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CARA: The Conscience of Antimicrobial Resistance Accountability, and the next big thing for CDDEP

CARA: The Conscience of Antimicrobial Resistance Accountability, and the next big thing for CDDEP

A UN Declaration is a great thing.

This includes the “political declaration of the high-level meeting of the General Assembly on antimicrobial resistance,” which, this September, gave the world its marching orders to do what’s necessary to ensure that everyone in the world has access to effective antibiotics for the long term. It provides a role for everyone to play, building on the World Health Organization’s Global Action Plan for antimicrobial resistance (AMR), which already has buy-in from the UN’s Food and Agriculture Organization (FAO) and World Organization for Animal Health (OIE) for a One Health front.

This clause, “recognizing that,” exemplifies the scope of this declaration:

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.

The declaration goes on to spell out the particulars of what governments, industry and the rest of us should do to preserve the effectiveness of antibiotics in every country on earth. Making sure it actually happens is a different task, however, and one even the United Nations cannot take on by itself. Enter CARA, intended as the eyes and ears of the world to track what is actually being done, in service to the global leadership that will lead the way following the UN General Assembly.

How CARA Will Operate

CARA is an alliance of organizations, which CDDEP expects will eventually number in the thousands. All organizations—public, private, for-profit and non-profit—are welcome as members of CARA.

Each organization will commit to reporting on mutually agreed upon indicators in countries around the world. CARA will have at least three main reporting branches: human, animal and environment, each led by several member organizations. A steering group of member organizations will be responsible for overall CARA leadership.

CARA will collect and collate data on these indicators and report back to the public and UN institutions every two years. Reporting will be transparent, naming all information sources.


It’s all very well to talk about indicators in the abstract. What do we really mean?  Some examples, keyed to the UN declaration:

AMR: Nationally representative antibiotic resistance rates for specific pathogen-drug combinations for humans and animals

Antibiotic use and misuse: Hospital and retail antibiotic sales

Infection prevention: Immunization rates for childhood infections

Policies and guidelines: Comprehensive national AMR policy in place and status of implementation

Going Forward

A steering committee has been formed from early entrants and will meet next month to finalize CARA’s structure and to negotiate a manageable list of the many possible indicators. The first global report is planned for September 2017, which will set the baseline for the future. 

CDDEP will report on progress in this space over the long haul. 

How You Can Help

In the meantime, if you are part of an organization that would like to join CARA, use this link: Get more information here: