23 November 2020

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It may seem strange when discussing tackling antibiotic resistance, but in this viewpoint, I will start by talking about SARS-CoV-2, the virus that is causing the COVID-19 pandemic. Other diseases caused by viruses include chickenpox which is caused by the varicella-zoster virus or Ebola by ebolaviruses. When we talk about these, we never talk about tackling all these viruses at the same time. However, that is exactly what we do when we talk about addressing antibiotic resistance: we group together many different bacteria, drug resistances and infections. It is much easier to focus attention on single infections.

The antibiotic resistance pandemic is with us

There are millions of cases of infections by various species of drug-resistant bacteria worldwide and so it is safe to say that the world is already in the midst of an antimicrobial resistance pandemic. However, the impact of this pandemic has hardly been felt by those who live in high-income countries. This is because there is considerable choice of and access to antibiotics. Despite this, there are tens of thousands of untreatable infections each year in these countries (e.g. USA1) and even more in low- and middle-income countries. Unfortunately, unlike COVID-19, many of these deaths by drug-resistant infections are hidden and if documented are usually recorded with a different cause of death, such as cancer or sepsis. If people realised how many deaths were caused by drug-resistant infections across the world they would act as quickly as they have for COVID-19.

We are a global community so what happens anywhere in the world can happen to anyone – COVID-19 has shown this. AMR travels too.

The World Health Organization (WHO) will shortly start a global surveillance project2 where attributable mortality data will be collected and this will show the real size of the problem. I expect that it will likely be high and may be similar to the current global mortality figures for COVID-19. Do we want to wait until then to act? Unlike COVID-19, which is a new disease, we know a lot about antibiotic resistance and there are many promising opportunities to develop new treatments. The world, however, needs to act together in partnership to develop these so that they reach the patients who need them. Global action as seen to tackle COVID-19 is one of the missing parts of the ‘puzzle’ to tackling antibiotic resistance.

New antibiotics are needed – all over the world

It is important to note that there are few vaccines to tackle drug-resistant infections and it may not be possible or even desirable to use this approach for all. This is because many bacteria are an important part of our microbiome, the so-called ‘good’ bacteria. However, any bacterium in the wrong place in the body such as the lungs or blood can cause a deadly infection. New treatments are the quickest and best hope for tackling the drug-resistance pandemic. The science of AMR is much more advanced than it is for COVID-19 and so we have the knowledge to do this now. Unfortunately, the drug discovery and R&D pipeline as well as how it is funded has been divided up into segments. Different sectors can also appear pitted against each other. The only way we can conquer AMR across the world is to link the parts of the pipeline with every actor working together. And yes, this needs more funding – not just to get new antimicrobials into the pipeline, to develop these into drugs and get them approved for use in high-income countries but also to make them available and accessible to all everywhere. Most new drugs are only approved for use in Europe and North America but worryingly there’s been a recent case3 where a new antibiotic was only approved for use in the USA.

If people realised how many deaths were caused by drug-resistant infections across the world they would act as quickly as they have for COVID-19.

AMR, like COVID-19, travels

We are a global community so what happens anywhere in the world can happen to anyone – COVID-19 has shown this. AMR travels too. In fact, many of the transmissible genes that code for antibiotic resistances that trouble us today have originated and spread globally (e.g. the Klebsiella pneumoniae carbapenemase (KPC) was first isolated in the United States4 and the NDM-1 carbapenemase was first isolated from an Indian patient in Sweden5). To protect us all, we must make sure that new treatments are manufactured and distributed throughout the world. Another way to view this is to talk about priority populations. This is already being done for COVID-19, where we are discussing those most at risk such as the elderly. With antibiotic resistance, we should focus on getting treatments for infections for which there is the biggest need and the priority populations that are often children and babies, as well as those parts of the world where access to old and new drugs can be limited.

In conclusion, we need to work together, and we need to make sure that there is enough funding to do this. If we do not act now to tackle the antibiotic resistance pandemic we could end up in the same situation as we are in with COVID-19, where good hygiene, social distancing and restricting our activities will be the only way we can control the situation. We are all too aware of the huge impact that has had on our economies and lives.

References

  1. US Centers for Disease Control and Prevention (CDC). 2020. US National Action Plan for Combating Antibiotic-Resistant Bacteria (National Action Plan).
  2. World Health Organisation (WHO). 2020. GLASS method for estimating attributable mortality of antimicrobial resistant bloodstream infections. 
  3. Shlaes, D. 2020. AMR and Europe – What Happened? 
  4. Arnold RS, Thom KA, Sharma S, Phillips M, Johnson JK, Morgan DJ. Emergence of Klebsiella pneumoniae Carbapenemase (KPC)-Producing Bacteria. Southern Medical Journal 2011; 104(1): 40–45. 
  5. Yong D, Toleman MA, Giske CG, Cho HS, Sundman K, Lee K, Walsh TR. Characterization of a New Metallo-β-Lactamase Gene, blaNDM-1, and a Novel Erythromycin Esterase Gene Carried on a Unique Genetic Structure in Klebsiella pneumoniae Sequence Type 14 from India. Antimicrobial Agents and Chemotherapy 2009;53(12):5046–5054. 

Laura Piddock joined the Global Antibiotic Research and Development Partnership (GARDP) in January 2018. As GARDP’s Scientific Director, Laura leads the Discovery and Exploratory Research and Scientific Affairs programmes, including the REVIVE programme. She also contributes to GARDP’s Policy & Advocacy activities.

Since Laura started her PhD in 1982, she has been at the forefront of antimicrobial research. Laura began her career in a hospital and successfully integrated this background with academic research. She has published over 250 articles, six chapters in academic books and co-authored nine reports to the UK government or WHO. She has given over 200 lectures at international conferences. She has an H-index of 86. Laura is also Professor of Microbiology at the University of Birmingham, UK, where she leads a team whose research focuses on multidrug efflux (pumping of antibiotics out of the bacterial cell), regulation (switching on and off) of bacterial multidrug efflux pumps and discovery of efflux inhibitors.

Laura has been involved in various Policy activities. She was the British Society for Antimicrobial Chemotherapy (BSAC) Chair in Public Engagement, and in this role was the Director of Antibiotic Action and led the secretariat of the UK All Party Parliamentary Group on Antibiotics from 2012 – 2017. Laura was a co-author of the first World Economic Forum report on AMR in 2013, and an expert adviser to the AMR review led by Lord Jim O’Neill.

Laura is an enthusiastic communicator about antibiotic resistance and the lack of new antibacterial treatments. She has given talks to various groups at local, national and international level. Laura frequently contributes to both the local, national and international media (print, radio, television and digital) and has been interviewed, advised on, and appeared in, several documentaries for numerous global networks including BBC (One, Two, Four, Radio 2, Radio 4, Radio 5 Live. World), Al Jazeera, CNN, Channel 4 and Sky News.

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