The gains in health and longer lives of the 20th century are at stake.
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Midsection of female pharmacist holding pill bottle. Professional is using computer keyboard at desk. Chemist is in drug store. Focus is on medicine bottle held by expert.
Midsection of female pharmacist holding pill bottle. Professional is using computer keyboard at desk. Chemist is in drug store. Focus is on medicine bottle held by expert.

Many global health crises are dramatic--think of SARS, Ebola, or Zika. New or forgotten diseases erupt or re-emerge, initially defying our understanding, causing serious illness, suffering, and death, traveling swiftly around the world, creating fear and anxiety and damaging economies. The world is in the midst of a different kind of public health emergency, one that is just as dramatic but not as visible. Except for the headline-grabbing "superbugs," antimicrobial resistance (AMR) doesn't cause much public alarm.

But AMR has the potential to be even more deadly than cancer, to kill as many as 10 million people a year and, according to a recent review undertaken by the United Kingdom, to cost the world economy as much as $100 trillion annually. Left unchecked, AMR will make chemotherapy and common dental and surgical procedures increasingly risky, as infectious complications become difficult or impossible to treat. The gains in health and longer lives of the 20th century are at stake.

AMR is also threatening sustainable food production. Antimicrobials are needed to control diseases in animals to produce high-quality food for all. Currently, antimicrobials are used in relation to the production of beef, dairy products, pork, poultry, farm-raised fish, and even fruits and crops. At the same time, antimicrobials are also used as animal growth promoters, to make them grow faster or produce more. Current practices need to be revisited and optimized, and practices such as improved hygiene and vaccination expanded where possible, to ensure sustainable practices that do not contribute unnecessarily to the development of AMR.

The challenge is that pathogens, whether bacteria, parasites, fungi, or viruses, can eventually develop resistance to the drugs used against them. The development of resistance is a natural phenomenon that occurs mainly through genetic changes. But the misuse of medicines like antibiotics has greatly accelerated this process. One consequence is that many drugs used to treat such diseases as malaria, tuberculosis, and gonorrhea are now useless.

In many countries, antibiotics can be bought over the counter without a prescription and can be used inappropriately, for colds and flu or to treat pets that do not have infections. At the same time, a painful irony is that plenty of other people, especially in the developing world, cannot get access to these life-saving drugs when they need them.

The residues of these drugs, as well as the resistant organisms themselves, are found in water, soil, and air. AMR can move across the world within hours thanks to globalized travel and trade. AMR knows no borders.

Another problem is that no new classes of antibiotics have reached the market in 30 years, and there is little incentive under current conditions for the pharmaceutical industry to develop them. Many companies do not find antimicrobials profitable enough to justify the investment.

We must reverse these trends. The Member States of our organizations have approved a global action plan on AMR, a blueprint that countries can use to develop tailored national action plans. We are committed to working together to slow the emergence of AMR, ensure the preservation of antimicrobials that still do work and stimulate innovation in new drugs, rapid and affordable diagnostic tests, and vaccines.

In September the United Nations General Assembly will debate how best to tackle AMR, only the fourth health issue ever to be considered by the UN, after HIV, noncommunicable diseases, and Ebola. Heads of state will be asked to make serious commitments to combat AMR and to mandate action across many government sectors, including human and animal health, food, agriculture, trade, and foreign affairs. Policy makers, health workers and patients, farmers, veterinarians and food producers need to work closely together to use antimicrobial drugs more responsibly.

But the September meeting will be an empty gesture if it is not accompanied by decisive action. Real change requires effective public policies, legislation, multisectoral collaboration, and new drug development. AMR is a global health emergency that must be stopped now.

The writers are the Directors-General of the World Health Organization, the Food and Agriculture Organization of the United Nations, and the World Organisation for Animal Health.

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