Drug-Resistant Bugs Are A Growing Concern In COVID-era, Say Global Health Leaders Antimicrobial Resistance 18/11/2020 • Raisa Santos Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Recent AMR successes include increased prominence in global discussion and a robustly funded discovery-stage and translational research but momentum and public communication have been long-standing issues. The COVID-19 pandemic has underlined the need to dramatically step up the combat against drug-resistant bacteria, viruses and other pathogens. The world can’t afford to be caught again by surprise with the spread of a dangerous infectious disease for which there is no cure, a growing chorus of global health leaders are warning as the world observes World Antimicrobial Awareness Week (18 – 24 November). “The antimicrobial resistance (AMR) agenda must move forward with renewed vigor and momentum in the global health space, one that can fit into a post COVID-19 narrative,” says Timothy Jinks, Head of the Drug Resistance Infections Program at Wellcome Trust. Timothy Jinks, Head of Wellcome Trust’s Drug Resistant Infections Priority Program, speaking on Wellcome Trust’s “The Global Response to AMR” Report He spoke as the Wellcome Trust released a new update on “The Global Response to AMR” that said concrete progress on attacking the root causes of AMR had been too slow and key priorities like water, sanitation, and hygiene (WASH) and infection prevention and control (IPC) have not been addressed. To up the political ante, WHO will be launching Friday a new “One Health Global Leaders Group on Antimicrobial Resistance” (AMR) – led by Sheikh Hasina, Prime Minister of Bangladesh and Mia Mottley, Prime Minister of Barbados – whose mission will be to give the issue more visibility among other world leaders. The “One Health Global Leaders” initiative was first announced in August by the WHO, the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE)- which are trying to work together more closely to curb both human and animal use of precious drugs – which is one of the key drivers of AMR. “The world is in an arms race against antimicrobial resistance and we hope the new group will consider solutions on all fronts against AMR, including encouraging sustainable production of antimicrobials,” said Alba Tiley, the Global Director of the Sustainable Antibiotics Program at Centrient Pharmaceuticals, regarding the WHO initiative. Centrient, a generic pharma firm based in Rotterdam, Netherlands, is one of the few remaining antibiotic manufacturers in Europe. Their portfolio covers many medicines on the WHO Essential Medicines list including amoxicillin, penicillin and cephalosporins. “We need to make sure the very process of making these life-saving medicines does not contribute to antibiotics losing their effectiveness.” Three Critical Gaps – Wellcome Trust Report AMR already causes some 700,000 deaths annually. But if current trends are not reversed, that number could rise to 10 million per year by 2050, a special UN task force has warned. As antimicrobial drugs lose their efficacy due to AMR, risks of prolonged hospital stays or additional surgical interventions increase substantially. AMR burdens health systems already struggling with cost inflation, and damages national economies from increasing illness and death that further hit health budgets. These health and economic burdens disproportionately fall on low and middle-income countries (LMICs). The Wellcome Trust report zeroes in on what it describes as three key gaps in global AMR response, that drive the risk of irreparable loss of valuable drugs. Ambition has not translated into action. Though there has been a prominent increase of global discussion on AMR over the past three to four years, this has not translated into a broader implementation of initiatives, especially in LMICs, where AMR typically competes for political attention and resources with other public health topics. The most critical drivers of AMR need to be prioritized. The ‘big tent’ approach of the AMR response to date has increased awareness among a broad range of stakeholders. However, AMR experts are concerned that the multifaceted nature of the issue, the complexity of its narrative, and the multitude of possible interventions are paralysing the community, preventing impactful action. The AMR agenda was losing momentum before SARS-CoV-2 emerged. And now? Already in late 2019, a growing circle of experts perceived the AMR agenda as losing momentum, due in part to the complexities of communicating about the issue to the broader public. The COVID-19 pandemic has exacerbated those concerns. The report notes that the COVID-19 pandemic has demonstrated how vital it is to conduct R&D to combat novel and drug-resistant viruses New Opportunities – and Solutions At the same time, now that politicians and the broad public have seen what damage an invisible virus can wreak, when no drug treatment exists, the time may be more ripe for warnings that this could happen again – very soon – if AMR trends aren’t vigorously addressed. Wellcome Trust’s key preventative measures for the next decade The Wellcome Trust report etches out a way forward for the next decade. The plan of attack focuses not only on accelerating the pace of R&D for new drug therapies to replace those rendered impotent by drug resistant bugs, but also limiting abuse of drugs in use now. Among the key preventive measures, are: Human consumption of antibiotics: Optimising human consumption of antimicrobials requires guaranteed access for those who need treatment – but adequate stewardship to limit overuse and abuse. This requires much stricter regulation of sales and use of classes of antibiotics and antiviral agents to which bacteria have developed, or are beginning to develop, resistance. In particular, greater restrictions on over-the-counter sales to the public – and more public awareness about the appropriate use of such drugs, is needed. Antimicrobial use in animals: A response that is preventative that doesn’t focus purely on treatment requires a holistic perspective that includes other topics such as ensuring appropriate antimicrobial use in animals. There needs to be a more prudent use of drugs needed for humans in the livestock sector, which is one of the world’s largest consumers of antibiotics, particularly in the USA, Europe and other OECD countries. Water, sanitation, and hygiene (WASH): Access to clean water and better management of sewage runoff both prevents infections, reducing the need for drugs in the first place, as well as reducing untreated waste streams laced with antibiotics or other drug residues that act as reservoirs where drug resistant pathogens might breed. Infection prevention and control (IPC): IPC measures in hospitals and communities reduce the need for antibiotics and their consumption. Surveillance: Right now, only about one-third of countries gather data and report systematically on use of antimicrobial drugs. Much more effective surveillance systems also are critical to understanding the problem, designing and implementing interventions, and assessing the effectiveness of the response, the report underlines. Livestock applications of antibiotics in metric tons/year, among countries reporting use. (The Antibiotic Footprint) Scaling up Research and Development for New Drugs Research and development also needs to be scaled up dramatically, the report emphasizes. This has already begun to happen, with the establishment of a new Global Antibiotic Research and Development Partnership (GARDP), created by the World Health Organization (WHO) and Drugs for Neglected Diseases initiative (DNDi), which aims to drive more private and public investment into R&D to replenish the antibiotic drug pipeline. In July an AMR Action Fund of nearly $1 billion was also established by more than 20 leading biopharmaceutical companies, with a mission to bring 2-4 new antibiotics to patients by 2030. In addition to that, the Wellcome report also underlines that in light of the COVID-19 pandemic – the source of which is a virus, not a bacteria – that R&D to combat new and drug-resistant strains of viruses, and other pathogens must also occur continuously and sustainably. In addition, by preventing infection in humans and animals, vaccines play an important role in reducing antimicrobial consumption. Can COVID be an Opportunity? Despite the complexity of the issue, this week is seeing a flurry of activity that suggests the ripples of a broader awakening about AMR. During Wellcome Trust’s panel on Wednesday, global leaders brought up AMR’s unique role in the face of the COVID-19 pandemic. COVID-19’s impact on the AMR global response “So while COVID-19 is taking over the public health dialogue, it simultaneously has opportunities through this pandemic that we should strategize around. This is prevention’s moment; prevention has never been sexier,” says Lindsey Denny, a health advisor at Global Water 2020, and a global health practitioner with experience across Africa, Asia, and Latin America. Denny spoke to how the pandemic has generated a better understanding of public health principles such as WASH and the importance of PPE. “We can and should capitalize on advocating both to decision makers and to the broader public for WASH and IPC strategies.” Jyoti Jyoshi, Head of the South Asia Center for Disease Dynamics, Economics, and Policy, discussed the need for the AMR community to integrate itself more so into the global health sphere. “The AMR community should tie in with the large global health preparedness and systemic response agenda. Because we don’t live in isolation. Infections don’t need visas. It’s a flat wall – people travel just as microbials and chemicals like antibiotics do.” There was also a joint statement on the AMR threat issued today by very diverse group of actors, including: the International Alliance of Patient Organizations, the International Hospital Federation, the International Society for Quality in Health Care, and the International Federation of Pharmaceutical Manufacturers and Associations. The statement supports innovative partnerships of healthcare providers, patients and the business sector in tackling the growing AMR threat. In an op-ed in Geneva Solutions, Neda Milevska, vice-chair of the International Alliance of Patients’ Organizations, says it is also the patient’s responsibility to become more aware about the need to prevent the abuse and overuse of antibiotics and other drugs. She describes the approach as one that can also enhance patient empowerment, saying that so far, the power of patients has been ignored by policymakers in the battle against AMR, even though personal behaviour plays a major role: “Among patients today, there is widespread practice of self-treatment with antibiotics. This is stimulated even more so by the COVID-19 pandemic, as physicians have increasingly prescribed antibiotics to stave off increased illness, which feeds back into the loop of drug-resistance. “It is always politically sensitive to mention that patients have some responsibility. But, no amounts of funding to develop new drugs or curb AMR now will work, if people at the grassroots continue to abuse their life-saving potential. The magnitude of people’s power is so great .. .and it can be destructive or productive.” Image Credits: DFID – UK Department for International Development, Wellcome Trust, antibioticfootprint.net. 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