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Towards a UN Security Council on Global Health Issues – EU Institutions Could Show the Way through Adapted HERA

Already in June 2020, the PA International Foundation presented a very similar proposal to the Independent Panel on Evidence Against Antimicrobial Resistance (AMR), a body established in line with the recommendations of the UN Interagency Coordination Group on Antimicrobial Resistance (UN IACG) that at the time was inquiring what actions the UN should take to best prevent AMR. The Foundation argues that – like preventing wars by preparing for them (‘si vis pacem, para bellum’) – pandemics require optimized measures of preparedness to prevent them. Such preparedness has successfully been realized through the North Atlantic Treaty Organisation (NATO) and its Allied command structure and ‘forward defence’ strategy. In a document presented to the European institutions and global health experts the Foundation pleaded to expand the European Commission’s current European Health Emergency Preparedness and Response Authority (HERA) with an agency similar to the European Defence Agency (EDA) that is led by EU Member States – and thus bridges the lack of harmonized EU health policies. It is indeed EDA that gains in prominence following a clearly sensed urgency for the EU Member States to strengthen their grip on foreign and security policy in a post-Trump era with worsening perceptions of Chinese and Russian foreign and security policies. While HERA is considered a positive development, bridging interinstitutional infighting to better defend European citizens’ (health and security) interests through a European Health Security Council as part of HERA at Heads of Government level may well offer the most immediate success (please refer to the links one and two for the full text of the PA International Foundation proposal).

This is all the more urgent following the address by European Health Commissioner Stella Kyriakides     during a Global Health Conference organized by the past Portuguese Presidency of the Council (26 March 2021). She referred to antimicrobial resistance as the next pandemic to be prevented. In their letters to the Foundation of 22 July 2021 and 7 June 2021 both Commission President Ursula von der Leyen and Health Commissioner Stella Kyriakides thanked the Foundation formally for its global conferences and website on AMR.

At EU level, PA’s work has been particularly focused on spreading awareness through www.stopAMR.eu and by identifying solutions to the antibiotic market failure dimension of AMR. But the imminent danger is larger than that. In the proposal to the Independent Panel on Evidence Against Antimicrobial Resistance, PA suggested that AMR must be part of UN Security Council deliberations as AMR threatens to kill more people than any war so far has managed to kill. The post-antibiotic era announced by then WHO Director General Margareth Chan may hit within just a few years; over the past 20 years the European Union already mourns 400,000 AMR deaths. This may grow to 10 million people per year globally by 2050. In this sense, the UN Security Council has to become involved to secure broadly supported and timely effective action to prevent AMR; otherwise, a future AMR outbreak will have a far more ruinous effect on the world’s population and economy than COVID-19. The Security Council also seems the only platform that can address the industrial reality behind the rapidly growing AMR crisis: continued overproduction and overuse of antibiotics over decades without developing any new categories of antibiotics. This was already established during the UN Special Session on AMR of 21 September 2016 which led to the creation of the UN IACG. Overseeing practical results since requires humanity to secure that the UN Security Council – after Ebola – puts pandemics and notably AMR on its agenda. In so doing a measure of global consultation and cooperation may be added to the current rather negative trends.

Policy manager at European Public Health Alliance (EPHA) Yannis Natsis affirms that, since the launch of the One Health approach in 2017, the EU does promote meaningful innovation in the fight and prevention of antimicrobial resistance. Now new incentive systems and approaches are proposed to the EU lawmakers to effectively tackle AMR. While it is good that the Commission has evolved from studying the AMR issue to taking action, an AMR outbreak may come sooner than effective action to prevent it. In Great Britain, a ‘Netflix-style’ subscription service, regularly paid from governments to the pharmaceutical industry, has been recently proposed and experimented to incentivise the creation of new antibiotics. According to the article, European ‘pull’ incentives are seen by some as the best instrument to reassure investors, as they pay for results rather than for the effort on the part of researchers, creating incentives for private sector engagement by creating viable market demand. However, in this regard the European Commission is considering whether to pilot innovative approaches to research and development (R&D) and public procurement for antimicrobials and their alternatives.“We put additional funds into the R&D budget of the European Union, but still we don’t see results,” said Andrzej Rys, director for medical products and innovation at the Commission’s DG Sante, adding that this difficulty led the EU executive to mull over the pull model.

A new approach that would create a viable proxy market while creating minimal profitability for producers may be the best solution to correct the current market failure in the sector. “Pharmaceutical companies have dropped the ball on AMR for decades now. No new class of antibiotics has been discovered in over 30 years using the usual market-based business model of the pharmaceutical industry,” affirmed EPHA’s Yannis Natsis to Euractiv. The world spends billions of USD on the funding of multinational enterprises to develop new medicines but – quite apart from the market failure – mostly Small and Medium Sized Enterprises (SMEs) are the ones developing new antibiotics. And because of the market failure these SMEs cannot survive.

In the past year the World Health Organisation – according to some already heavily politicised – has been subjected to severe criticism. Matters seem improving, but the learning process may be too slow for comfort. Only the UN Security Council may be able to map a faster and better way forward as in the Ebola case. The European Union, through the initiatives of both the European Council and the European Commission, could demonstrate unity of purpose by a joint call on the UN Security Council to move in the required direction.