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The G20 Hamburg Leaders’ Declaration is out: Antimicrobial Resistance (AMR) is on the agenda again
Following the G20 Leaders’ Summit held on 7-8 July, the G20 Hamburg Leaders' Declaration was announced yesterday. In general, when compared to the exciting declaration announced last year during China’s presidency, it is possible to say that this year's G20 communique is back to its old static self. The Chinese presidency of the G20, in addition to main global affairs agenda being written up year-in-year-out, had given space to new rhetoric and actions showing that it had transformed into a 21st century platform. However, especially regarding its general framework, it is not hard to see that the G20 has gone back to square one.
Many issues such as sustainable development, climate change and migration, which gained attention during the 2015 Turkish presidency period and continued in the 2016 Chinese era, were also given attention in the G20 Hamburg Declaration this year. The expectation from the first months of 2017 was that the G20 Germany period and the Leaders’ Declaration would give a more dominant position to the immigration issue in comparison to other issues. But this year's report saw the placing of similar importance to similar issues as before. Additionally, an emphasis was placed on the mechanisms of migration management and several new decisions and statements were announced.
One of the issues included in this year’s report as well as in the Hangzhou Declaration, because it continues to be of global relevance, is Antimicrobial Resistance (AMR). Recent years saw Antimicrobial resistance constitute one of the most fundamental issues on the global agenda due to its economic cost and its impact on public health. Last year, the only health-related issue that entered the Leaders’ Declaration in 2016 was antimicrobial resistance. This year, this issue continued to be influential during the German Presidency. It was even one of the main issues discussed at the B20 Health Conference, which was held for the first time this year under the G20, and suggestions on the topic were included within the B20 Health Initiative Policy Paper. At the Hamburg Declaration announced yesterday, the importance of establishing and implementing national action plans based on a shared framework aimed at reducing the effects of antimicrobial resistance on humans, animals and the environment was pointed out while emphasizing the necessary arrangements for the use of antibiotics. At the same time, the importance of prevention, control and diagnosis were given emphasis as well.
One of the points relating to the Hamburg Declaration was the call for an international R&D Collaboration Hub to support and enhance current and next generation antibiotic R&D. All relevant countries and stakeholders were invited to participate in this initiative through the Declaration. In addition, it was announced that in collaboration with relevant experts including from the OECD and the WHO, practical market incentive options will be further examined.
Briefly, AMR emerges as a consequence of the exposure of microorganisms to antimicrobial drugs, which in time gain resistance and transform. Microorganisms become resistant to drugs and therefore making options available for the treatment of diseases to not work. Moreover, because antimicrobials are widely used not only on humans, but also in veterinary medicine, antimicrobial resistance can also be caused by drugs used on animals.
From the perspective of global public health, approximately 700,000 people die each year due to antimicrobial resistance. In addition, if resistance continues to increase at this rate, it is estimated that 10 million lives will be lost each year depending on antimicrobial resistance in 2050. On the economic front, the increasing resistance rate is expected to cause a fall of 0.5 percent and 1.5 percent, in the global GDP in 2020 and 2030, respectively. If no measures are taken, it is estimated by 2050 that global GDP will fall by 2-3 percent, which in turn will lead to a global economic loss of $100-600 trillion according to models created by international organizations such as the World Bank.  Aside from its global economic effects, antimicrobial resistance is also directly and indirectly related to sustainable development. That is why, as far as Sustainable Development Goals (SDGs) are concerned, AMR comprises one of the main issues on the agenda.
Among countries with the necessary data, Turkey is the second country with the highest rate of antimicrobial resistance in the world. Greece is in first place. Turkey is also the country with the highest rate of consumption of antibiotics. Due to this correlation, it stands out as one of the countries with the highest potential for increased resistance rates in the coming period. For all these reasons, antimicrobial resistance is an important threat to Turkey placing the country in the middle of relevant global debates. Policies and programs aimed at reducing antibiotic use rates in recent years therefore stand at the top of the health agenda in Turkey. In relation, many studies are being carried out by relevant public institutions, and policies designed are put into practice quickly.
In addition to current efforts, a detailed mapping of an antimicrobial resistance map of Turkey which is inclusive of both medical and livestock applications stands out as one of the priority issue areas. However, as it was included in this year’s Declaration, it is also important for countries that are similar to Turkey in terms of a need for battling resistance to focus on conducting on R&D.
When looking at the programs, strategies and discourses of recent years, pharmaceutical R&D and manufacturing stand out as one of the most pressing issues in R&D and industrial policy in Turkey. The value added by the steps taken and programs implemented must be debated separately, but it is obvious that there is also a lack of focus here, as is the case with every field. Although many efforts are being made, Turkey is not in a position to compete with advanced and developing countries that stand out in the world with regards to pharmaceutical R & D and production. One of the prerequisites for Turkey to become a competitive player is for it to have one or multiple focuses when it comes to drug R&D. Turkey needs to reshape its incentives and policies around the focal point it chooses to focus on.
It is very important for Turkey to interpret this call in the latest Declaration and to start discussing the point reached in antibiotics within this scope. One focus for Turkey should be antibiotics that are being met with decreased demand but will still be required in the coming period. This may make an opportunity form the current situation and make a worldwide contribution. In relation, it may be beneficial to focus on specific incentive program designs, R&D, new initiatives and investments. As can be seen in the Hamburg Declaration, while AMR remains relevant both internationally and in the G20, it is of the utmost importance for Turkey not to be excluded from these discussions and to specify its position in terms of both R&D and agro-health practices.
 World Bank, September 2016, “Drug Resistant Infections: A Threat to Our Economic Future