When the UN convened in September to discuss antimicrobial resistance (AMR) it sent a message to the world about the global severity of the problem. Only three other health issues, HIV/Aids, non-communicable diseases and Ebola, have been the subject of the general assembly high-level meetings.

Professor Ramanan Laxminarayan, Director and Senior Fellow at the Centre for Disease Dynamics, Economics & Policy, was part of the UN discussions. He points out that, “meetings and documents by themselves won’t affect change. They merely provide a wave of opportunity. It’s up to us to see how much distance we can get from that wave.”

The global commitment for change has inspired international collaboration around a whole range of issues including the innovation of new medicines, data collection, improving surveillance and the development of best practice for the use of antibiotics.

The trouble is that, whilst AMR affects both developing and developed countries alike, the issues surrounding the problem differ from region to region. “To change things will take a fundamental shift in the way we think about AMR,” says Laxminarayan, who is also vising Professor at the University of Strathclyde. “This requires a much more localised approach that focuses on the specific challenges of each country.”

Typically, developing countries have experienced the greatest AMR due to the high burden of disease, fewer restrictions on the use of antibiotics and the lack of second line drugs, but the situation is not static. There are a growing number of countries where rapid economic development is creating what Laxminarayan describes as a “perfect storm”. Countries such as India, Kenya and China still have a high burden of disease, but as incomes have increased so too has the sale of unregulated antibiotics, perpetuating AMR.

Country specific practices have also enhanced the problem. In China hospitals make money from the sale of antibiotics, and consequently the country is now one of the world’s highest users of the drugs. In parts of India farmers fatten their animals using antibiotics, to meet the changing diet of the nation. And, in many Western countries, requests from patients for antibiotics to treat simple ailments have resulted in many drugs being prescribed unnecessarily. Global legislation alone can’t tackle specific issues such as these; that requires an ongoing local commitment.

“AMR is going to be a problem forever, so the challenge we have is maintaining the momentum for change,” concludes Laxminarayan. There certainly is an appetite for that change; it’s up to us not to squander it.