1–10-100: Unifying goals to mobilize global action on antimicrobial resistance

Globalization and Health Rogers Van Katwyk et al. Globalization and Health (2024) 20:66 https://doi.org/10.1186/s12992-024-01070-8 Open Access COMMENT 1–10‑100: Unifying goals to mobilize global action on antimicrobial resistance Susan Rogers Van Katwyk1, Mathieu J. P. Poirier1,2*, Sujith J. Chandy3, Kim Faure4, Caitlin Fisher5, Guillaume Lhermie6,7,8, Arshnee Moodley9,10, Satyajit Sarkar11, Masika Sophie12, Kayla Strong1, Isaac Weldon1,13 and Steven J. Hoffman1,2,14 Abstract The Bellagio Group for Accelerating AMR Action met in April 2024 to develop the ambitious but achievable 1–10-100 unifying goals to galvanize global policy change and investments for antimicrobial resistance mitigation: 1 Health; 10 million lives saved; and 100% sustainable access to effective antimicrobials. High profile political goals such as the Paris Agreement’s objective to keep global warming well below 2° Celsius compared to pre-industrial levels, UNAIDS’ 90–90-90 goal, and the Sustainable Development Goals challenge global norms, direct attention towards relevant activities, and serve an energizing function to motivate action over an extended period of time. The 1–10-100 unifying goals propose to unite the world through a One Health approach to safeguard human health, animal welfare, agrifood systems, and the environment from the emergence and spread of drug-resistant microbes and infections; save over 10 million lives by 2040 through concerted efforts to prevent and appropriately treat infections while preserving the vital systems and services that depend on sustained antimicrobial effectiveness; and commit to ensuring that antimicrobials are available and affordable for all, used prudently, and secured for the future through innovation. Compared to existing technical targets, these unifying goals offer advantages of focusing on prevention, encouraging multisectoral action and collaboration, promoting health equity, recognizing the need for innovation, and integrating with Sustainable Development Goals. By committing to 1 Health, 10 million lives saved, and 100% sustainable access to effective antimicrobials, we can protect lives and livelihoods today and safeguard options for tomorrow. Keywords Antimicrobial resistance, Unifying goals, Global governance, One health, Sustainable development goals *Correspondence: Mathieu J. P. Poirier 1 Global Strategy Lab, Dahdaleh Institute for Global Health Research, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto M3J 2S5, Canada 2 School of Global Health, Faculty of Health, York University, Toronto M3J 2S5, Canada 3 International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark 4 Global Antibiotic R&D Partnership, 1202 Geneva, Switzerland 5 School of the Arts, Media, Performance, and Design, York University, Toronto M3J 2S5, Canada 6 School of Public Policy, University of Calgary, Calgary T2P 1H9, Canada 7 Faculty of Veterinary Medicine, University of Calgary, Calgary T2N 4Z6, Canada 8 One Health at UCalgary, University of Calgary, Calgary T2N 1N4, Canada 9 Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark 10 Animal and Human Health Programme, International Livestock Research Institute, Nairobi, Kenya 11 Department of Policy & Economic Research, International Vaccine Institute, Seoul 08826, Korea 12 World Federation for Animals, Boston, USA 13 Centre for Law, Medicine, and Life Sciences, Faculty of Law, University of Cambridge, Cambridge CB3 9DZ, UK 14 Osgoode Hall Law School, York University, Toronto M3J 1P3, Canada © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Rogers Van Katwyk et al. Globalization and Health (2024) 20:66 Main text The rapid global increase in drug-resistant infections threatens to undermine decades of progress on global health and development, exacerbating inequalities between the Global North and Global South [1]. The human burden of antimicrobial resistance (AMR) – which was associated with 4.95 million deaths in 2019 – falls disproportionately on low- and middle-income countries (LMICs) and particularly on children under five [2]. AMR is also expected to reduce global animal production by up to 7.5%, resulting in economic losses up to one trillion dollars, increasing the cost of food [3], and undermining decades of progress in food security and nutrition worldwide [4]. These interconnections between people, animals, agrifood systems, and our shared environment means that a collaborative and multisectoral “One Health” approach is fundamental to addressing AMR [5]. As world leaders convene in New York to chart a path forward on AMR in a United Nations General Assembly High-Level Meeting this September, it is imperative that they set out an ambitious vision that drives progress for the coming decades [6, 7]. Goal setting is an inherently political challenge: goals are tools of global governance that act as vehicles for global norms, direct attention and effort towards relevant activities, and serve an energizing function to motivate action over an extended period of time [8]. High profile goals such as the Millennium Development Goals (MDGs) [9] and subsequent Sustainable Development Goals (SDGs) [10], the Paris Agreement’s objective to keep global warming well below 2° Celsius compared to pre-industrial levels [11], and UNAIDS’ 90–90-90 goal [12] make concrete a shared vision for the future and rally support for action to address a global challenge. The Bellagio Group for Accelerating AMR Action met from April 8th to 12th 2024 to identify unifying global goals for AMR which could, 1) unite technical perspectives across all countries and sectors into a memorable concept that is easily communicated, 2) act as a barometer of global progress by providing a framework into which an action-oriented roadmap can be crafted with concrete and sector-specific targets, and 3) be useable by heads of government and ministers when communicating with citizens and journalists about the importance of action on AMR while providing identifiable moments of success [7]. Our 1–10-100 goals (Fig. 1) put forward an ambitious but achieva (...truncated)