Governing Global Antimicrobial Resistance: 6 Key Lessons from the Paris Climate Agreement

Antimicrobial resistance (AMR) is among the most urgent global health challenges of our time. AMR can develop with each use of an antimicrobial, regardless of the setting. The ongoing use of the same antimicrobials across sectors and the ability of microbes to transfer among people, animals, food, and environments; spread across borders through global trade and travel; and bring entire economies to a halt means that every antimicrobial consumed has global implications. Some microbes have already developed resistance to all known antimicrobials, meaning previously curable diseases have become untreatable. If immediate action is not taken, the effectiveness of these vital medicines will continue to diminish, further undermining modern medicine's ability to treat infectious diseases and perform essential medical procedures.1 The global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants that cause COVID-19 has sparked new discussions on the need for an international pandemic treaty,2 presenting a unique opportunity to reflect on AMR as one pathway through which new crossborder global health threats emerge. Similar to zoonoses such as COVID-19, AMR can lead to untreatable infectious diseases in humans with the potential to become deadly pandemics. AMR diminishes the global common pool of antimicrobial effectiveness - a nonexcludable but rivalrous resource - meaning that maintaining the viability of antimicrobial therapy is a global common-pool resource challenge.3 Overcoming this challenge will require global mechanisms to coordinate interests and investments, limit free riding, and steer cooperation toward preserving the common pool. This aspect of AMR enables us to draw lessons from other common-pool resource challenges, such as climate change, in building collective action to target the pathways by which AMR may emerge, maximize the antimicrobial commons for everyone's benefit, and avoid further descending into this tragedy-ofthe-commons scenario. Building global collective action while accommodating varying national circumstances is a monumental but, in our view, achievable task. The 2015 Paris Agreement under the United Nations Framework Convention on Climate Change, for example, successfully mobilized substantial collective action to protect a shared global commonpool resource similar enough to antimicrobial effectiveness that it can provide lessons for advancing global action in this area. While countries struggle to meet their specific climate targets, the Paris Agreement has stimulated global cooperation by engaging countries in an ongoing effort to mitigate greenhouse gas emissions and adapt to the impacts of climate change. AMR lacks an equivalent global vehicle for building cooperation and would benefit from a Paris Agreement-style coordinating structure. The Paris Agreement offers 6 key lessons relevant to managing the global antimicrobial commons (Table 1).