Imagine going into a hospital for a routine surgery and picking up an infection. Your doctors prescribe something, but the microbe is resistant to it. They go to the second- and third-line treatments, but it’s resistant to them as well. An infection that could have been treated successfully in the past suddenly has no cure.
Antimicrobial resistance (AMR) happens when microbes become resistant to the treatments that we use to keep people and animals healthy. While it is a natural process, AMR is accelerated by the misuse of antimicrobials in human and animal health, food, and agricultural systems. Worldwide, AMR is associated with about 5 million deaths and is projected to cause around $400 billion in damages by 2035.
As director of the Global Strategy Lab, Dr. Mathieu Poirier works at the intersection of health equity and health policy, focusing on issues that require global collaboration to solve. He and his team understood the threat posed by AMR and knew that concerted action was needed to change the course of the issue.
In April 2024, they gathered a multi-sector group of experts at The Rockefeller Foundation Bellagio Center (the Bellagio Center) for the Accelerating Collective Global Action on AMR Conference. The unifying goals they created are helping to shape the conversation on AMR and guide international efforts.
We spoke to Poirier in November 2024, shortly after the release of the United Nations General Assembly’s landmark political declaration on AMR to learn about the goals created at the convening and the role they’re playing in driving global action on AMR.
No one country can address antimicrobial resistance on their own. We can't achieve these goals unless the whole world takes part.
Mathieu PoirierDirectorGlobal Strategy Lab
How did the Accelerating Collective Global Action on AMR Conference at the Bellagio Center come about?
The conversation on AMR is missing unifying goals that could be used to promote cooperation and measure progress, similar to limiting global warming to less than two degrees Celsius. We need an easy-to-communicate, action-oriented benchmark that countries can use as a north star.
When the United Nations General Assembly scheduled a high-level meeting on AMR for September 2024, we realized it offered a huge opportunity to raise the political profile of this massive issue. We decided to convene experts from all the different sectors – human, animal, agricultural, and environmental health – and from a range of high-, middle-, and low-income countries to identify what unifying goals could look like.
At the Bellagio Center, we made it safe to try new ideas. If people can discuss an initial idea, tear it apart and see what else they can come up with, they will experiment and explore new directions. Iteratively going back from the larger group to smaller groups over several days led to goals that worked for everyone.
Our initial proposed unifying goal was a percentage reduction in the years of life loss that are attributable to AMR. But as the group dove into the issues, a few gaps started to emerge. First, it didn’t represent all the sectors in putting forward something that was truly “One Health.” Second, it wasn’t easy to communicate to the public. Percentage change can be much harder for people to understand than a simple, clear number. And importantly, it didn’t address issues around access to antimicrobials that face low- and middle-income countries.
We went back to the drawing board and together came up with a strong proposal that everyone was happy with. Overall, we captured all of the high-level objectives in the room with the goals we put forward, which we call the 1-10-100 goals.
What are the 1-10-100 unifying goals, and what impact do you hope that they have?
To overcome the global threat of antimicrobial resistance, we need a shared approach, measurable outcomes to demonstrate success and goals that everyone can all agree on. Millions of lives depend on it.
The 1-10-100 goals have three components. One Health, 10 million lives saved by 2040, and 100% sustainable access.
“One Health” means protecting humans, animals, food systems, and the environment. We also have to find shared benefits that help small farmers, prevent poverty, and sustain biodiversity. These are shared objectives, and we can’t act on one without including the other sectors.
To save 10 million lives by 2040, we need to focus on prevention in an equitable way, not just on AMR-specific deaths. If you prevent infections from happening in the first place, you reduce human morbidity and mortality while reducing the need for antimicrobials at the same time. Vaccination programs, improving water sanitation and hygiene, and other extremely cost-effective, proven interventions can go a long way towards meeting this goal.
When we talk about 100% sustainable access, we mean that everyone who needs effective microbials should be able to use them prudently. Even with the high number of deaths attributable to AMR, it’s still the case that more people die from lack of access to antimicrobials than from resistance. So the answer can’t just be to conserve our existing resources and not provide lifesaving drugs to those who need them. Full access isn’t a goal that we can ever totally meet, but it’s our north star.
After the convening, we immediately started trying to get these ideas out there. We published a policy brief; met with representatives from different governments through the U.N. Foundation, the World Health Assembly and others; hosted webinars; and put out an op-ed that was picked up around the world. In some ways, the most powerful outreach was the one-on-one conversations that took place in hallways or on Zoom to urge adoption of the goals we set at the Bellagio center.
What was accomplished at the UNGA high-level meeting, and what still needs to be done?
The meeting led to a declaration which is a landmark moment in the global governance of AMR. Its most high-profile commitment is reducing AMR-associated deaths by 10% by 2030, and it calls for an independent panel on AMR evidence by the end of 2025. A new global action plan on AMR will be negotiated in 2026. These are opportunities for the unifying goals to be taken up in a more formal way and still drive progress.
One area where I think we played a role in shifting the conversation is sustainable access. We were a part of many conversations at the World Health Assembly and other meetings leading up to the UNGA where calls for sustainable access became far more prominent.
Looking ahead, we need to make progress on addressing AMR in an equitable way. There are many legitimate reasons for use of antimicrobials, and we need to protect livelihoods and sustainable use of these treatments. We also need to raise the political profile of AMR, which the 1-10-100 goals could help accomplish. Further work on sustainable access is also crucial. No one country can address this issue alone. We can’t achieve these goals unless the whole world takes part.
In an increasingly polarized world, building international consensus can seem more challenging than ever. Yet issues like AMR, climate change, and others don’t stop at any one country’s border, and global cooperation is needed to address them. “We need to start thinking in different ways,” Poirier said. “We need solutions that are win-win, where we prevent infections and promote health equity while reducing AMR at the same time. If we have a shared horizon we’re looking to, we can get there together.”
The opinions expressed in this article are those of the author. The Rockefeller Foundation is not responsible for and does not endorse its content.
Learn More:
- Explore the 1-10-100 unifying goals to mobilize global action on antimicrobial resistance.
- Read the declaration from the 2024 U.N. High-Level Meeting on Antimicrobial Resistance.
- Watch Global Strategy Lab’s panel on the importance of equity in AMR policymaking