What does the O’Neill report on antimicrobial resistance cover?

The O'Neill report on antimicrobial resistance (AMR) outlines urgent steps to address the global rise in drug-resistant infections. It calls for increased public awareness, better infection prevention, and reduced antibiotic misuse across healthcare and agriculture. Emphasising innovation, it advocates for new diagnostics, vaccines, and financial incentives to drive antibiotic development. The report underscores the need for a coordinated global response, involving governments, industries, and organisations, to tackle AMR effectively:

1. Global public awareness campaign: It emphasises the need for a large-scale global effort to increase awareness about the misuse of antibiotics and AMR. The campaign should target not only the general public but also healthcare providers, veterinarians, policymakers, and the farming community. Raising awareness about responsible antibiotic use is a key first step toward reducing the unnecessary consumption of antimicrobial drugs.
2. Improving hygiene and preventing infection spread: The report stresses the importance of sanitation and hygiene to prevent infections in the first place. This includes simple actions like handwashing and more systematic improvements, such as clean water access, infection prevention measures in hospitals, and addressing hygiene issues in care settings.
3. Reducing antimicrobial use in agriculture: A substantial portion of antibiotics is used in farming, often not to treat sick animals but to promote growth. The report calls for the reduction of unnecessary use of antibiotics in agriculture through international regulations and policies. It proposes 10-year targets to limit antibiotic use in livestock, focusing on high-income countries first, while improving global transparency about the use of antibiotics in food production.
4. Improved global surveillance systems: Surveillance of AMR and antimicrobial consumption is essential to track the spread of resistance and guide policy actions. The report calls for better data collection and more extensive use of technology, like big data and cloud computing, to monitor resistance patterns worldwide. It suggests countries collaborate to develop a global AMR surveillance system, overseen by organisations like the World Health Organization (WHO).
5. Promoting rapid diagnostics: One of the main contributors to AMR is the overuse of antibiotics due to a lack of practical and/or rapid diagnostics. Often, antibiotics are prescribed based on symptoms rather than confirmed infections, leading to misuse. The report advocates for the development and widespread adoption of rapid diagnostic tools, particularly in wealthier countries by 2020 (note we are now in 2024), and suggests incentives to encourage the development of such technologies.
6. Developing vaccines and alternatives: Vaccines and alternative treatments are critical to reducing reliance on antibiotics. The report suggests a global push for both research and deployment of new vaccines, particularly in developing countries where access to vaccines can greatly reduce the incidence of infections. Research into alternatives to antibiotics, such as bacteriophage therapy and immunotherapies, should be incentivised.
7. Building workforce capacity: The report identifies a shortage of professionals in infectious disease fields, particularly in low-income countries. There is a call for governments to improve career opportunities, pay, and recognition for specialists working in this area, as well as for increasing training programs and educational opportunities globally.
8. Global Innovation Fund for R&D: The report suggests the establishment of a Global Innovation Fund with a $2 billion endowment over five years, focusing on early-stage research into antimicrobials and diagnostics. It highlights existing efforts such as the UK and China’s joint innovation fund and the work of the European Innovative Medicines Initiative, but stresses that much more funding is needed to close the gap between infectious diseases and other research fields like oncology.
9. Incentivising new antibiotic development: Financial incentives are crucial to stimulate the development of new antibiotics. The commercial return on investment in antibiotics has been low compared to other sectors like cancer, which discourages pharmaceutical companies from investing. The report proposes a system of "market entry rewards" where a successful new antibiotic could yield up to $1 billion in financial incentives to its developers. These incentives would be paired with conditions ensuring that the drugs are used responsibly and made available to patients globally.
10. Global coalition for action: AMR is a global issue, and the report stresses that no single country can solve it alone. It calls for international cooperation through forums such as the G20 and the United Nations to create a unified global response. Governments, international organisations, and industries must collaborate to implement these recommendations.