Jun 11, 2025 Antimicrobial Resistance: Protecting Antimicrobial Effectiveness (Part 3)

In July 2014, following the persistent advocacy of Dame Sally Davies, England’s Chief Medical Officer, Prime Minister David Cameron tasked an expert group with producing a report on the spread of antimicrobial resistance. Lord Jim O’Neill, an economist, was appointed as the chair of this expert group. Cameron believed that highlighting the economic impact of the global spread of antimicrobial resistance would effectively draw attention to the issue.

The Commission received joint support from the UK government and the Wellcome Trust, the world’s second-largest non-governmental funder of biomedical research after the Gates Foundation. The report, known as the O’Neill report, was delivered on May 19, 2016. It projected that by 2030, drug-resistant infections could lead to 10 million annual human deaths globally and result in a $100 trillion cost to the global economy.

On receiving the report, the Prime Minister commented that the world is “looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine.”

The report’s recommendations include several key initiatives:

• Reduce global demand for antimicrobials through all means possible, including improving sanitation and minimizing the spread of infections. For example, enhancing access to clean water and better sanitation can significantly decrease the incidence of child diarrhea, which is often caused by viruses rather than bacteria. The World Health Organization (WHO) reports nearly 1.7 billion cases of child diarrhea worldwide each year.
• Launch a comprehensive global awareness campaign highlighting the dangers of overusing antimicrobials.
• Decrease the unnecessary use of antimicrobials in animal agriculture and limit the dissemination of these substances into the environment, particularly through waste streams.
• Promote the development of new, rapid diagnostic tests to help reduce the unnecessary and ineffective use of antimicrobials.
• Improve global surveillance of antimicrobial resistance.
• Expand the supply of new antimicrobials by establishing a global innovation fund and creating better incentives to encourage investments in developing new antimicrobial drugs and treatments.
• Establish a supra-national entity to address the challenge of antimicrobial resistance (AMR).

From 2018 to 2021, Lord O’Neill served as Chairman of the Council of Chatham House, the Royal Institute of International Affairs. This role involved overseeing the strategic direction and governance of the prestigious British think tank. During his tenure, Chatham House developed and published a report in 2019 that assessed global progress in addressing antimicrobial resistance, specifically focusing on the impact of the O’Neill report. This review, conducted by Dr. Charles Clift, was published on October 8, 2019. The Chatham House website highlighted a “startling lack of progress on critical recommendations to combat antimicrobial resistance.”

Lord O’Neill had a somewhat different perspective on the impact of the 2016 AMR report. In the Foreword to the Chatham House report, he remarked that before the O’Neill report was even published, the UK Government had already taken action on surveillance by establishing the UK-Fleming Fund. He pointed out that antimicrobial resistance (AMR) had been included on the agenda for the 2015 G20 Summit in Turkey. Furthermore, he believed that the O’Neill report significantly contributed to the adoption of the UN political declaration on AMR in September 2016.

In terms of agriculture, he noted that real progress had been made. The UK successfully implemented the report’s recommendation of using no more than 50 mg of antibiotics per kilogram of livestock body weight raised. Lord O’Neill stated that he had publicly discussed the ten broad recommendations from the reports and acknowledged progress on seven of them. However, there had been virtually no advancement in three critical areas: diagnostics, vaccines, and the market for new drugs, despite ongoing discussions. He expressed disappointment over the lack of progress in these areas, emphasizing that the primary issue was a shortage of funding.

It is essential to highlight that various initiatives addressing antimicrobial resistance (AMR) were underway while the O’Neill panel discussed potential solutions. In 2015, the World Health Organization (WHO) published its action plan on AMR and launched World Antibiotic Awareness Week, which takes place from November 16 to 22. In January 2016, eighty-five companies and nine industry associations signed a declaration to combat AMR, which was introduced at the World Economic Forum.

In 2017, the European Union initiated its action plan on AMR. Later, in 2022, the U.S. National Academy of Sciences (NAS) released a report on AMR that explicitly referenced the O’Neill report. The NAS report confirmed Lord O’Neill’s observations regarding the impact of the findings from his 2016 commission report. The NAS publication noted that “the O’Neill report encouraged global interest in the problem of antimicrobial resistance” and that “its call for the attention of the United Nations (UN) and the G7 and G20 forums resulted in antimicrobial development partnerships” (page 55). However, several of the O’Neill Commission recommendations for financial investments to address antimicrobial resistance threats had not progressed.