Since the Influenza Pandemic of 1918 when between 50-100 million died (5-10% of the human population) we have been fully aware of how vulnerable our place on this planet is.

Even in the absence of significant global mortality, epidemics and pandemics can cost tens of billions of dollars, reversing development gains and pushing communities and households into poverty. The SARS outbreak in 2003 cost the economies of East Asia between $30-50 billion and estimates of the global economic cost of an influenza pandemic range from $374 billion, for a mild pandemic, to $7.3 trillion, for a severe pandemic - with a 12.6% loss of gross domestic product.

Strategically, policies to address a potential pandemic threat are constrained by an unresolved debate over the use of adaptive measures - that aim through the use of technological measures to reduce the impact of diseases after they have emerged vs mitigation measures - that focus on the underlying causes of disease emergence. The adaptive tools we traditionally rely on to protect us from the world of infectious diseases – vaccine and therapeutics – too often are shown ineffective against a novel threat; and, the timely development and deployment of new and effective biomedical countermeasures is undercut by the speed at which the threat spreads.

Similarly, our ability to mitigate the emergence of new threats is undermined by a lack of knowledge about the viral ecology and the drivers, including human behaviors, which propel the emergence of a new threat. It is at these moments we realize just how few our adaptive and mitigation options are – and how vulnerable the global community is. After each episode the world admonishes itself for being ill prepared to deal with a global threat – but after decades of largely reacting adaptively to each event, with only a tangential focus on mitigation, we are only marginally better able to deal with the next one.

The development and commercialization of antimicrobials stands as a defining achievement of 20th century medical practice. Antimicrobials heralded an era of expanded life expectancy, paved the way for advanced medical and surgical treatments, improved animal health and welfare, and made possible curative therapy for once fatal infections. Decades of superfluous and inattentive use of antimicrobials across the human and animal health sectors now threaten these advancements. The pace of reported treatment failures and antimicrobial resistance (AMR) in common pathogens is increasing, with multi-drug resistant pathogens creating the prospect of a ‘post antibiotic’ world. In the absence of interventions, AMR-associated human mortality is projected to soar from a current rate of 700 000 to over 10 million annually by 2050—as readily treatable infections become life threatening, and routine procedures are rendered unsafe. Asia is expected to account for half of this projected global mortality. The impact of AMR on morbidity and mortality is matched by a substantial economic burden, with resistance linked to aggregate losses anticipated to exceed USD 100 trillion by 2050.

Antimicrobial resistance is exacerbated by the unregulated use of antimicrobials across both the human health and animal health sectors. A particular concern is the shared use of same classes of antibiotics in humans and in animals, potentially exacerbating the selection pressures on pathogen populations in animals and humans that encourage the development of resistance and exchange of resistance genes. By example, in the United States the livestock production industry accounts for 80% of the total use of antibiotics used for treatment of human infections.

Antimicrobial resistance is one of the three flagship topics for the tripartite (FAO, OIE and WHO) collaboration. At the Sixty-eight World Health Assembly in May 2015, the World Health Assembly endorsed the Global Action Plan (GAP) on AMR and requested to strengthen the tripartite collaboration between FAO, OIE and WHO for combating antimicrobial resistance in the spirit of the “One Health” approach. The Global Action Plan, which ensured a One Health approach and consistency with Codex Alimentarius and OIE inter-governmental standards and guidelines, aims to ensure continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them. Guided by this global action plan, the Member States, the Secretariat, and their international and national partners aim to: (1) improve awareness and understanding of antimicrobial resistance; (2) strengthen knowledge through surveillance and research; (3) reduce the incidence of infection; (4) optimize the use of antimicrobial agents; and (5) develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

A high level meeting on anti-microbial resistance was held in September 2016 at the United Nations General Assembly, generating a statement of global commitment to address AMR through a multi-disciplinary approach.

Protecting the world from the threat of zoonotic diseases and ensuring effective stewardship of antibiotics requires a common and well-coordinated multi-sectoral effort. While there has been significant progress in building multi-sectoral One Health action against zoonotic diseases, AMR efforts remain highly siloed with an unequal focus on the respective contributions made by the inappropriate use of antibiotics in clinical care and animal production, as well as limited opportunities for bringing human, animal and environmental health sectors together to forge a common strategy. There is an urgent need to bring a comprehensive One Health risk mitigation approach to address zoonotic and AMR related diseases that addresses the direct consequences of animal-human interactions and contributory pressures related to environmental and climate changes.

PMAC 2018 will provide an important setting for fostering policy and strategic action by engaging multi-sectoral experts in zoonosis and AMR, as well as climate change and related environmental fields from across the public and private sectors, international organizations, foundations, academics and non-governmental organizations, as well as critical players in Global Health Security Agenda (GHSA). Importantly, a PMAC sponsored “Making the World Safe from the Threats of Emerging Infectious Diseases” would build on PMAC 13’s highly successful conference on One Health and lead to real change.

Since 2007, the Prince Mahidol Award Conference has been organized as an annual international conference focusing on policy-related public health issues of global significance – including, Universal Health Coverage, Health Equity, Meeting the Needs of Vulnerable Populations, and addressing the threats posed by infectious diseases. Each of these meeting has brought together leading public health leaders and stakeholders from around the world to propose concrete solutions and recommendations. PMAC 2018 will explicitly look to build on the successes of past PMACs and to identify opportunities to further contribute to the systems and capacities required to address the comprehensive health needs of the world’s populations.