J Antimicrob Chemother 2014; 69: 2883 – 2885

doi:10.1093/jac/dku346 Advance Access publication 8 September 2014

The World Health Assembly resolution on antimicrobial resistance

Laura J. Shallcross1,2* and Sally C. Davies2
1
Research Department of Infection & Population Health, University College London, Farr Institute of Health Informatics Research, 222
Euston Road, London NW1 2DA, UK; 2Office of the Chief Medical Officer for England, Department of Health, 79 Whitehall,
London SW1A 2NS, UK

*Corresponding author. Tel: +44-(0)20-3549-5540; E-mail: [email protected]

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Antimicrobial resistance is a global problem that can only be tackled successfully through strengthened inter-
national partnerships. A concerted political, scientific and media campaign has garnered support for the recent
World Health Assembly resolution on antimicrobial resistance, mandating the WHO to develop a global action
plan. This resolution has the ‘One Health’ approach at its core, emphasizing collaboration across human and
animal health sectors at the international, national and regional levels, coupled with strong leadership and
the political will to act. Key themes are communication, prevention of infection, using knowledge to guide action,
sustainability and optimizing the use of antimicrobial medicines and diagnostic devices. Implementation of the
global action plan will require member states to make a commitment to developing national action plans and
strengthening capacity, building on collaborations between the WHO, the World Organisation for Animal Health,
the World Bank, Codex Alimentarius and the Transatlantic Task Force on Antimicrobial Resistance.

Keywords: World Health Organization, WHO, public health, policy, global health

Introduction focus in many countries was tackling healthcare-acquired infec-

tions caused by bacteria such as MRSA and Clostridium difficile.
Antibiotics underpin all aspects of modern medicine from major Since 1998 there have been a series of World Health Assembly
surgery, chemotherapy for cancer and organ transplantation (WHA) resolutions on AMR (Figure 1),4 paving the way for the
through to the treatment of simple bacterial sore throats. Until 2001 WHO global strategy for the containment of AMR,5 the
now we have escaped the dire consequences of resistance because 2011 EU AMR Strategic Action plan2 and the 2012 EU Council
of the stream of new antibiotics introduced in the last century, but Conclusions.6 Despite these efforts, AMR has continued to escal-
there have been few such new drugs over the last 25 years. Now, ate and the need to accelerate progress has been acknowledged
cautious estimates of the attributable deaths run at 25 000 per by the WHO, the USA and the European Commission. To achieve
year in Europe and 23 000 per year in the USA.1,2 Emergence of change at the rate required to impact on AMR requires political
resistance is a natural phenomenon but certain environmental will and global action, working across human and animal health
conditions promote its development, including using the wrong sectors through an international partnership, known as the ‘One
antibiotic, the wrong dose or too short a course and using one anti- Health’ approach.7 The WHO is well placed to coordinate this
biotic alone when combination therapy would be more appropriate. action, and the existing tripartite relationship between the WHO,
In addition, international travel allows resistant strains of bacteria the World Organisation for Animal Health and the United Nations
such as multidrug-resistant Mycobacterium tuberculosis or carba- Food and Agriculture Organization provides a mechanism for
penem-resistant Enterobacteriaceae, for example those producing collaboration across sectors, including through the Codex
NDM-1, to travel rapidly across the globe.3 Although antimicrobial Alimentarius.8 The WHA resolution is critical because it gives the
resistance (AMR) affects every country, the challenges faced by WHO a mandate to develop a global action plan by 2015, legitim-
low- and high-income countries are different, as many patients in izing action on behalf of the member states.
low- and middle-income countries with treatable infections have
little or no access to effective antibiotics. An international reso-
lution must embody the disparate needs and priorities of all Building political momentum
member states. In the UK the first national Strategy and Action Plan on
Antimicrobial resistance was published in 2000.9 It focused on
reducing rates of healthcare-acquired infection such as MRSA
Why we needed a resolution
and C. difficile and so stimulated little interest in AMR from either
AMR is not a new problem and has long been recognized as a Ministers or senior government. By the time Professor Dame Sally
threat to effective treatment. For a number of years the priority Davies published her independent report as Chief Medical Officer

# The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
For Permissions, please e-mail: [email protected]

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Leading article

2009 1 to increase political awareness, engagement and leadership in

• Progress report on 2007 Rational Use of Medicines Resolution order to accelerate efforts to secure access to effective
2007 antimicrobials and to use them responsibly;
• Secretariat's report on Rational Use of Medicines 2 to take urgent action at national, regional and local levels to
• Progress report: WHA A60/28—Progress reports on technical strengthen infection prevention and control, by means that
and health matters—Improving the containment of
antimicrobial resistance include application of basic hygiene measures;
3 to develop or strengthen national plans and strategies and
• Discussion: Report on Progress of Implementation of Resolution
on Antimicrobial Resistance adopted by the Assembly in 2005 international collaboration for the containment of
• Resolution WHA 60.16 antimicrobial resistance;
2005 4 to mobilize human and financial resources in order to
• Background: WHA A58/14—Antimicrobial resistance: a threat implement plans and strategies to strengthen the

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to global health security. Rational use of medicines by
containment of antimicrobial resistance;
prescribers and patients
5 to strengthen overall pharmaceutical management systems,
• WHA58.27 Improving the containment of antimicrobial
resistance including regulatory systems and supply chain mechanisms,
2001 and, where appropriate, laboratory infrastructure, with a view
• Background: WHA A54/17—Revised drug strategy to ensuring access to and availability of effective antimicrobial
• Resolution: WHA 54.11—WHO medicines strategy agents, taking into account financial and other incentives that
• Background: WHA A54/9—Global health security—epidemic might have a negative impact on policies for prescribing and
alert and response dispensing;
• Resolution: WHA 54.14—Global health security: epidemic alert 6 to monitor the extent of antimicrobial resistance including
and response
regular monitoring of the use of antibiotics in all relevant
1998 sectors, in particular health and agriculture, including animal
• Background: WHA A51/9—Emerging and other communicable husbandry, and to share such information so that national,
diseases: antimicrobial resistance
regional and global trends can be detected and monitored;
• Resolution: WHA 51.17—Emerging and other communicable
diseases: antimicrobial resistance 7 to improve, among all relevant care providers, the public and
Regional Committees Resolutions other sectors and stakeholders, awareness of (i) the threat
• European strategic action plan on antibiotic resistance posed by antimicrobial resistance, (ii) the need for responsible
Regional Committee for Europe, September 2011 use of antibiotics and (iii) the importance of infection
prevention and control measures;
Figure 1. Previous WHA resolutions.
8 to encourage and support research and development, including
by academia and through new collaborative and financial
models, to combat antimicrobial resistance and promote
(CMO) in 2011, this had all changed.10 She highlighted infections
responsible use of antimicrobial medicines, develop practical
and the rise of resistance, drawing national and global attention
to this problem and calling for AMR to be put on the National Risk and feasible approaches for extending the lifespan of
Register. Recognizing the need for faster progress, a new AMR antimicrobial medicines and encourage the development of
strategy was developed with greater emphasis placed on surveil- novel diagnostics and antimicrobial medicines;
lance and collecting data to measure outcomes.11 AMR was 9 to collaborate with the Secretariat in developing and
quickly placed on the risk registers of both the Department of implementing a draft global action plan to combat
Health and the Department for Environment, Food and Rural antimicrobial resistance, including antibiotic resistance,
Affairs and is being considered for inclusion on the government
which is based on all available evidence and best practices;
risk register as part of the national security risk assessment.
10 to develop antimicrobial resistance surveillance systems in
Although important for the UK, this action alone could not drive
three separate sectors:
the collaborative response and commitment that was required
from governments across the world. This demanded a strategic (i) inpatients in hospitals; (ii) outpatients in all other health care
approach: maximizing political influence, engaging with the public settings and the community; and (iii) animals and non-human
and working to develop the scientific evidence base to deliver new usage of antimicrobials.
antimicrobials.
The UK worked across government to maximize influence and Figure 2. WHA resolution 67.25.
raise AMR on the political agenda worldwide. The CMO capitalized
on her high-profile position as independent advisor to the govern-
ment to convey a compelling narrative on the threat of AMR and in the pipeline. Nonetheless it was essential to build the evidence
reach out to civil society through activities such as her TED talk base by obtaining an accurate global picture of the magnitude
‘The Drugs Don’t Work’ and book of the same name.12 The of AMR and national surveillance capacity through the WHO’s
scientific case was apparent: the burden of drug-resistant 2014 report on global surveillance, highlighting the need for
Gram-negative infections was increasing, with no new antibiotics capacity-building.13

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Leading article JAC
The WHA resolution on AMR (WHA67.25) and
Transparency declarations
global action plan
S. C. D. is the Chief Medical Officer for England and chairs the WHO
Sweden and the UK drafted the resolution, which was adopted at Strategic and Technical Advisory Group on Antimicrobial Resistance
the 67th WHA in May 2014.14 The overarching goal was to slow (STAG-AMR). Both authors declare no financial conflict of interest.
the development of resistance with focused activities around
improving knowledge on and understanding of AMR, conserving
and stewarding the effectiveness of existing treatments and
stimulating the development of new antibiotics, diagnostics and
novel therapies. It emphasized practical measures to support References
member states to develop national policies, driving global stan- 1 CDC. Antibiotic Resistance Threats in the United States, 2013. http://www.
dards on antibiotic stewardship, data collection and infection pre- cdc.gov/drugresistance/threat-report-2013.

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vention and control. This is relayed in 10 objectives (Figure 2), 2 European Commission. Communication from the Commission to the
which will culminate in the development of a global action plan European Parliament and Council. Action Plan Against the Rising Threats
with metrics to measure progress. As member states have differ- From Antimicrobial Resistance. http://ec.europa.eu/dgs/health_consumer/
ent priorities and needs related to AMR, the plan is being con- docs/communication_amr_2011_748_en.pdf.
ceived as a series of building blocks so countries can choose the 3 Johnson AP, Woodford N. Global spread of antibiotic resistance: the
most relevant blocks. A key block relates to communication, example of New Delhi metallo-b-lactamase (NDM)-mediated carbape-
improving awareness and understanding to change behaviour nem resistance. J Med Microbiol 2013; 62: 499–513.
and social norms relating to antimicrobial use. A second block 4 WHO. Governing Body Documentation. Official Records. http://apps.who.
focuses on preventing infection through hygiene and vaccination int/gb/or/.
and by developing systems to improve prevention in healthcare 5 WHO. WHO Global Strategy for Containment of Antimicrobial Resistance.
settings. Optimizing antimicrobial use is the next theme, develop- 2001. http://www.who.int/drugresistance/WHO_Global_Strategy_English.
ing evidence and protocols to support the delivery of antimicro- pdf.
bials in humans, animals and agriculture. A fourth theme 6 Council of the European Union. Council Conclusions on the Impact of
highlights the need for evidenced-based action through data col- Antimicrobial Resistance in the Human Health Sector and in the
lection and research. Further themes look to the future, develop- Veterinary Sector—a ‘One Health’ Perspective. http://www.consilium.
ing new market models to distribute products and technologies europa.eu/uedocs/cms_data/docs/pressdata/en/lsa/131126.pdf.
related to AMR and assessing the long-term economic, develop- 7 One Health Initiative. http://www.onehealthinitiative.com/index.php.
mental and societal costs of AMR. The draft Action Plan is cur-
8 Codex Alimentarius International Food Standards. http://www.
rently undergoing consultation,15 overseen by the Strategic and
codexalimentarius.org.
Technical Advisory Group on AMR, which the CMO chairs. The
9 Department of Health. UK Antimicrobial Resistance Strategy and Action
aim is to secure support for adoption of the plan at the 68th
Plan. http://antibiotic-action.com/wp-content/uploads/2011/07/DH-UK-
WHA in 2015.
antimicrobial-resistance-strategy-and-action-plan.pdf.
10 Annual Report of the Chief Medical Officer. Volume Two, 2011.
Turning the plan into action Infections and the Rise of Antimicrobial Resistance. http://media.dh.gov.
uk/network/357/files/2013/03/CMO-Annual-Report-Volume-2-20111.pdf.
A sceptic may question why this plan will make a difference where
other strategies have failed. The key issue is that AMR is like cli- 11 Department of Health. UK 5 Year Antimicrobial Resistance Strategy
2013 to 2018. https://www.gov.uk/government/uploads/system/uploads/
mate change—we do not have to let it happen. There is a strong
attachment_data/file/244058/20130902_UK_5_year_AMR_strategy.pdf.
international commitment to act, galvanized through a high-
profile campaign to convey key messages on AMR to politicians, 12 Davies S. TED Talk: The Drugs Don’t Work. http://www.youtube.com/
opinion leaders and civil society. Our global organizations are watch?v=7evvWt8XN7o.
starting to rise to the challenge, with the WHO developing stra- 13 WHO. Antimicrobial Resistance: Global Report on Surveillance. http://
tegic action plans and supporting countries developing their www.who.int/drugresistance/documents/surveillancereport/en/.
own. By talking we can raise this up the political agenda so that 14 67th World Health Assembly WHA67.25. Antimicrobial Resistance. http://
government and global action is taken so that we do not lose apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R25-en.pdf.
the wonderful benefits of modern medicine that we have gained 15 WHO. Consultation on a Draft Global Action Plan to Address Antimicrobial
through scientific research until now. Resistance. http://www.who.int/drugresistance/amr-consultation/en/.

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