We, Heads of State and Government and representatives of States and Governments, meeting at United Nations Headquarters in New York on 21 September 2016, in accordance with General Assembly resolution 70/183, in which the Assembly decided to hold a high-level meeting in 2016 on antimicrobial resistance:

1. Reaffirm that the blueprint for tackling antimicrobial resistance is the World Health Organization global action plan on antimicrobial resistance and its five overarching strategic objectives developed by the World Health Organization in collaboration with, and subsequently adopted by, the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health;

2. Also reaffirm that the 2030 Agenda for Sustainable Development offers a framework to ensure healthy lives, and recall commitments to fight malaria, HIV/AIDS, tuberculosis, hepatitis, the Ebola virus disease and other communicable diseases and epidemics, including by addressing growing antimicrobial resistance and neglected diseases affecting developing countries in particular, while reiterating that antimicrobial resistance challenges the sustainability and effectiveness of the public health response to these and other diseases as well as gains in health and development and the attainment of the 2030 Agenda;

3. Acknowledge that the resistance of bacterial, viral, parasitic and fungal microorganisms to antimicrobial medicines that were previously effective for treatment of infections is mainly due to: the inappropriate use of antimicrobial medicines in the public health, animal, food, agriculture and aquaculture sectors; lack of access to health services, including to diagnostics and laboratory capacity; and antimicrobial residues into soil, crops and water: within the broader context of antimicrobial resistance, resistance to antibiotics, which are not like other medicines, including medicines for the treatment of tuberculosis, is the greatest and most urgent global risk, requiring increased attention and coherence at the international, national and regional levels;

4. Also acknowledge that, due to antimicrobial resistance, many achievements of the twentieth century are being gravely challenged, in particular: the reduction in illness and death from infectious diseases achieved through social and economic development; access to health services and to quality, safe, efficacious and affordable medicines; hygiene, safe water and sanitation; disease prevention in community and health-care settings, including immunization; nutrition and healthy food; improvements in human and veterinary medicine; and the introduction of new antimicrobial and other medicines;

5. Recognize that the above achievements are now gravely challenged by antimicrobial resistance, including: the development of resilient health systems and progress towards the goal of universal health coverage; treatment options for HIV and sexually transmitted infections, tuberculosis and malaria, as well as other infections acquired in community and health-care settings; gains in infection prevention and control in community and health-care settings; advances in agriculture and animal husbandry that help to ensure that the quality of food is preserved; and prevention and treatment options for infectious diseases in veterinary medicine;

6. Also recognize that, due to antimicrobial resistance, there will be fewer options for the protection of people most vulnerable to serious life-threatening infections, especially women giving birth, newborns, patients with certain chronic diseases or those undergoing chemotherapy or surgery;

7. Note with concern that the fulfilment of the right to the enjoyment of the highest attainable standard of physical and mental health, as well as access for millions of people to health services and to quality, safe, efficacious and affordable antimicrobial medicines, food, clean water and a healthy environment, remain a distant goal, especially in developing countries;

8. Also note with concern that while the current lack of access to health services and access to antimicrobial medicines in developing countries contributes to more deaths than antimicrobial resistance, without an effective One Health approach and other multisectoral cooperation and actions, antimicrobial resistance is projected to cause millions of deaths worldwide, with massive social, economic and global public health repercussions;

9. Recognize that the keys to tackling antimicrobial resistance are: the prevention and control of infections in humans and animals, including immunization, monitoring and surveillance of antimicrobial resistance; sanitation, safe and clean water and healthy environments; investing in strong health systems capable of providing universal health coverage; promoting access to existing and new quality safe, efficacious and affordable antimicrobial medicines based, where available, on diagnostic tests; sustained research and development for new antimicrobial and alternative medicines; rapid diagnostic tests, vaccines and other important technologies, interventions and therapies; promoting affordable and accessible health care; and resolving the lack of investment in research and development, including through the provision of incentives to innovate and improve public health outcomes, particularly in the field of antibiotics;

10. Also recognize that the overarching principle for addressing antimicrobial resistance is the promotion and protection of human health within the framework of a One Health approach, emphasize that this requires coherent, comprehensive and integrated multisectoral action, as human, animal and environmental health are interconnected, and in this regard:

(a) Recognize further that effective antimicrobial medicines and their prudent use represent a global public benefit and, for addressing antimicrobial resistance, it is essential to allow people to have access to efficient and resilient health systems; as well as to quality, safe, efficacious and affordable antimicrobial medicines and other technologies, when they are needed; and healthy food and environments;

(b) Underline that basic and applied innovative research and development, including in areas such as microbiology, epidemiology, traditional and herbal medicine and social and behavioural sciences, as appropriate, are needed in order to better understand antimicrobial resistance and to support research and development on quality, safe, efficacious and affordable antimicrobial medicines, especially new antibiotics and alternative therapies, vaccines and diagnostics;
(c) Underline also that all research and development efforts should be needs- driven, evidence-based and guided by the principles of affordability, effectiveness and efficiency and equity, and should be considered as a shared responsibility: in this regard, we acknowledge the importance of delinking the cost of investment in research and development on antimicrobial resistance from the price and volume of sales so as to facilitate equitable and affordable access to new medicines, diagnostic tools, vaccines and other results to be gained through research and development, and welcome innovation and research and development models that deliver effective solutions to the challenges presented by antimicrobial resistance, including those promoting investment in research and development; all relevant stakeholders, including Governments, industry, non-governmental organizations and academics, should continue to explore ways to support innovation models that address the unique set of challenges presented by antimicrobial resistance, including the importance of the appropriate and rational use of antimicrobial medicines, while promoting access to affordable medicines;

(d) Underline further that affordability and access to existing and new antimicrobial medicines, vaccines and diagnostics should be a global priority and should take into account the needs of all countries, in line with the World Health Organization global strategy and plan of action on public health, innovation and intellectual property,3 and taking into consideration its internationally agreed follow-up processes;

(e) Improve surveillance and monitoring of antimicrobial resistance and the use of antimicrobials to inform policies and work with stakeholders from industry, agriculture and aquaculture, local authorities and hospitals to reduce antimicrobial residues in soil, crops and water;

(f) Enhance capacity-building, technology transfer on mutually agreed terms and technical assistance and cooperation for controlling and preventing antimicrobial resistance, as well as international cooperation and funding to support the development and implementation of national action plans, including surveillance and monitoring, the strengthening of health systems and research and regulatory capacity, without jeopardizing, in particular in the case of low- and middle-income countries, health or posing barriers for access to care;

(g) Acknowledge that increasing awareness and knowledge on antimicrobial resistance and all of its implications requires the sharing of good practices and findings, collaboration with the media and national and multisectoral actors and the provision of sufficient financing for these activities across sectors;

11. Recognize that national conditions and priorities should be taken into account at all levels, and that relevant sectors of government should be engaged in the development and implementation of multisectoral national action plans, policies, regulations and regional initiatives, taking into account the national context, legislation and jurisdictional responsibilities;

12. We therefore commit to work at national, regional and global levels to:

(a) Develop, in line with World Health Assembly resolution 68.7,1 multisectoral national action plans, programmes and policy initiatives, in line with a One Health approach and the global action plan on antimicrobial resistance,
including its five overarching strategic objectives, with a view to implementing national measures for strengthening appropriate antibiotic use in humans and animals: to support the implementation of such plans, national and international collaboration is needed to assess resource needs and to provide sustained technical and financial investment in shared research, laboratories and regulatory capacities, as well as professional education and training, with a view to safeguarding human health, animal health and welfare and the environment;

(b) Mobilize adequate, predictable and sustained funding and human and financial resources and investment through national, bilateral and multilateral channels to support the development and implementation of national action plans, research and development on existing and new antimicrobial medicines, diagnostics, vaccines and other technologies and to strengthen related infrastructure, including through engagement with multilateral development banks and traditional and voluntary innovative financing and investment mechanisms, based on priorities and local needs set by governments, and ensuring public return on investment;

(c) Take steps to ensure that national action plans include the development and strengthening, as appropriate, of effective surveillance, monitoring and regulatory frameworks on the preservation, use and sale of antimicrobial medicines for humans and animals that are enforced according to national contexts and consistent with international commitments;

(d) Initiate, increase and sustain awareness and knowledge-raising activities on antimicrobial resistance in order to engage and encourage behavioural change in different audiences; promote evidence-based prevention, infection control and sanitation programmes; the optimal use of antimicrobial medicines in humans and animals and appropriate prescriptions by health professionals; the active engagement of patients, consumers and the general public, as well as professionals, in human and animal health; and professional education, training and certification among health, veterinary and agricultural practitioners; and consider, as appropriate, innovative approaches to increase consumer awareness, giving attention to local conditions and needs;

(e) Support a multisectoral One Health approach to address antimicrobial resistance, including through public health-driven capacity-building activities and innovative public-private partnerships and incentives and funding initiatives, together with relevant stakeholders in civil society, industry, small- and medium- sized enterprises, research institutes and academia, to promote access to quality, safe, efficacious and affordable new medicines and vaccines, especially antibiotics, as well as alternative therapies and medicines to treatment with antimicrobials, and other combined therapies, vaccines and diagnostic tests;

13. Call upon the World Health Organization, together with the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health, to finalize a global development and stewardship framework, as requested by the World Health Assembly in its resolution 68.7, to support the development, control, distribution and appropriate use of new antimicrobial medicines, diagnostic tools, vaccines and other interventions, while preserving existing antimicrobial medicines, and to promote affordable access to existing and new antimicrobial medicines and diagnostic tools, taking into account the needs of all countries and in line with the global action plan on antimicrobial resistance;
14. Call upon the World Health Organization, in collaboration with the Food and Agriculture Organization of the United Nations, the World Organization for Animal Health, regional and multilateral development banks, including the World Bank, relevant United Nations agencies and other intergovernmental organizations, as well as civil society and relevant multisectoral stakeholders, as appropriate, to support the development and implementation of national action plans and antimicrobial resistance activities at the national, regional and global levels;

15. Request the Secretary-General to establish, in consultation with the World Health Organization, the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health, an ad hoc interagency coordination group, co-chaired by the Executive Office of the Secretary-General and the World Health Organization, drawing, where necessary, on expertise from relevant stakeholders, to provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance, and also request the Secretary-General to submit a report for consideration by Member States by the seventy-third session of the General Assembly on the implementation of the present declaration and on further developments and recommendations emanating from the ad hoc inter-agency group, including on options to improve coordination, taking into account the global action plan on antimicrobial resistance.