It’s Been One Year Since the World Took On Superbugs. Here’s What’s Changed

This week marks one year since world leaders met at the United Nations General Assembly in New York City in 2016 and unanimously committed to tackling antimicrobial resistance (AMR). The risks of not doing so were clear: a recent report estimated that if AMR continued to spread at its current rate, there would be up to 10 million deaths globally by 2050.

On Thursday, leaders gathered once again, in a less formal setting near the UN, to discuss what progress has been made one year later. “We are not where we should be,” said Professor Dame Sally Davies, the chief medical officer of England, during her keynote speech kicking off the meeting.

Davies said that while there was significant pressure to move quickly on the issue after the 2016 UNGA, the movement stalled for about six months, due in part to changes in United Nations leadership. “I think everyone is committed,” Davies told TIME in an interview after the event, but the formation of a coordination group to move the progress forward took longer than intended. “A lot of people felt we had lost momentum. In practice there was still a lot going on, but it wasn’t so visible.”

The World Health Organization (WHO) director general Dr. Tedros Adhanom Ghebreyesus told TIME earlier in the week that while the consensus on the threat of AMR is a step forward, countries need to be taking more action. “What is missing is a buy-in from countries,” he said. “We have to work very, very hard at the country level to really go into action.”

It was a sentiment he reiterated in front of stakeholders. “We have reached an historic turning point,” he said. “We must not let this moment pass. The cost of inaction would be unbearable.”

Since the 2016 meeting, more meetings and committees have been formed to tackle AMR and provide recommendations on the global and national level. The WHO has urged countries to develop a national action plan on the issue. Currently, 85% of member countries are developing or have developed a plan, but only 5% of counties have developed an AMR action plan that addresses multiple sectors and has been implemented with funding sources and monitoring processes.

“There is good progress made so far,” says Dr. Hajime Inoue, special representative of the director-general for antimicrobial resistance at WHO. “But now we are moving toward the next phase—the actual implementation on the ground. How do we actually implement what we agreed at each national level?”

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In the meantime, drug-resistant bugs have continued to spread. On Tuesday, the WHO released a report showing what the agency called a “serious lack” of new antibiotics to combat antibiotic-resistant infections that pose a threat to human health. The report notes that most drugs in the pipeline are modifications on existing antibiotics, which the group considers short-term solutions.

“What [we’ve] found drawing from our best economists is that the AMR fallout by 2050 would be equivalent to a financial crisis that we saw in 2008…if there’s no action,” said Tim Evans, senior director of health, nutrition and population at the World Bank Group. “If you look at the distribution of that economic fallout, it hits the poor disproportionally.” Evans says low-income countries could lose more than 5% of their GDP due to failure to act on AMR.

WHO’s Inoue says he’s seeing progress in high, middle and low-income countries. “Some countries make good progress in human health, some have made good movement in the agriculture sector,” he says. Countries that stand out to him include the Netherlands, which has reduced antibiotic use in animals by nearly 60%, Thailand, which has significantly reduced antibiotic use in hospitals and health clinics for three common conditions in the country, and Namibia, which does not use antibiotics in its beef production.

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When experts talk about combatting AMR, they tend to focus on three prongs: use in human health, use in agriculture and discovery of new drugs. In the U.S. an estimated 30% of oral antibiotics prescribed in U.S. outpatient settings are unnecessary. When it comes to changes in the food industry, there’s some momentum in chicken production. Major companies like McDonald’s and Tyson are no longer using antibiotics important to human medicine. The same shift has yet to occur in the pork and beef industry.

Developing new antibiotics has also been slow, largely due to a lack of financial incentives, according to an update report from the Wellcome Trust and UN Foundation. New antibiotics are often used as a last resort, which means they sell in low amounts, which is not an especially attractive business opportunity for pharmaceutical companies. Still, a drug development accelerator program set up by the U.S. government and the Wellcome Trust launched in July 2016 raised $65.6 million in funding for 18 antibiotic projects around the world.

Overall, the fact that so many countries are continuing to keep antibiotic resistance as a national priority is promising, but whether substantial and tangible action is taken by leaders who have made commitments is still largely yet to be seen.

At the end of her keynote, Davies left the attendees with a straightforward rallying cry. “Come on folks,” she said. “Let’s get on with it.”