Keynote Address"Advancing Global Political Action Against Antimicrobial Resistance: A Call for
Unified Leadership and Sustainable Solutions"
Yasuhisa Shiozaki
CSIS-JCIE Co-hosted Roundtable on Antimicrobial Resistance (AMR)
September 23, 2024, Washington, D.C., USA

Ladies and gentlemen, distinguished guests,
Thank you for the warm welcome and for the opportunity to speak before youtoday. I would like to extend my sincere appreciation to CSIS and JCIE fororganizing this crucial roundtable at such a pivotal moment in our collective fightagainst antimicrobial resistance (AMR).
For over a decade, I have been committed to combating AMR from a politicalstandpoint. As we gather during the UN General Assembly High-Level Meetingweek, I cannot help but reflect on the long road we have traveled to reach thispoint.
The convening of this week’s High-Level Meeting on AMR and the adoption of apolitical declaration is a landmark achievement, born from over two years oftireless preparation.
While it may not be perfect, I firmly believe this declaration marks a significant andmeaningful step forward in the global fight against AMR. I would like to take amoment to recognize and commend the tireless efforts of everyone who has
contributed to this important progress.
(AMR: A Persistent Political Challenge)
AMR has been a concern since Dr. Alexander Fleming's warning in 1945, but it
has only gained significant political attention in the past decade. The turning
point came around 2014-2015 when leaders like US President Obama, UK Prime1

Minister Cameron, and German Chancellor Merkel recognized AMR as a globalthreat.
Following the 2015 WHO resolution on One Health, Germany immediately
responded at the G7 Summit in Elmau a month later. This was followed by the G7Health Ministers' Meeting in Berlin in October 2015, where I saw firsthand thegaps in our response as the Health Minister of Japan. Imagine my surprise when I
realized Japan was the only G7 country without a National Action Plan!
I also worked extensively with global experts, notably Dame. Sally Davies, a former
Chief Medical Officer for England. In June 2016, Prime Minister Abe addressed
AMR at the Ise-Shima Summit, and later that year, I highlighted the issue at theG7 Health Ministers' Meeting in Kobe. These efforts culminated in the first UN
General Assembly High-Level Meeting on AMR in September 2016.
Since then, AMR has been discussed at numerous political fora, but the UNGA
High-Level Meeting holds particular legitimacy. Unlike at the G7 or G20, politicaldeclarations adopted at UNGA represent the consensus of all UN member states.
(Global Leadership and the UNGA High-Level Meeting on AMR)
A key milestone this week is the UN General Assembly AMR High-Level Meeting,where global leaders will address this critical issue. AMR has had this platform
twice—first in 2016 and now—but it may be another five years before we haveanother chance. We must seize this opportunity.
The Global Leaders Group (GLG) on AMR, which I am part of, was established in2020 and chaired by Mia Amor Mottley, Prime Minister of Barbados. The GLG has
pushed for sustained political commitment, increased funding, and stronger global
coordination.
The UNGA High-Level Meeting’s Political Declaration, while not legally binding,represents global consensus and drives action. There are two crucial
advancements in the Political Declaration that I believe warrant special attention.
First, the establishment of an independent panel for evidence for action against
AMR. For too long, the lack of solid, reliable data on antibiotic resistance has

2hindered progress. This panel, with a clear and structured timeline, will provide
the necessary foundation for more effective AMR measures.
Second is the emphasis on "access" to antibiotics. While much of the focus has
been on ensuring appropriate use, developing nations have rightfully stressed thataccess to antibiotics is equally vital. In fact, more people die from lack of accessto antibiotics than from AMR itself. Therefore, ensuring access is just as crucial
as regulating proper use, particularly in under-resourced regions where the needis most acute.
(Challenges in promoting interagency cooperation on AMR in Japan)
One of the challenges I encountered was the lack of coordination during thenegotiation process. In Japan's case, while our UN Mission in New York wasresponsible for negotiating the Political Declaration, the guidance from Tokyo wasessentially a patchwork of comments from various ministries. These often
included conflicting positions that should have been reconciled by the CabinetOffice, which is tasked with overseeing inter-ministerial coordination.
Unfortunately, this process fell short, leading to Japan adopting a moreconservative stance than was necessary, which unintentionally weakened thesubstance of the Political Declaration. This outcome highlighted the critical needfor streamlined and unified communication between government entities,
especially on issues as complex and urgent as AMR.
Looking ahead, it is vital that our government speaks with a single, cohesive
voice, particularly on matters like AMR that demand a comprehensive, One Healthapproach. I am eager to learn more about how the United States manages
domestic coordination across ministries and agencies, and how Japan might draw
valuable lessons from your experience to strengthen our own internal processes.
(Recognizing Pandemics and AMR as Security Threats)
The COVID-19 pandemic has shown us that health crises, including pandemics
and AMR, are not just public health crises—they are national and economic
security threats. We must all recognize that AMR also has the potential to disrupt
economies, strain national resources, and challenge societal stability.

3In my 28-year career as a Member of Parliament, I have learned that "globalhealth" does not usually win votes, as politicians often focus on specific groupinterests and public opinion. However, between 2014 and 2017, when I served
as Minister of Health, there was an exception.
During the Ebola outbreak, with Prime Minister Abe’s support, we led Japan’sinvestment in CEPI—a pandemic vaccine development engine—by framing healthcrises as national security issues. This approach, combined with dialogue
between health and financial authorities, made it easier to secure politicalcommitment.
Integrating AMR into national security frameworks and treating it with urgency
would secure greater political commitment and ensure a more effective crisis
response. Promoting collaboration between health and financial authorities islikely to ensure smoother budget allocation and more effective responses whencrises arise.
（Addressing Untapped Agendas）
While the global community has made significant strides in pandemic
preparedness, efforts to develop new antibiotics have lagged behind. Despitesome progress through "push and pull" incentives in G7 discussions, the overallcommitment remains insufficient. We must address this “market failure” withthe strongest political will if we are to make meaningful progress.
Another critical but often overlooked issue is the delicate balance between
antibiotic use and regulation, akin to the tension between economic growth andpublic health in climate change debates. This conflict exists both within andbetween nations, particularly in the context of AMR and the One Health approach.
It is crucial that we place greater emphasis on the environmental dimensions ofAMR. Much like climate change, AMR is a shared global challenge that demands
innovative solutions and bold political leadership.
Financing, too, remains a significant hurdle. Establishing a new financing
mechanism for AMR might be an ideal approach, but considering the optimizationof global health as a whole and the cross-disease and cross-sectoral nature ofAMR, we should explore ways to make existing global health financing mechanisms

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more responsive to AMR challenges. Institutions such as the Global Fund, Gavi,
CEPI, the Pandemic Fund, and the Global Financing Facility (GFF) are alreadywell-established pillars in the global health landscape. Rather than constructing
something entirely new, it would be more feasible—and impactful—to adapt these
existing mechanisms to better incorporate AMR-related priorities.
(Post-UN General Assembly Efforts)
Reflecting on the progress we have made, I believe that this moment, on the eveof the UNGA High-Level Meeting, represents the peak of our collectivemomentum. However, the true challenge begins after the “festival” ends. It is
the steady and effective implementation of the commitments outlined in thePolitical Declaration that will determine our success.
Our success will not be measured by the declaration alone, but by the tangible
actions that follow. By the time we reconvene for the next High-Level Meeting in2029, I am hopeful that we will have achieved even more substantial progress.
Though I now serve in a different capacity as a former politician, my dedication tothe fight against AMR and advancing the One Health approach remains
unwavering. I look forward to working alongside all of you to continue this vital
work, and I am eager for today’s discussions as we plan the path forward
together.
Thank you.

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