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Since Alexander Fleming’s discovery of penicillin in 1928, antibiotics have protected hundreds of millions of people from infectious diseases and are now taken for granted as part of modern life. But overuse of antibiotics is leading to new bacteria strains immune even to antibiotics of last resort.

On 21 September world leaders will meet at the United Nations headquarters in New York to adopt a new declaration on antimicrobial resistance.

In advance of this meeting GEDB researcher Peter Søgaard Jørgensen and colleagues have published a commentary in Nature arguing that the susceptibility of microbes to antibiotics is a global commons that has been “depleted by the massive use of antimicrobial compounds”. They point to the need for coordinated action worldwide across economics sectors, since the problem of antibiotic resistance by no means concerns only human health care. The authors take the use of antibiotics in the food industry as an example:

“In the United States, 70–80% of all antimicrobials consumed are given to livestock; agricultural use in the BRICS emerging economies (Brazil, Russia, India, China and South Africa) is expected to double by 2030, compared to 2010 levels. As a result, antibiotics and resistance genes enter the food chain, soil and the water table.”

Solutions require creativity

The authors, which also include Stockholm Resilience Centre researcher Maja Schlüter and Beijer Fellow Simon Levin, argue that the aim of such a declaration must be to build resilience of our global society and the microbiome to maintain low levels of resistance and they set out a series of recommendations to protect this global commons.

While technical innovations such as new drugs or diagnostic systems are essential, they are only part of the solution and are likely to backfire without a complementary strategy.

“There are strong economic incentives to pursue these solutions, and powerful vested interests to promote them, with large pharmaceutical companies in wealthy nations benefitting directly from such policies,” says Søgaard Jørgensen.

“However, long-term resilience might be better served by launching the broadest and most creative participatory education campaigns about resistance and the importance of the microbial world.”

Stronger action needed

Countries are now taking action. The authors point to the European Union, which a decade ago phased out the use of medically important antibiotics for growth promotion in agriculture. More recently the private sector has started moving in the right direction as well, with companies taking the lead in responding to consumer demand by reducing antibiotic use in the products they sell.

However, action needs to be stronger, truly global and the incentive systems and financial backing present in the global “north” need transferring south. “The Ebola crisis highlighted the Achilles Heel of a global threat-response system dependent on resources from wealthy nations but where the threats originate in poor countries,” say the authors.

They call for new global platforms to share best practice and data. Moreover, countries should set targets on limiting resistance and develop indicators such as median yearly consumption of antibiotics per person. Finally, the authors say the world needs an international code for companies to limit their promotion of antibiotics.

Read Peter Søgaard Jørgensen's blog-post in the World Economic Forum Blog.