KEYNOTE ADDRESS BY MINISTER FOR HEALTH MR ONG YE KUNG AT GLOBAL HIGH-LEVEL MINISTERIAL CONFERENCE ON ANTIMICROBIAL RESISTANCE IN JEDDAH, SAUDI ARABIA

1.             I would like to thank our host, especially His Excellency Fahad bin Abdurrahman Al-Jalajel, Minister of Health of the Kingdom of Saudi Arabia, for your warm hospitality, and for organising this wonderful conference. 

2.             We are in the presence of clinicians and scientists. But I thought, after hearing the speeches this morning, perhaps I would take a political angle this afternoon. 

3.             So, let's imagine how healthcare will be like in the year 2050. Healthcare systems around the world will be vastly improved. Scientific advancements will make sure that many incurable diseases today become curable.

4.             But unfortunately, people are fearful to go to a hospital. I thought the introductory video this morning was very good and salient. This is because many patients who go for routine procedures in hospitals – say, for a knee replacement, or arthroplasty – contracted infections of their wounds that cannot heal. Doctors will try various antibiotics to no avail. As the days go by, the patient develops symptoms like high fever, rapid heart rates and shortness of breath. As their condition worsen, many develop sepsis, which is when the infection becomes uncontrollable, with widespread inflammation of the body with multiple organ failures. The patient then becomes confused, disoriented, weak, and develop seizures. They cough blood, and are unable to urinate. Eventually, they will die a painful or prolonged death. These are typical antimicrobial resistance- (AMR) related deaths. Under these circumstances, going to a hospital, even going to a dentist, carries a non-trivial risk of death. Any substantial wound suffered during sports or accidental cuts is a cause for concern. 

5.             In 2050, up to eight million people die every year due to drug-resistant infections. Collectively, AMR is causing governments around the world $1.2 trillion per year, roughly the GDP of South Korea, Mexico or Spain today. 

6.             Most critically, people lost trust in their healthcare systems. It is ironic that advancements in medical science can treat numerous serious diseases, while many patients die of simple infections. Provision of good healthcare has been a basic social security and a key tenet of the compact between people and the government, and it is breaking down.

7.             What I painted is not a dystopian fictional story set in 2050. It is the future we are heading towards, if no action is done. The numbers I quoted are scientific estimates, and this is happening because we are losing the battle against AMR. 

8.             Why has this happened? In short, as humankind, we are not doing enough or doing the wrong things. Every inappropriate antibiotic prescription, say for viral infection, does nothing for the patient's sickness. Instead, it kills off normal bacteria in the body, while harmful ones lurking in the background have an opportunity to develop resistance to antibiotics. Every course of unfinished or inappropriate antibiotics leaves behind remnant bacteria that will also learn to become resistant to the drug. Improper use and mixing of antibiotics into animal feeds further strengthen the resistance of bacteria. 

9.             So the problem is not caused by a huge battle between science and bacteria, and diseases and science laws, not at all. But simple actions that we take that accumulated into great harm. As to why we are doing these simple things that lead to self-harm, there are many complex reasons. But a common thread going through all global problems of this nature is that when cost and benefit do not align. 

10.          It is the case with overfishing; it is the case with climate change. A bigger catch today benefits the fishermen immediately, but the cost of a depleting fish population is for everyone to bear in the future. Excessive carbon emissions satisfy my current needs for creature comfort or convenience, but the cause will be borne later and by faraway places, from devastating floods in Spain to typhoons in Vietnam or Taiwan. 

11.          Likewise, when we use antibiotics inappropriately, often just to cure, or we think will cure common cough, cold and fever for an individual patient, it will create a major global AMR problem in the future. 

12.          To address global problems of this nature, we will need to find ways to effectively align the benefits and costs of inappropriate actions. Therefore, to prevent overfishing, there are strict limits on daily catches. To tackle climate change, one of the most effective ways is to impose a carbon tax so that we curb over-consumption. And there's an additional cost to over consumption of carbon. 

13.          The question then is what can we do about AMR? The United Nations General Assembly has just issued a significant political declaration on AMR. The global action plan will be refreshed in 2026 and this provides the international community the opportunity to undertake decisive actions to combat AMR. Let me put out a few simple wishes that I have in the refreshed global action plan. 

14.          First, call AMR for what it is – a long term global public health emergency. On AMR, the trajectory for the future is a gloomy one, and it is time for us to ring the alarm bell to rally an urgent and effective response. 

15.          Second, tackle AMR as an integral part of a broader effort to upgrade healthcare systems around the world, especially in developing countries. I fully agree with the Nigerian Health Minister that we need to upgrade our healthcare systems, because with that, there's better infection control, more vaccinations against diseases, proper sanitation, proper prescriptions for antibiotics, and proper antibiotic stewardship programme. Potentially, tackling AMR in the context of upgrading healthcare systems is a big plus for governments. 

16.          Third, we need to start marshalling international resources to help upgrade healthcare systems around the globe. There are many existing mechanisms to leverage from an AMR perspective alone. It should be a compelling case, because instead of incurring reactively over $1 trillion every year on AMR-related health expenditure, it is far better to spend proactively now with a much smaller amount to address the challenge. 

17.          Fourth and finally, we need to reinvigorate the antimicrobial pipeline. The development of new antibiotics has slowed to a trickle, with major pharmaceutical companies largely abandoning the field due to scientific challenges and poor economic incentives. There needs to be new financial mechanisms to calibrate the cost-benefit equation for pharmaceutical companies. For example, there can be direct grants for R&D, market entry awards or a subscription to the latest antibiotics for a fee regardless of usage order. 

18.          Excellencies, ladies and gentlemen, we have risen up to other public health challenges before. For example, smallpox was a major scourge in the 20th century. Up to two million people died every year of smallpox. Through international cooperation, we developed a vaccine, produced, delivered, administered all over the world. In May 1980, the World Health Assembly declared the eradication of smallpox. When I was a new Health Minister visiting the World Health Organization for the first time, the first stop I was brought to was the smallpox eradication commemorative statue. That's how proud we are about the eradication of smallpox. 

19.          AMR is a silent pandemic, and it's unfortunately more complicated with multi-faceted root causes than smallpox. It will be just as severe and will demand an even more coordinated, effective, and decisive global response. Through global solidarity, scientific ingenuity, sustainable financing and strong international cooperation, AMR can be the smallpox story of the 21st century. Thank you.