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June 25, 2024 The Honorable Charles Schumer The Honorable Mike Johnson Majority Leader Speaker United States Senate U.S. House of Representatives Washington, DC 20510 Washington, DC 20515 The Honorable Mitch McConnell The Honorable Hakeem Jeffries Minority Leader Minority Leader United States Senate U.S. House of Representatives Washington, DC 20510 Washington, DC 20515 Dear Speaker Johnson, Majority Leader Schumer, Minority Leader McConnell, and Minority Leader Jeffries: The 1,050 undersigned organizations—which represent the full breadth of investments that support all of America, every day—call on Congress to reject arbitrary and damaging funding levels for Fiscal Year 2025 and, at the very least, to fully appropriate the necessary non-defense discretionary (NDD) funds to keep pace with rising costs and demand and keep poison pill policy riders that undercut the priorities of the American people out of the package. Cutting funding from the FY 2024 levels appropriated just three months ago will do little to reduce the national debt and federal deficit but will greatly jeopardize American competitiveness, security, economic strength, and services on which families and individuals rely. Vital domestic and international appropriations are a small part of the federal budget—less than one-sixth—yet they fund a wide range of important services and investments that keep America strong now and in the future. Examples include: scientific and medical research; health care for veterans; federal law enforcement; environmental conservation; home energy assistance; housing and child care assistance for low-income families; mental health and substance use disorder treatment; rural development; K-12 education and skills training; nutrition assistance for young children, families, and older people; financial aid for higher and technical education; infrastructure investments in roads and bridges, sewage treatment, safe drinking water, flood control and navigation improvements; diplomacy, humanitarian aid and development; services for victims of gender-based violence; courts and reentry programs; assistance for small businesses; public safety and other programs for older people; life-saving services for people with disabilities; public health; and much more. Every state and congressional district benefits from NDD investments. Denying NDD programs the increases needed to keep pace with rising costs and provide effective services is a pennywise, pound-foolish way to address the larger fiscal challenges facing our country. As seen with enactment of FY24 appropriations law, there is a strong governing majority for more robust investments. Rather than constraining NDD appropriations to an arbitrary and insufficient funding target, our organizations urge you to avoid poison pill policy riders and invest the amounts needed to meet the needs of our country and protect American competitiveness, economic strength, security, and services critical to families and individuals. Sincerely, 20/20 Vision 3 Daughters and 1000 Sons A New PATH (Parents for Addiction Treatment & Healing) A Safe Place - Lake County, IL A Safe Place - West PA A Woman's Place AACTE AASA, The School Superintendents Association Abuse & Rape Crisis Center Academy for Radiology & Biomedical Imaging Research Academy of Nutrition and Dietetics AcademyHealth ACCESS FAMILY SERVICES., Inc Access Ready Inc. Accessia Health ACT for NIH Act Now: End AIDS (ANEA) Coalition Actors' Equity Association ADAP Advocacy Addiction Professionals of North Carolina Administration of Resources and Choices ADRC of Sauk County WI Advance CTE Advocates for Better Children's Diets Affordable Homeownership Foundations Affordable Housing Centers of Pennsylvania AFL-CIO AFT Afterschool Alliance Ahimsa House AIDS Alliance for Women, Infants, Children, Youth & Families AIDS Foundation Chicago AIDS United Alaska Native Women's Resource Center-AKNWRC Alice Paul House Aliveness Project All4Ed Allen Institute Allergy & Asthma Network Alliance for Academic Internal Medicine (AAIM) Alliance for Retired Americans Alma Domestic Violence Foundation ALS Association Alzheimer's Association/ Alzheimer's Impact Movement Alzheimer's Los Angeles America Forward America Learns American Academy of Allergy, Asthma & Immunology American Academy of HIV Medicine American Academy of Neurology American Academy of Nursing American Academy of Pediatrics American Alliance of Museums American Anthropological Association American Association for Cancer Research (AACR) American Association for Dental, Oral, and Craniofacial Research American Association for Respiratory Care American Association for the Advancement of Science American Association for the Study of Liver Diseases American Association of Colleges of Nursing American Association of Colleges of Osteopathic Medicine American Association of Community Colleges American Association of Neuromuscular and Electrodiagnostic Medicine American Association of State Colleges and Universities American Association of University Women American Association of Veterinary Medical Colleges American Astronomical Society American Atheists American Bird Conservancy American Brain Coalition American Cancer Society Cancer Action Network (ACS CAN) American Chemical Society American College of Clinical Pharmacy American College of Lifestyle Medicine American College of Obstetricians and Gynecologists American College of Physicians American College of Preventive Medicine American Council on Education American Dental Education Association American Diabetes Association American Educational Research Association American Epilepsy Society American Federation for Aging Research American Federation of State, County and Municipal Employees (AFSCME) American Foundation for Suicide Prevention American Foundation for the Blind American Friends Service Committee American Geophysical Union (AGU) American Geriatrics Society American Heart Association American Indian Higher Education Consortium American Institute of Biological Sciences American Library Association American Liver Foundation American Lung Association American Nurses Association American Physiological Society American Psychological Association Services American Public Health Association American Rivers American School Counselor Association American Society for Gastrointestinal Endoscopy American Society for Investigative Pathology American Society for Microbiology American Society for Nutrition American Society for Pharmacology and Experimental Therapeutics (ASPET) American Society for Reproductive Medicine American Society of Agronomy American Society of Hematology American Society of Human Genetics American Society of Nephrology American Society of Neuroradiology American Society of Pediatric Nephrology American Society of Plant Biologists American Society of Tropical Medicine and Hygiene American Thoracic Society American Urogynecologic Society Americans for Tax Fairness Amigos Del Valle, Inc. Amorc Amputee Coalition Ann Arbor Housing Commission Anxiety and Depression Association of America Any Positive Change Inc. APLA Health Appalachian Trail Conservancy Arab American Family Services Artemis Center Arthritis Foundation Asian American Community Services Asian Americans for Community Involvement (AACI) Asian Services in Action, Inc. Association for Career and Technical Education Association for Clinical and Translational Sciences Association for Clinical Oncology (ASCO) Association for Professionals in Infection Control and Epidemiology (APIC) Association for Psychological Science Association of Academic Health Sciences Libraries Association of American Cancer Institutes Association of American Medical Colleges Association of Clinicians for the Underserved (ACU) Association of Community College Trustees (ACCT) Association of Educational Service Agencies Association of Farmworker Opportunity Programs (AFOP) Association of Immunization Managers Association of Independent Research Institutes Association of Jesuit Colleges and Universities Association of Maternal & Child Health Programs Association of Minority Health Professions Schools Association of Nurses in AIDS Care Association of Population Centers Association of Prosecuting Attorneys Association of Public and Land-grant Universities Association of Public Data Users Association of Public Health Laboratories Association of Rehabilitation Nurses Association of Research Libraries Association of School Business Officials International (ASBO) Association of Schools and Colleges of Optometry Association of Schools and Programs of Public Health Association of State and Territorial Health Officials Association of State Public Health Nutritionists Association of University Centers on Disabilities Association of University Professors of Neurology Association of University Professors of Ophthalmology (AUPO) Association of Women's Health, Obstetric and Neonatal Nurses Autism Society of America Autistic People of Color Fund Autistic Self Advocacy Network Autoimmune Association AWAY Basic Education Coalition Bay Area Community Resources BDSRA Foundation Belair-Edison Neighborhoods, Inc. BeLEAF Survivors Berks Encore Berrien RESA Between Friends Beyond Celiac Beyond Literacy Big Cities Health Coalition Biophysical Society Bond County Senior Center, Inc. Bread for the World - South Dakota Chapter Breakthrough Collaborative Breakthrough T1D Bright Horizons Resources for Survivors of Domestic Violence and Sexual Assault, Inc. Brighter Beginnings Bristol Bay Area Health Corporation Cabarrus Meals on Wheels Caldwell Meals on Wheels, Inc. California Association of Food Banks California Child Care Resource & Referral Network California Competes: Higher Education for a Strong Economy California Consortium of Addiction Programs & Professionals California Partnership to End Domestic Violence Caminar Latino - Latinos United for Peace and Equity Caring Across Generations Case Management Society of America CASEL Catholic Charities Domestic Violence Shelter Catholic Charities of the Diocese of St. Cloud Celiac Disease Foundation Center for Biological Diversity Center For Domestic Peace Center for Employment Training Center for Law and Social Policy (CLASP) Center for Nonviolence Center for Science in the Public Interest Center for Sexual Assault and Domestic Violence Survivors CenterLink: The Community of LGBTQ Centers Centre Safe Chapel of the Good Shepherd Episcopal Campus Ministry Charleston Area Urban League CHERRY's CORNER Chicago Jobs Council Chicago Women's AIDS Project Chiefs for Change Child & Family Resources, Inc. Child Care Resources, Inc Child Neurology Foundation ChildFund International Childhood Education International Children's Defense Fund Children's Environmental Health Network Children's HealthWatch Choose Healthy Life Christian Connections for International Health Christopher & Dana Reeve Foundation Church of Scientology National Affairs Office Church World Service Citizens Against Domestic Violence, Inc (CADV) City Year Inc. Citymeals on Wheels Clary Strategies Clean Water Action Clinical Research Forum Coalition for Academic Scientific Computation Coalition for Clinical and Translational Science Coalition for Health Funding Coalition for the Life Sciences Coalition on Adult Basic Education (COABE) Coalition on Human Needs Coalition to Cure CHD2 Code.org Colorado Consumer Health Initiative Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR) Colorado Youth Corps Association Columbia University Columbus Alliance for Battered Women, Inc. d/b/a Hope Harbour Commercial Vehicle Training Association Committee for Children Committee for Education Funding (CEF) Common Good Iowa Common Sense Media Common Threads Community Access National Network (CANN) Community Action Partnership Community Action Partnership of Orange County - Food Bank Community Action, Inc. 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Domestic Violence Emergency Services Dana-Farber Cancer Institute DASACC Dave Purchase Project/NASEN Dayle McIntosh Center for the Disabled DC Coalition Against Domestic Violence DCADV Deaf Unity Dementia Society of America Depression and Bipolar Support Alliance (DBSA) Desert Rose Foundation, Inc. Disability Law Center Disability Law Center of Alaska Disability Law Center of Utah disAbility Law Center of Virginia Disability Law Center, Inc. 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Domestic Violence Center Domestic Violence Intervention of Lebanon County Domestic Violence Service Center Domestic Violence Services of Southwestern Pennsylvania Domestic Violence Solutions for Santa Barbara County Dravet Syndrome Foundation Drug Policy Alliance Dup15q Alliance Dystonia Medical Research Foundation E&ES (Employment & Employer Services) Earthjustice East Bay Housing Organizations Ecological Society of America Economic Opportunity Institute EDGE Consulting Partners EdTrust Educational Theatre Association Educators for Excellence Elevate Elizabeth Glaser Pediatric AIDS Foundation Embrace Services, Inc. Emmanuel Congregational UCC Emory University Empower Missouri enCourage Advocacy Center Endangered Species Coalition Endocrine Society Enterprise Community Partners Entomological Society of America EPCON Epilepsies Action Network (EAN) Epilepsy Alliance America Epilepsy Foundation Epilepsy Leadership Council Equitas Health F Fentanyl Inc Faces & Voices of Recovery Faith in Harm Reduction Family Centered Treatment Foundation Family Crisis Shelter Family Recue Family Services Incorporated Family Services of Southern Wisconsin & Northern Illinois Inc Family Services of Tulare County Family Values @ Work FamilyAid FARE (Food Allergy Research and Education) Federation of American Societies for Experimental Biology (FASEB) Federation of Associations in Behavioral and Brain Sciences Fenway Health Fifth Ward Community Redevelopment Corporation Fight Colorectal Cancer First Focus Campaign for Children Five Horizons Health Services FL National Organization for Women (FL NOW) FL0365 Pasco County National Organization for Women, Inc. Florida Harm Reduction Collective Food Bank of Central New York Food Bank of Northern Nevada Food Research & Action Center (FRAC) Forbes Field Associates,llc Foundation for Sarcoidosis Research Friedreich's Ataxia Research Alliance (FARA) Friends Committee on National Legislation Friends of NCHS Friends of the Earth Friends of the Global Fight Against AIDS, Tuberculosis and Malaria FRIENDS, Inc. Friendship Home of Lincoln Funders Concerned About AIDS Funding Caucus Futures Without Violence GABA-A Alliance Gaithersburg HELP Gateway Rehabilitation Center GBS|CIDP Foundation International Generations United Georgia Advancing Communities Together, Inc. Georgia Coalition Against Domestic Violence Georgia Council of Administrators of Special Eduation Georgia Council of Administrators of Special Education Gerontological Society of America Ginny's Safe House GLMA: Health Professionals Advancing LGBTQ+ Equality Global Down Syndrome Foundation Global Focus on Cancer Global Health Council Global Health Technologies Coalition Global Liver Institute Global Network of Black People working in HIV GLSEN GO2 for Lung Cancer Good Days GRACE- End Child Poverty CA Grand Street Settlement Greater Orlando National Organization for Women (Greater Orlando NOW) Greater Wisconsin Agency on Aging Resources, Inc. GreenHouse17 Grow Food Northampton Habitat for Humanity Chicago Harbor House Domestic Violence Center Haven House Family Services Center Haven of Stanislaus County HAVEN, Inc. Health Care for America Now (HCAN) Health Care Voices Healthcare Information and Management Systems Society (HIMSS) HealthHIV Healthy Schools Network Healthy Teen Network HealthyWomen HelpAge USA Heluna Health Hematology/Oncology Pharmacy Association Hemophilia Federation of America Henry County Senior Center Hereditary Angioedema Association Higher Education Consortium for Special Education (HECSE) HIV Dental Alliance HIV Medicine Association HIV+Hepatitis Policy Institute Home Grown HomeFree-USA Homesafe, Inc. Hope Charities Hope Crisis Center Hope House of South Central Wisconsin Housing Action Illinois Housing and Family Services of Greater New York, Inc. Housing Assistance Council Housing Opportunities of Fort Worth, Inc. Housing Works, Inc. Houston Food Bank Humboldt Senior Resource Center Hunger Free Colorado Hunger Free Vermont Hunger-Free Pennsylvania Hydrocephalus Association IAVI IC&RC ICWUC Center for Worker Health & Safety IDEA Infant and Toddler Coordinators Association (ITCA) iFoster Illinois Alliance For Reentry And Justice Illinois Alliance of Administrators of Special Education Illinois Coalition Against Domestic Violence Illinois Iowa Center for Independent Living Illinois Society for the Prevention of Blindness Impact Fund Indiana Association of Area Agencies on Aging Indiana Coalition Against Domestic Violence, Inc. Indiana Recovery Alliance Indivisible Marin Infectious Diseases Society of America InnovateEDU Institute for Policy Studies, Poverty Project Integrated Community Solutions, Inc International Association for Indigenous Aging International Federation of Professional and Technial Engineers (IFPTE) International Society for Stem Cell Research International WELL Building Institute International Women's House Interstitial Cystitis Association Iowa Coalition Against Domestic Violence Islamic Relief USA JADASA (Journey Against Domestic And Sexual Abuse) James' Place Inc. Jeffrey Modell Foundation Jewish Family Service Los Angeles Jewish Women International Jordan's Guardian Angels Just Future Project Just Solutions Justice Center of Southeast MA Justice in Aging Kanawha Valley Senior Services Kansas Association of Area Agencies on Aging and Disabilities Kansas Coalition Against Sexual & Domestic Violence KAN-WIN KCNQ2 Cure Alliance Kids Above All Kids for Saving Earth Klickitat County Senior Services Knowledge Alliance Knowledgepanel Koolen-de Vries Syndrome Foundation LA Community Legal Center Lafayette Urban Ministry Lake County Crisis Center DBA A Safe Place Latino Christian National Network Latino Texas Policy Center Laurel House LEAD Coalition (Leaders Engaged on Alzheimer's Disease) LeadingAge League of Conservation Voters Leavenworth County, KS Council on Aging Lennox-Gastaut Syndrome (LGS) Foundation Libertae, Inc. LINCOLN COUNTY PUBLIC HOUSING AGENCY Little Listeners of the Carolina's Live Violence Free LiveSafe Resources Local Initiatives Support Corporation (LISC) Lock Out Luv Lumina Alliance Lupus and Allied Diseases Association, Inc. Lupus Foundation of America Lupus Research Alliance Lutheran Settlement House Lydia's House, Inc. Lymphatic Education & Research Network Main Street Alliance Maine Center for Economic Policy Maine Coalition to End Domestic Violence Maine Prisoner Advocacy Coalition March of Dimes Maryland Association of County Health Officers Maryland Network Against Domestic Violence Mass General Brigham Massachusetts Health Officers Association Massachusetts Organization of Educational Collaboratives Maui Economic Opportunity, Inc. MAZON: A Jewish Response to Hunger M-CM Network MdDS Balance Disorder Foundation Meals on Wheels America Meals on Wheels Arlington Meals on Wheels California, Inc Meals on Wheels Greenville Meals on Wheels of Hillsborough County Meals on Wheels of Mercer County Meals on Wheels of Salem County Meals on Wheels of Syracuse, NY Inc. Meals on Wheels of Union County Meals on Wheels of Wake County Meals on Wheels People Meals on Wheels Santa Cruz County Meals on Wheels Spokane Meals On Wheels, Inc. of Tarrant County Medical Impact Melanoma Research Foundation Memorial Sloan Kettering MENTOR METAvivor Methodist Action Program Metro Erie Meals on Wheels Inc Metro New York Health Care for All Metro West Housing Solutions Metropolitan Inter-Faith Association (MIFA) MICAH- Metropolitan Interfaith Council on Affordable Housing Michigan State University Milwaukee Center for Children and Youth Minnesota Administrators for Special Education Minuteman Senior Services Missouri Council of Administrators of Special Education Mohawk Valley Community Action Agency, Inc. 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Oklahoma Disability Law Center Olive Hill Community Economic Development Corporation, Inc One Roof Community Housing OnTrack WNC Open Arms Domestic Violence and Rape Crisis Services Oregon Coalition Against Domestic and Sexual Violence Oregon Coalition of Local Health Officials Organic Acidemia Association Our Children Oregon Oxfam America P Street PA Education Association PAI Parachute Credit Counseling, Inc. 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Safe States Alliance Salem County Women's Services San Francisco Community Health Center SARA - Roanoke Save the Children SBP School Social Work Association of America SchoolHouse Connection Second Harvest Food Bank of Orange County (CA) Second Wind Dreams Senior Citizens Of Holt County Inc Senior Coastsiders, Inc. Senior Services for South Sound Services for the Elderly of Farmington Inc. Sexual Violence Prevention Association (SVPA) SHALVA Share Food Share Love Food Pantry Sharon Baptist Head Start SHE MATTERS Sheldon Heights CoC Food Pantry Shot@Life Sierra Club Sisters of Charity of the Blessed Virgin Mary Sisters of St. Joseph Healthcare Foundation Sisters of the Presentation, Dubuque. 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Komen Synergistic Hawaii Agriculture Council SynGAP Research Fund Tahirih Justice Center Teach For America Teacher Education Division of the Council for Exceptional Children (TED) Tennessee Justice Center Texas Council of Administrators of Special Education The Advocacy Institute The AIDS Institute The Association for Frontotemporal Degeneration The Association for Research in Vision and Ophthalmology (ARVO) The Baker Gordon Syndrome Foundation The Black Men's Brain Health Initiative The Breakthrough Institute The Bridge The Care Service The Center Nutrition Program The Cute Syndrome Foundation The Domestic Violence Resource Center of South County The FamilieSCN2A Foundation The First Community Christian Pentecostal Church of God Inc The Gault Center The Glynn Community Crisis Center, Inc. The Haven Shelter and Services, Inc. The Headache and Migraine Policy Forum the Ion Center for Violence Prevention The Kelsey The MED13L Foundation The Michael J. 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Women In Transition Women of Reform Judaism Women’s International League for Peace and Freedom San Francisco Branch WomenHeart: The National Coalition for Women with Heart Disease Women's Center & Shelter of Greater Pittsburgh Women's Center of Montgomery County Women's Refugee Commission Women's Resource Center WV Foundation for Rape Information and Services WZA Consultant YMCA of the USA Youth First Justice Collaborative YouthBuild USA YWCA Evansville YWCA Hanover YWCA Hanover Safe Home YWCA South Hampton Roads ZERO TO THREE ZeroV

On June 10, Sarah Bachar joined GHTC as our new Senior Program Assistant and Lindsey Brown joined as our new Multilateral Policy & Advocate Associate. GHTC’s Deputy Director Marissa Chmiola and Communications Coordinator Hannah Sachs-Wetstone sat down with Sarah and Lindsey to find more about themselves and their interests.1. What first got you interested in the field of global health research and development (R&D), and what inspires you about this line of work?Sarah: I grew up living in the United States and spending my summers in rural Tanzania, which laid the foundation for my lifelong global perspective and sparked my initial desire to work overseas. I studied international development in college, and, as an adult, I have had the opportunity to volunteer in East Africa on several projects bringing basic human services to under-resourced communities. I see health as the most central basic need that must be addressed to improve lives, and it’s exciting to live during a time in which incredible strides in R&D are making it more possible than ever to bolster health outcomes around the world. I’m thrilled to be part of a team helping to champion those solutions on a global scale.Lindsey: My interest in health R&D was sparked at a young age watching my father’s experience with type 1 diabetes. I can recall the significant improvement in his health and quality of life with each updated iteration of his insulin pump and supplies, which allowed greater ease with his blood sugar management. Witnessing firsthand the transformative impact of advanced and accessible medical technology underscored for me the critical importance of R&D in saving lives and improving health outcomes. During my graduate program, I fell into the global health policy space and delved deeper into the pivotal role of multilateralism. I became impassioned about the pursuit of universal health coverage, especially for low- and-middle income countries. In recognizing the potential for R&D to bridge health disparities and enhance health outcomes worldwide, I am proud to advocate for greater R&D to achieve health equity for all. 2. What are you most excited to learn about global health R&D at GHTC?Sarah: In my professional career thus far, I have been in roles focused on US policy and advocacy for domestic-facing investments, so, broadly, I’m thrilled to be learning more about the mechanisms and impact of health R&D globally. I’m also looking forward to diving more deeply into the different areas of technical work being focused on by each of the leading organizations that make up GHTC’s diverse membership and how to effectively tailor R&D approaches to maximize their impact. Lindsey: I am interested in delving into the sustainability and equity of global health R&D. With the GHTC team and extensive membership, I look forward to gaining insights into cutting-edge advances that are shaping global health outcomes. I am particularly enthusiastic about exploring resilient approaches to R&D, such as fostering partnerships that ensure equitable access to health innovations and health care delivery. Additionally, I believe that targeted investment in our last-mile communities can not only save lives but also foster sustainable health improvement on a global scale. I am excited by GHTC’s dedication to advancing global health R&D, with the ultimate goal of ensuring that everyone, regardless of geography or circumstance, has access to essential, lifesaving medical technology.3. What are your first impressions?Sarah: In my first few weeks with GHTC, I have been inspired and excited by the fantastic work being done by the GHTC team and our coalition’s individual members to improve lives across so many critical areas of need. It’s impressive to learn more about the successful outcomes of GHTC’s advocacy and to witness how partnerships among diverse stakeholders are boosting equity and sustainability in approaches to solving global health problems. Given emerging global health challenges on the horizon, it’s energizing to see the creative ways in which scientific innovation and emerging technologies are being leveraged to deliver meaningful, lasting solutions.Lindsey: In my first few weeks with GHTC, I have been consistently impressed by the caliber and productivity of my colleagues. It has been exciting, and at times intense, to swiftly integrate into GHTC’s advocacy efforts in the intertwined multilateral space of global health initiatives. Advocacy in the US and multilateral realms is a continuous and demanding endeavor, and, with that, it has also been fantastic to see the proactive engagement of GHTC’s members in advancing our collective advocacy agenda. Moving forward, I am eager to contribute to the coalition’s goals and witness the outcomes of our collaborative efforts. 4.  What do you enjoy doing in your spare time outside work?Sarah: I’m originally from Colorado, and, in my spare time, I love hiking, skiing, running, and spending time outdoors. I also love to eat and spend a lot of time exploring Washington, DC’s amazing restaurant scene!Lindsey: Outside of work, I enjoy exploring Washington DC’s extensive running paths and trails, restaurants, and breweries! 

AMR GLOBAL LEGISLATORS REPORT Tackling AMR is essential to save lives and contain this threatening health crisis that is quietly unfolding. In this context, political will is key. This report is an incredible tool for politicians and parliamentarians worldwide to speak with the same voice and act efficiently. Professor Agnes Buzyn Professor of Hematology at Paris-Sorbonne University, France The challenge of tackling AMR is one of unique complexity and ever-growing importance. This report focuses on what Parliamentarians around the world can best do to both hold their own Governments to account for progress & keep a political focus on what is too often seen as just a medical issue. If AMR renders all antibiotics powerless to fight infection the world will enter a very dark place indeed with routine medical procedures becoming too dangerous to use. We must avoid this dystopia by working together and holistically to slow the spread of resistant pathogens, discover new treatments & distribute them equally across the globe. Parliamentary accountability will be key to progress in this crucial battle. Dame Angela Eagle DBE, UK MP- Chair, G20&G7 AMR Legislators Grop Hon. Dr Christopher Kalila Member of Parliament Zambia, Former Executive Committee member of the Commonwealth Parliamentary Let us reward Dr.Alexander Fleming( discoverer of Penicillin) by containing AMR. This will require concerted effort and Multisectoral collaboration on a similar scale as we did with HIV and COVID. ANNEX 1 The need for a more systematic and common approach in tackling AMR at both global and national levels REFERENCES ACKNOWLEDGEMENTS 16 Table of CONTENTS PREAMBLE AMR IS A GLOBAL PROBLEM REQUIRING URGENT, EFFECTIVE AND LONG TERM POLITICAL ATTENTION. - Why is it such a complex problem? - Why this initiative? - Why do we need legislators involved in this initiative? - Ensuring Effective Global Action on AMR - Essential Common Tools RECOMMENDATIONS - Enhancing the Role of Global Legislators - Enhance the role of National Legislators - Create Global Benchmarks for Research and Data - Updating the 2015 Global Action Plan and ensuring global convergence in multilateral fora on AMR Action - Sustainable Finance for Research & Product Development 6 7 8 9 12 13 14 11 15 18 22 23 6 7 Preamble AMR is a global problem requiring urgent, effective, and long-term political attention. 1. AMR is a huge and growing problem at the world level, and yet it has not received the same degree of attention as some other global challenges, such as climate change. 2. While there have been significant organizational changes, policy initiatives, and background reports all aimed at tackling the problem they have not yet had the desired impact, and not yet been sufficient game changers. 3. 2028 will mark the centenary of the development of the first antibiotic and yet rising levels of antimicrobial resistance or AMR are attacking our entire ecosystem and are no longer just a health challenge. It is time, therefore, for more integrated inter-ministerial and multi-sectoral collaboration. 4. Despite the wealth of evidence and the creation of countless initiatives on AMR from across all sectors, there seems to be a critical disconnect in translating the challenges posed by AMR into the necessary political messages and actions amongst legislators in governments and parliaments. 5. Indeed, the January 2024 Executive Board Meeting of the WHO confirmed that AMR has not attracted the “sustained political attention it demands”a) and expressed the need for greater urgency on this matter. In order to help address this need, there will be a high-level meeting at the UN General Assembly (HLM UNGA) on 26th September 2024 and at the 4th AMR Ministerial Conference in the Kingdom of Saudi Arabia (KSA) on 14th -16th November 2024. Why is it such a complex problem? 6. AMR is not a disease. It is, however, endemic to the world and is an umbrella term to indicate the growing threat of drug-resistant microbes. This makes it less understood by the public and by political leaders. 7. Antimicrobial medicines such as antibiotics, antivirals, antifungals, and antiparasitics are powerful tools to prevent infections across human, and animal health and food, plant, and environmental ecosystems. In some places, notably in many Low and Middle Income Countries (LMICs), there is still insufficient access to these tools. In other places, however, antimicrobial medicines can be misused or overused, and bacteria, viruses, fungi, and parasites may no longer respond to them. 8. AMR also has a profound impact on illnesses such as Cancer, Tuberculosis, Malaria, HIV/AIDS, and untreatable resistant infections significantly increasing the risks to patients undergoing surgical procedures. Deaths caused by these illnesses are often attributed to them rather than to drug resistance, and AMR is thus often underreported. 9. Bacterial AMR has already been directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths, with children under 5 and people in LMICs, notably in Sub-Saharan Africa, being particularly vulnerable b). AMR is made worse by inadequate infection prevention and control 8 9 Why do we need legislators involved in this initiative? 18. Legislators are in a unique position to influence governments and to draw the attention of citizens to the growing problems caused by AMR at the global level. Legislators can play a critical role in developing policies and comprehensive strategies, writing appropriate laws, allocating resources, ensuring oversight, and promoting international cooperation. 19. The involvement of Legislators thus complements the roles of other actors. National governments are often too focused on the short-term to take the longer-term measures that are necessary to tackle AMR and national policymakers are often working in narrow silos. Civil society organisations are often organized within disease silos and broader-based patient safety issues related to AMR are poorly represented. Experts on AMR in national and international administrations are often talking to each other more than to the wider public. 20. It is essential, therefore, that legislators play a vital role in the development of this initiative and take the necessary steps to ensure both transparency as well as stronger political leadership on these issues. 21. It is also essential to create a common narrative on AMR to promote a wider understanding and joint action among legislators, Ministers of Health, Finance, Agriculture, and Environment. Ensuring Effective Global Action on AMR 22. To address this, the current initiative sets out some essential objectives and some essential common tools for the guidance of legislators. measures in healthcare settings, lack of access to water, sanitation, and hygiene (WASH) and weaknesses in hospital and primary healthcare structures. New environmental threats, notably those caused by climate change, are already having adverse effects on health and on AMR. 10. Unless there are concrete, clear, and actionable measures on AMR, the situation will continue to deteriorate and there will be great damage to human, animal, and plant health as well as to the environment. The world economy, especially in LMICs, will also suffer greatly. The World Bank has estimated that AMR could result in US$ 1 trillion in additional healthcare costs by 2050 and US$ 1 trillion to US$ 3.4 trillion gross domestic product (GDP) losses per year by 2030c). 11. The complex and multi-sectoral nature of AMR is reflected in the complexity of the necessary governance arrangements to respond to the AMR challenge at both national and international levels. Many different actors are involved, and there are many overlapping initiatives, which reduce their impact and visibility. 12. One of many examples of this complexity concerns target setting. Many such targets have already been set (reducing global deaths, reducing levels of antibiotic use for humans and animals, etc), and others may still be required, such as R&D targets for antibiotics and diagnostics. At the same time, target setting is complicated by the absence of appropriate benchmarks, since, for example, in many countries, there is a lack of knowledge on the impact of antibiotics in their agricultural sector and in their water. The ambition should be to avoid the setting of artificial targets and to save more lives by collecting better data on the scale of the problem within the animal, health and water/food supply. 13. A number of actions have been taken at national and international levels, but they have often not been followed up nor adequately financed. There are a large number of National Action Plans, for example, but recent track survey results show that only 17%d) of them are fully funded through a budgetary allocation, others are all funded through ad hoc mechanisms and many are not funded at all. 14. Measures to address AMR are currently insufficient to tackle the scale of this problem. The development of new antibiotics is at its lowest level since 1945, and there are inadequate diagnostic tools. Scientific challenges, low return on investments, and lack of compensating economic support have led to a chronic lack of innovatione). 15. Finally, AMR also greatly reinforces the risks of Sepsis, which causes 13.7 million deaths a year, of which almost 5 million or 36% of the total are associated with, or directly attributable to AMRf). Why this initiative? 16. The current initiative has a twofold purpose. The first is to raise awareness of the AMR crisis among policymakers and regulators at national, regional as well as at global levels and bridge the disconnect between scientists and policymakers. The second is to enlist global legislators to advocate for the necessary measures to tackle AMR and to implement them effectively. 17. The present report puts forward precise recommendations and a model resolution covering each key issue where legislators can have an impact. This is designed to be used by as many actors as possible and aims to ensure a commonality of approach. 10 11 23. he need to set in motion a multiyear process in governments and parliaments, keeping AMR high up the political agenda on a continuing rather than occasional basis, incorporating all countries and regions in that process, reflecting the priorities of legislators as well as of technical experts, and fully taking into account the very differing national contexts 24. The need to create an understanding of what “One Health “means for non-health experts and to promote an integrated approach to this complex multi-sectoral, multi-jurisdictional problem, with human, animal, and plant health components, as well as concern for the environment. 25. The need to balance the excess use of antimicrobials in many contexts against antimicrobial access and affordability problems for the LMICs. 26. The need for essential preventative measures, notably in the areas of clean water, effective sanitation, infection control, vaccines, as well as sustainable production systems for animals and food and good animal husbandry. 27. The need for a more visible and binding framework for future measures on AMR, with sustainable long-term funding. These should be based both on common guidelines at the global level and on appropriate adaptation and implementation of these guidelines at the national level, including cost, well-resourced, and accountable National Action Plans. Essential Common Tools 28. These should include the following: Enhancing the role of global legislators, strengthened research and data, appropriate legislation and regulation, innovative funding, enhanced governance and transparency, and joined-up Communication amongst all sectors and at all levels of policy-making in governments: Key Objectives Balancing Excess and Access Legislative Framework One Health approach Multiyear Process 12 13 Recommendations Enhancing the Role of Global Legislators by: a) Promoting the appropriate set of policies and regulatory framework, including, where necessary, binding, and realistic targets and other measures, whilst recognizing that we cannot apply a “one size fits all” policy. b) Pushing for the necessary funding through Multilateral Organisations and Development Finance Institutes as well as encouraging accompanying funding in national budgets. c) Establishing an independent Science Panel on Evidence for Action against Antimicrobial Resistance to identify evidence and data gaps, on the lines of the IPCC for climate change. Such a panel should propose benchmarks across the one-health spectrum, in order to facilitate effective oversight over national reporting mechanisms. d) Formalizing on a bi-annual basis the role of the periodic High-level Ministerial Conferences on AMR to provide the necessary political impetus for global action and progress on AMR, in collaboration with the WHO, The Joint Quadripartite (FAO, UNEP, WOAH) and the Global Leaders Group on AMR. e) Establishing an annual meeting of national legislators and policymakers for Health, Agriculture, Environment, and Finance. f) Working on a convincing narrative and communicating on AMR both to other policymakers and to the general public concerning the consequences of the crisis and the measures that are being taken to tackle it. g) Empowering the voices of affected communities, including civil society and youth and patient-based organizations, and leveraging their messages to policymakers. h) Intensifying efforts for strengthening early detection, diagnosis, and therapy of Sepsis in the context of AMR, as called by the 2017 World Health Assembly Resolution on Sepsis (WHA70.7), the G7 Health Ministers’ Communiqué of 2022, and the 2023 Berlin Declaration on Sepsisg). Enhance the Role of National Legislators by: a) Ensuring there is integrated decision-making for AMR and intersectoral coordinating mechanisms at the national and international levels, incorporating all the concerned government ministries, and international organizations. b) Pushing for the necessary national funding. c) Using the findings of the proposed International Science Panel, in order to identify priority national actions, monitor progress, and set appropriate indicators. d) Call for an annual hearing and report to be presented to legislators by governments on the funding and implementation of NAPs, as well as on other AMR mitigation measures, such as the provision of clean and adequate sanitation to communities. e) Appointing national AMR envoys to coordinate country and interministerial and sectorial efforts to implement NAPs and to facilitate international exchange of views and experiences. f) Creating an AMR platform for Legislators, in order to share national and regional best practices. g) Holding periodic AMR Summits to bring together international stakeholders from all sectors, to review targets, guidelines and build on commitments, and track their progress from one summit to the next. h) Promoting strong antimicrobial stewardship, both for the prudent and appropriate use of existing antimicrobials and to maximise the effective use of diagnostic tools. Create Global Benchmarks for Research and Data: a) Establish common and global/sectorial benchmarks for data collection, including mapping of hotspots of AMR, maximising the use of existing surveillance mechanisms1 . b) Direct research towards innovative diagnostic tools, and new antimicrobials to meet current and future unmet needs including resistance c) Encourage additional research on the impacts of, and on the more appropriate use of existing antibiotics across the One Health approach d) Provide more research on the causes and impact of drug-resistant infections on account of age, gender 1 For example GLASS, ANIMUSE, and TrACSS. 14 15 Updating the 2015 Global Action Plan and ensuring global convergence in multilateral fora on AMR Action: a) In the coming months the Global Leaders Group and the Quadripartite, the WHO, the G7, the G20, and others preparing the WHA, UN High-Level Meeting on AMR, and the 4th Ministerial Conference on AMR in Saudi Arabia, are all urged to ensure the fullest possible convergence around a concise set of implementable actions and targets to be incorporated in an updated version of the 2015 AMR Global Action Plan. b) Global legislators should now urge that country-specific targets should be better coordinated, clear, and transparent, should be measurable, and be monitored through regularly updated scoreboards. These should be sufficiently flexible to adapt to country-specific needs and be presented in such a way that is easier to communicate with policymakers and with the general public. c) National measures against AMR should complement international guidelines and be enshrined in national legal frameworks to ensure that they are properly funded, implemented, and subject to regular reporting and hence fuller accountability. d) Measures and legislation to tackle AMR should be coordinated between sectors and government ministries, in order to fully embrace the One Health approach. e) National or Regional regulatory bodies should be established or strengthened in areas where enforcement is lacking. f) Fully utilize the portfolio of vaccines that are available, in order to reduce the number of infections in the population and thereby minimise the use of antibiotics. g) Establish a Global Essential Veterinary Medicine and Vaccine List and AWaRe guidance for veterinary medicines as well as working towards an agreed target for antibiotics use in animals. Sustainable Finance for Research & Product Development: a) Develop innovative and blended financing mechanisms to encourage new forms of investments via private/ public partnerships and the support of Multilateral and Regional Development Banks and ensure that there is continuity in funding so that promising projects are not curtailed. b) Include sufficient and predictable long-term funding for push and pull incentives, that are incentivised and driven by governments and supported by the private sector and funders as both mechanisms are required to drive the progress of the antibiotic pipeline. c) Support push funding to sustain R&D and ensure new and existing antibiotics meet all public health needs. Higher income countries (G7+, G20, EU27) should seek to incorporate such funding into their national budgets at the earliest opportunity. d) Push mechanisms also require additional, substantial, long-term global investments, in particular, to support innovative scientific research, to build a robust early-stage pipeline, and to facilitate early access in LMICs. e) When appropriate, enact legislation directing relevant evaluation, procurement, and reimbursement authorities to implement realistic pull incentives. Maximise the use and scope of existing funds rather than prioritize the establishment of a new dedicated AMR Fund. f) Encourage countries to cooperate at a regional level , to develop multi-national pooled procurement mechanisms for antimicrobial tools and diagnostics, in order to strengthen the market environment and access for new and old products. g) Preferentially procure antibiotics that are responsibly made (for example, as certified by the BSIh) or in line with any forthcoming guidelines set by the WHO), in order to reduce manufacturing discharges into the environment. identity and sex, and socioeconomic status. e) Ensure that all R&D actors take into account access considerations as early as possible including shaping clinical development to cater to real-world needs. f) Push for simplified administration, reduction of production costs, and the generation of relevant clinical data and medical evidence to support the appropriate use of approved medicine in diverse settings/ or post-approval 16 17 Annex 1 (a) Whereas AMR is a huge and growing problem at the world level, and yet it has not received the same degree of attention as some other global challenges, such as climate change. (b) Whereas AMR is not a disease but is an umbrella term to indicate the growing threat of drug-resistant microbes, and is endemic to the world; whereas it also has a profound effect on diseases such as Cancer, TB, Malaria and HIV/AIDS, and greatly increases the risks of Sepsis. (c) Whereas AMR is made worse by inadequate infection prevention and control measures in healthcare settings, lack of access to water, sanitation, and hygiene (WASH), and weaknesses in hospital and primary healthcare structures. (d) Whereas measures to tackle climate change and other environmental threats, may also be very useful in the AMR context. (e) Whereas the economic consequences of AMR are also very great. (f) Whereas 2028 will mark the centenary of the development of the first antibiotic and yet few new ones are being developed. (g) Whereas there is now increasing resistance to all antimicrobials, which threatens our entire ecosystem, and is no longer just a health challenge. (h) Whereas significant organizational changes, policy initiatives, and background reports have been taken to tackle the problem, they have not yet had the desired impact, nor been sufficient game changers. (i) Whereas there seems indeed to be a critical disconnect in translating the challenges posed by AMR into the necessary political messages and actions amongst legislators in governments and parliaments. (j) Whereas there now needs to be a renewed global impetus on containing the AMR crisis (k) Whereas unless concrete, clear, and actionable measures are taken on AMR within a genuinely integrated “One Health” approach, the situation will continue to deteriorate and there will be great damage to human, animal, and plant health as well as to the environment. (l) Whereas AMR governance needs to be strengthened since there are so many different actors involved at the national and international levels, and so many overlapping initiatives which reduce their impact and visibility. (m) Whereas there needs to be targeted and monitored reduction in the inappropriate use of antimicrobials in human, animal, and plant health. (n) Whereas action plans at national and international levels need to be properly followed up and adequately funded on a continuing basis (o) Whereas the excess use of antimicrobials in many contexts needs to be balanced against antimicrobials access and affordability problems for the LMICs (p) Whereas it is vitally important to create a common narrative on AMR in order to promote a wider understanding and joint action amongst legislators, governments, international organisations, and all other key actors. (q) Whereas global and national legislators are in a unique position to influence governments and to draw the attention of citizens to the growing problems caused by AMR at the global level. (r) Whereas it is essential, therefore, that legislators play a vital role in the development of this initiative, in developing policies and comprehensive strategies, writing appropriate laws, allocating resources, ensuring oversight, and promoting international cooperation and more generally in ensuring both transparency as well as stronger political leadership on AMR issues. 1. Taking into account the 2015 Global Action Plan on Antimicrobial Resistancei). 2. Taking into account the Muscat Declarationj). 3. Taking into account regional initiatives such as the 2017 EU One Health Action Plan against AMR k) and subsequent resolutions including the EU Parliament resolutions of 2018 l) and 2023m); 4. Taking into account 170 adopted National Action Plansn); 5. Taking into account forthcoming important multilateral meetings on AMR, including the WHA, the Global Leaders Group Summit, the high-level meeting at the UN General Assembly in September 2024, and the 4th AMR Ministerial Meeting in the Kingdom of Saudi Arabia (KSA) in November 2024; MODEL RESOLUTION 07 June 2024 18 19 The need for a more systematic and common approach in tackling AMR at both global and national levels: 1. Calls for the following measures to be taken: 2. Enhance the role of Global Legislators by: a) Promoting the appropriate set of policies and regulatory framework, including, for example, binding, and realistic targets and other measures, whilst recognizing the need for them to be sufficiently flexible to adapt to country-specific needs. b) Pushing for the necessary funding through Multilateral Organisations and Development Finance Institutes as well as encouraging accompanying funding in national budgets. c) Establishing an independent Science Panel on Evidence for Action against Antimicrobial Resistance to identify evidence and data gaps, on the lines of the IPCC for climate change. d) Formalizing on a bi-annual basis the role of the periodic High-level Ministerial Conferences on AMR to provide the necessary political impetus for global action on AMR, in collaboration with the WHO and the other members of the Quadripartite (FAO, UNEP, WOAH). e) Establishing an annual meeting of national legislators and policymakers for Health, Agriculture, Environment, and Finance. f) Fully utilizing the portfolio of vaccines that are available, to reduce the number of infections in the population and thereby minimise the use of antibiotics. g) Intensifying efforts for strengthening early detection, diagnosis, and therapy of Sepsis in the context of AMR, as called by the 2017 World Health Assembly. 3. Enhance the Role of National Legislators by: a) Ensuring that there is integrated decision-making and coordination for AMR at national and international levels. b) Pushing for the necessary national funding. c) Using the findings of the proposed International Science Panel, in order to identify priority national actions, monitor progress, and set appropriate indicators. d) Calling for national measures against AMR to complement international guidelines and be enshrined in national legal frameworks to ensure that they are properly funded, implemented, and subject to regular reporting and hence to fuller accountability. e) Appointing national AMR envoys to coordinate country and interministerial and sectorial efforts to implement NAPs and to facilitate international exchange of views and experiences. f) Establishing or strengthening National or Regional regulatory bodies in areas where enforcement is lacking. g) Calling for an annual hearing and report to be presented to legislators by governments on the funding and implementation of NAPs, as well as on other AMR mitigation measures. h) Creating an AMR platform for Legislators to share national and regional best practices. i) Holding periodic AMR Summits to bring together international stakeholders from all sectors, to review targets and guidelines, and to build on commitments. 4. Create Global Benchmarks for Research and Data by: a) Establishing common and global/sectorial benchmarks for data collection. b) Directing research toward innovative diagnostic tools, on new antimicrobials and towards promoting more appropriate use of existing antimicrobials. c) Providing for more research on the causes and impact of drug-resistant infections on account of age, gender identity and sex, and socioeconomic status. d) Ensuring that all R&D actors take into account real-world needs and access considerations at the earliest stage possible. e) Promoting appropriate use of approved medicine in diverse settings and pushing for simplified administration and reduction of production costs. 5. Create Global Convergence in Multilateral Fora to Update the 2015 Global Action Plan by: a) Calling on the key decision-makers to ensure the fullest possible convergence around a concise set of implementable actions and targets in the official meetings at the world level over the coming months. 20 21 b) Further urging these to be incorporated in an updated version of the 2015 AMR Global Action Plan and ensuring that they are monitored through regularly updated scoreboards. c) Ensuring that measures and legislation to tackle AMR should fully embrace the One Health approach and be coordinated between policy sectors, government ministries, and international organizations. d) Establishing a Global Essential Veterinary Medicine and vaccine list and AWaRe guidance for veterinary medicines as well as working towards an agreed target for antibiotics use in animals. e) Promoting global stewardship through more prudent and better use of existing antimicrobials and maximising the effective use of diagnostic tools. 6. Provide Sustainable Finance for Research & Product Development by: a) Developing innovative and blended financing mechanisms to encourage new forms of investments via private/public partnerships and the support of Multilateral and Regional Development Banks. b) Including sufficient and predictable long-term funding for push and pull incentives, that are incentivised and driven by governments and supported by the private sector. c) Supporting push funding to sustain R&D and ensure new and existing antibiotics meet all public health needs, build a robust early-stage pipeline, and facilitate early access in LMICs. d) Calling for higher income countries (G7+, G20, EU27) to incorporate push funding into their national budgets at the earliest opportunity. e) Calling for legislation directing relevant evaluation, procurement, and reimbursement authorities to implement realistic pull incentives. f) Maximising the use and scope of existing funds rather than prioritizing the establishment of a new dedicated AMR Fund. g) Encouraging countries to cooperate at a regional level to develop multi-national pooled procurement mechanisms for antimicrobial tools and diagnostics, in order to strengthen the market environment and access to new and old products. h) Seeking to reduce manufacturing discharges into the environment through promoting responsible production of antimicrobials. 7. Enhance Transparency and Communication on AMR by: a) Working on a practical, evidence-based and convincing narrative to emphasise the consequences of AMR on human lives across the planet, as well as on animal and plant health and on the environment. b) Communicating clearly on measures that are being taken and will have to be taken on AMR, both to policymakers, without a health portfolio or expertise, and to the general public. c) Empowering the voices of affected patients, farmers and communities by including the civil society, youth and patient-based organizations to empower these messages to policy-makers and legislators. 8. Calls for this resolution to be submitted for the attention of all legislators at national, regional, and international levels. 22 23 References a. 154th WHO Executive Board Agenda Item 13: Antimicrobial resistance: accelerating national and global responses – Global Health Council b. Antimicrobial resistance (who.int) c. Antimicrobial Resistance (AMR) (worldbank.org) d. Special focus: Assessing the landscape of national action plans on antimicrobial resistance | Embracing a One Health Framework to Fight Antimicrobial Resistance | OECD iLibrary (oecd-ilibrary.org) e. Why is it so difficult to discover new antibiotics? - BBC News f. An estimated 1.2 million people died in 2019 from antibiotic-resistant bacterial infections | University of Oxford g. The Berlin Declaration on Sepsis – An Urgent Call for the Enforcement of the WHA Resolution 70.7 and Reinvigorated Global Action on Sepsis — World Sepsis Day - September 13 h. Antimicrobial resistance | BSI (bsigroup.com) i. Global action plan on antimicrobial resistance (who.int) j. Final Version Muscat Manifesto AMR with Annex.pdf (amrconference2022.om) k. 353f40d1-f114-4c41-9755-c7e3f1da5378_en (europa.eu) l. Texts adopted - A European One Health Action Plan against Antimicrobial Resistance - Thursday, 13 September 2018 (europa.eu) m. Texts adopted - Antimicrobial resistance - Thursday, 1 June 2023 (europa.eu) n. Microsoft PowerPoint - AMR MS Briefing 22 Mar 2023 - final.pptx (who.int) Acknowledgements This report was authored by Dame Angela Eagle, DBE, Professor Agnes Buzyn, Hon. Dr Christopher Kalila and Mr Francis Jacobs. We would like to express our deepest appreciation to everyone who supported us with the creation and completion of this report. We would like to thank our Chair and Founder of The G20&G7 Health and Development Partnership (G20/G7HDP) Alan Donnelly and Executive Director Hatice Beton for their expertise and valuable advice in guiding the report creation. We would also like to extend our thank to the team at the G20 & G7 Health and Development Partnership, Luisa Mucci and Marc Muller for their support in organising the hearings and collating information for the report. We thank everyone for their collegiate efforts. We would like to express our utmost appreciation to all experts who have kindly participated in our hearings, shared their insights, and added great value to the report’s content in leveraging the importance of the legislators’ role in advancing concrete actions for AMR. We like to express a special thanks to the International Federation of Pharmaceutical Association (IFPMA) for their support of the initiative and financial contribution and for sharing with us valuable content material and expertise. A special thanks to James Anderson for Chairing the Working Group who supported the organization of the Hearings and contributed to the successful realization of our hearings. We would like to extend our thanks to the Working Group, the WHO Quadripartite for their technical expertise and all the speakers and attendees that attended the hearings. This report would not have been possible without the valuable support of our partners in the G20&G7HDP, our Global Ambassadors and our Academic Partners, all of whom supported this project. We are grateful for the support of Shenel Osman in designing this report. This report is based on evidence heard during the four hearings the G20&G7HDP conducted on NAPs, Funding Mechanism and One Health Approach The G20 and G7 Health and Development Partnership is a not-for-profit advocacy organisation representing over 30+ global health organisations from across the public and private sectors and academia aiming to ensure G20&G7 countries coordinate their current and future health innovation strategies to tackle the growing global burden of communicable and non-communicable diseases and promote the delivery of the United Nations Sustainable Development Goals (UN SDGs) by 2030 with a focus on SDG3 “health and well-being for all” and SDG17 “strengthening partnerships.“ At the heart of its efforts the Partnership aims to build on the narrative that health is a positive investment to socioeconomic growth and supports a sustainable dialogue between health and finance ministers. Since 2017 our partnership emerged as an informal coalition of like-minded organisations and global ambassadors during the G20 Presidency in Germany. Over the last 7 years, we have increased our collaboration with both the G20&G7 Presidencies to reflect the need for increased convergence and stronger multilateral agendas. For more information contact us: office@ssdhub.org g20healthpartnership.com The G20 & G7 Health and Development Partnership @G20&G7Partnership

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Last week, Gilead Sciences shared results from a late-stage study showing that its long-acting injectable HIV prevention drug, lenacapavir, was more effective at preventing HIV infection in cisgender women and adolescent girls compared to the company’s daily pill, Truvada. The study, which included more than 5,300 cisgender women and adolescent girls, was stopped early by an independent committee because the results exceeded efficacy expectations, with no incidences of HIV infection among participants who received the drug compared to those who were not on any prevention regimen. Truvada is already in wide use for both HIV treatment and prevention, but the twice-a-year lenacapavir injection, which could be approved for HIV prevention regimens by the end of next year, offers an option that could be much easier to adhere to than the daily pill for many people, especially higher-risk individuals.In Paris last week, as part of the replenishment launch for Gavi, the Vaccine Alliance, the African Vaccine Manufacturing Accelerator was launched, a project Gavi will invest $1 billion into over the next decade to help increase Africa’s vaccine manufacturing base to accelerate the rollout of vaccines and improve pandemic preparedness on the continent. This project follows glaring inequities in access to COVID-19 technologies faced by African countries during the pandemic. Specifically, Gavi will provide financial incentives to African vaccine manufacturers once they hit supply and regulatory milestones, using market forces to drive down prices and encourage upstream investment. The project set the goal for Africa countries to produce 60 percent of the vaccines used by the continent by 2040, up from 2 percent currently. It will also explore issues including technology transfer and regulatory harmonization.Elion Therapeutics recently announced the close of an $81 million funding round to advance the development of its next-generation polyene antifungal candidate, SF001, designed to reduce toxicity and address critical challenges associated with currently available antifungal options. The news comes as growing resistance to existing antifungals and increasing fungal infection rates highlight the need for new and improved tools. The promising compound received Qualified Infectious Disease Product and Fast Track designations in 2023 from the US Food and Drug Administration for early antifungal therapy of presumed invasive fungal infection and treatment of invasive aspergillosis. The funding round includes investments from the public-private partnership AMR Action Fund, the fund’s first investment in an antifungal company.