more focus on an information sharing platform to increase capacity building, facilitate open forums for debate, and identifying opportunities to keep the topic on international political agendas. His talk underscored the importance of training in countries to strengthen surveillance efforts and laboratory capabilities as a considerable component to tackling antimicrobial resistance is truly understanding the scope of the problem and properly identifying patients with such infections. Towards the end of his presentation, Adkin pointed to a frequently forgotten aspect of antimicrobial resistance – the environment. Thankfully the GHSA and the tripartite both emphasize the One Health approach to these infectious disease issues. Lastly, Adkin left the audience with a vital lesson –we may have made progress, but there is still considerable work to be done and while this is a serious issue, its inherently hidden nature means that people aren’t up in arms and this does us a disservice.
As an infection prevention epidemiologist who has worked on stewardship initiatives and management of patients with highly resistant infections, Adkin’s talk on antimicrobial resistance was truly rewarding and informative. He raised issues with existing gaps while pointing to successes, which was inspiring but also a startling reminder that we still have a long road ahead. While Adkin’s talk may have only been a small portion of the Ministerial Meeting, the continued dialogue surrounding this issue was a comforting reminder that the GHSA doesn’t just focus on the current outbreaks and issues, but the full spectrum of biological threats. Attending the 5thMinisterial Meeting was a truly rewarding experience that offered attendees not only the chance to witness frank dialogue about global health security and the challenges to reaching it, but also the vast community of dedicated people and nations that work together to help reduce the threat of infectious diseases.