A Call to Action
on Making the World Safe from the Threats of Emerging Infectious Diseases
On the centenary of the Great Influenza Pandemic of 1918, representatives from across the globe – high-level policy and decision makers, thought leaders, subject matter experts, researchers, representatives from international organizations (including those involved with human, animal, and environmental health), academia, donors, foundations, civil society and the private sector – gathered at the Prince Mahidol Award Conference 2018 in Bangkok between January 29 and February 3, 2018 to develop a shared vision for making to the world safe from the threats of emerging infectious diseases, including the threats posed by antimicrobial resistance.
We, the attendees,
1. Note that despite extraordinary advances over the past century in science and unprecedented improvement in global health standards, we still live in a world where an infectious agent could emerge without warning and spread rapidly to every community and every household with no regard to national borders or to social and economic standing. This remains a real and present threat.
2. Recognize that over the course of the coming century, the likely threat of epidemics and pandemics will continue to increase, driven to a large extent by demographic trends, including urbanization, increased activities by the extractive industries, environmental degradation and climate change, persistent inequalities, and globalized trade and extensive international travel.
3. Are concerned that the devastation caused by emerging infectious diseases can be catastrophic. The pandemic of 1918-19 infected 500 million people—about one-third of global population, and killed approximately 50 million people (5% of the human population), and, more recently, the HIV pandemic has caused 39 million deaths.
4. Are aware that even in the absence of significant mortality, the economic and social impact can be staggering: the SARS epidemic in 2003, which killed less than 1000 people, cost the economies of Asia at least USD 16 billion global.
5. Appreciate that the development and commercialization of antimicrobials and vaccines stand as a defining achievement of 20th century medical practice. Both antimicrobials and vaccines 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 and prevention of once fatal infections.
6. We note that only two new classes of antibiotics were developed after 1962; though analogue development had kept pace with the emergence of resistant bacteria. The stagnation of research and development of new classes of antibiotic threatens global human security.
6. Recognize that the decades of superfluous and inappropriate use of antimicrobials and failure to maximally use available vaccines across the human and animal health sectors, along with the threat posed by substandard and falsified antimicrobial, now threaten these advancements.
7. Further that 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. Multi-drug resistant tuberculosis, for example, with some 490,000 new cases and 1.8 million deaths annually, is viewed as a public health crisis and health security challenge. 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.
8. Are also aware that antimicrobial resistance extends to many of the life-saving antivirals and antibiotics that represent first-line responses to an emergent pandemic virus leaving the world increasingly vulnerable should a novel influenza or other virus emerge again.
9. Accept that the impact of AMR on morbidity and mortality is matched by a substantial economic burden, with resistance linked to aggregate economic losses anticipated to exceed USD 100 trillion by 2050.
10. Stress that the burden of these diseases is not equally distributed across the world – with economically disenfranchised, displaced populations and people living with pre-existing conditions disproportionately affected by these diseases, these are the great threats to human security
11. Further, that local, regional, and global human mobility and displacement driven by social and political instability can amplify the spread of communicable disease, and coupled with obstacles faced by migrants in accessing essential health services, result in emergence or reemergence of infectious disease or spread of drug resistance, and globalize public health threats.
12. Recognize that health events themselves can constitute “humanitarian emergencies”, as we witnessed with the Ebola epidemic in West Africa, and that effective response to these events require “whole of society” engagement to help reduce the consequences of these events across sectors, not only for the health and well-being of communities, but also for economies, livelihoods, and critical services within the entirety of society.
13. Understand that while the drivers underlying the emergence of zoonotic and antibiotic resistant diseases are complex, human behaviours and their impact on animal populations and the environment are central to their emergence. We also recognize that changing environmental and climatic conditions have been closely linked to the emergence of novel infectious disease and the redistribution of those already existing. Their aggregate impact will continue to increase over the course of this century.
14. Note that the upgrading of the health security apparatus over the last 2-3 years is welcome, but that the processes and institutional arrangements are either untested or incomplete. Strengthening the core capacities in compliance with the International Health Regulations (2005), that provide a normative framework for surveillance, preparedness, notification and international support coordination, is inadequate.
15. Acknowledge that new efforts are needed to craft global policies and regulations that more directly address these multisectoral aspects of disease emergence in order to improve capacity of governments to prevent and appropriately respond to threats by strengthening health systems, increasing policy coherence, including access to health technologies and innovations, and reducing risks of both new zoonotic threats and antimicrobial resistant organisms.
16. While welcoming the significant progress in building multi-sectoral ‘one health’ action against zoonotic diseases and the emerging work on planetary health, are concerned that AMR efforts remain highly fragmented. The respective contributions made by the inappropriate use of antibiotics in clinical care and animal production, the lack of access to prevention and treatments in many parts of the world, as well as limited opportunities for bringing human, animal and environmental health sectors to work together demand combination within a common strategy.
17. Underline that innovation in the development of and access to health technologies is key to prevent, diagnose and appropriately treat infectious diseases.
A Global Vision for Action
In the face of such challenges, we the attendees at PMAC 2018 call for unified global actions that;
Is built on a bold vision that embraces not only a renewed commitment to address the threats posed by emerging infectious diseases and antimicrobial resistance and is fully aligned and reinforcing of the commitments made in the 2030 Agenda for Sustainable Development, including to leave no one behind, and the UN Political Declaration on AMR in 2016
- Facilitates full, universal and sustained compliance with the International Health Regulations (2005) and aggressively adopts strategies and approaches that recognize that multi-sectoral responses are vital
- Removes the professional, bureaucratic and cultural barriers, as well as the obstacles inherent within social, economic and political processes, that silo human health, animal health and the environmental sectors from effective multi-sectoral partnership and actions
Renews efforts to craft policies and regulatory frameworks to address more directly the multi-sectoral responses to emerging infectious diseases and antimicrobial resistance
- Invests in building an evidence base to improve our understanding of the drivers of disease emergence, including climate change, environmental degradation and urbanization, and for tracking progress towards control of these threats
- Strengthens medicines regulation and stewardship programs across the human and animal health sectors to ensure the quality and safety of medicines and preserve the effectiveness of existing and new therapies
- Fosters research in infectious diseases and in the development of new class of antimicrobial agents, point of care diagnostics and new vaccines for both human and animal sectors.
Reaches across the public and private sectors and civil society to fully harness their collective power for change, and invests in research to develop new, affordable, available and more effective countermeasures and health technologies to prevent, diagnose, treat and minimize the impact of these threats ensuring a full social return on public investments, safeguarding human secuirty for everyone especially the vulnerable population ,
- Invests in strengthening the multi-sectoral systems required for the prevention, early detection and effective response and treatment to emerging infectious disease threats and antimicrobial resistance. The universal health coverage is the solid platform for achieving this objective
Invests in and promote “whole of society” approaches to ensure preparedness strategies and capacities are in place to detect, responses and mitigate the effects of emergent health threats across the entirety of society by establishing and strengthening relationships between health and non-health sectors, establishing multi-sectoral policies and practices for effective preparedness and response to health emergencies, and strategically utilizing technical and financial resources to support systems strengthening and social resilience.
- Builds a workforce in all relevant fields, including in health, agriculture, food production and environmental sectors that demonstrates the core competencies necessary to meet the future challenges posed by these emerging threats.