Is Antimicrobial Resistance (AMR) the Next Health Crisis? Finding a solution to the hidden pandemic

Imagine a world where treatments for diseases such as cancer are just too dangerous to administer or routine operations become life threatening, having critical consequences for both individual safety and healthcare systems everywhere.1 It may seem far-fetched after decades of medical progress, but the emergence of antimicrobial resistance (AMR) makes this a very real and present danger.

AMR is occurring because microbes - bacteria, fungi, viruses and parasites - are increasingly resistant to antibiotics and other medicines we use to combat them, mostly due to overuse or misuse.1 Without prevention, prolonged illness will increase pressure on health systems, seeing longer hospital stays and worse patient outcomes.

According to the World Health Organization (WHO), AMR is the next public health crisis - and unless countered, could become a ‘hidden pandemic’.1,2??????????????????????????????????????????????????????????????????????????????????????????????????????????

The need for new antimicrobials

The threat of AMR is not just hypothetical. Drug-resistant tuberculosis (DRT) accounts for one third of all AMR deaths worldwide, with almost 200,000 people dying to the disease in 2019 alone.3 In the most serious cases, only a third of patients were treated successfully.3

Other, equally dangerous diseases are on the horizon. Antiretroviral drugs are at risk of becoming inactive against serious diseases such as HIV.? Drug-resistant parasites pose one of the greatest risks to malaria control.? In the wake of the recent pandemic, the potential for AMR to make respiratory illnesses and infections unmanageable for vulnerable populations is a danger we desperately need to avoid.?

So far, the research needed to find new medicines is lacking. Carbapenem medicines, for example, are an important defence against a number of potentially life-threatening infections, such as pneumonia. Yet there are few compounds in development that can stop carbapenem-resistant bacteria.?

One reason for this is a lack of commercial incentives to investigate new compounds.? Research, testing, manufacturing and dissemination within healthcare take a long time: by the time an antibiotic becomes the standard for first line of care, it is often near or beyond the end of its patent.

New antimicrobials are still not a permanent solution if we do not change how we are using antibiotics.1 AMR begins as soon as new antimicrobials appear. Novel agents will never be the most cost-effective, sustainable or sole solution to the challenge we face.

How, then, can we truly face the threat of AMR? The answer is not an easy one. It requires significant societal changes to how we use and think about antimicrobials. It requires effective measures to reduce the use of these medicines, and control the spread of AMR without relying on new treatments.

How a well-care attitude helps antimicrobial stewardship

Antibiotic overuse is not the only thing driving AMR. The main drivers include a lack of access to clean water and sanitation, poor disease control in some healthcare facilities, poor access to quality medicines and a general lack of education around the issue.1

The problem is holistic, and requires a holistic solution. It requires not waiting for novel antibiotics to come out, but preventing the need for antibiotics in the first place.

How can we accomplish this? The answer is a paradigm shift - from the current sick-care mindset, where we wait for symptoms to appear to treat someone, to one of well-care: where the underlying causes of illness are dealt with before sickness occurs, and we look holistically at the factors that cause illnesses themselves. This includes everything from geography to diet and standard of living. It means looking at ways we can prevent illness and protect communities, reducing the need for antimicrobials in the first place.

This is an enormous undertaking, of course, but there are already ways we can begin moving in the right direction. Introducing new, rapid diagnostic tests to community care hubs, such as pharmacies, can relieve pressure on primary care, and reduce the rate at which antibiotics are prescribed.

Changes to healthcare alone are not enough. Sustainable antimicrobial use requires behavioral, cultural, political and economic change before we will see a definite solution. Even more so, it requires a system of oversight that lets us determine where action is needed most.

Fortunately, that system is already arriving. The digitization of surveillance techniques - for example, analysis of health records and internet searches - allows us to determine where outbreaks are occurring and predict or prevent crises before they happen, instead of reacting when they do.? We have already seen success in this area, for example against swine flu and the zika virus.1? The Global Antimicrobial Resistance and Use Surveillance System (GLASS), a collaborative effort to standardize AMR surveillance, has been adopted internationally as a standardized approach to collecting, analyzing, interpreting and sharing data between organizations, so that prediction and rapid reaction to new threats is co-ordinated and decisive.11

Collaboration is essential

Systems like GLASS are essential because AMR will only be halted by a united, pan-industry approach. No one sector can take the glory on this one: governments, healthcare organizations and other industries must be united in designing and implementing programmes, research and legislation to attain better public health outcomes.

This comes back to the necessity of a holistic solution: working together, governments and healthcare organizations must blend health policy with reforms to housing, social care, and environmental policies. We must ensure that the root causes of illness, not just the symptoms, are treated.

As part of the healthcare system, pharma’s responsibility goes beyond solving symptoms to protecting health, and that involves many factors. We need to incorporate this multifactorial approach into everything we do, be it disease research, training, or the partnerships we create. This holistic viewpoint is critical to ushering in a well-care era that lets people stay healthy, not just wait to get sick.

None of us saw the recent pandemic coming, and the world suffered for it. We must learn from this. AMR is a threat, but it is not yet a global crisis. An AMR crisis can be prevented, if we utilize the digital tools we have and coordinate across industries to share information and research. We do not have to wait for it to get worse. Inaction on AMR is simply not an option.

References

1. WHO: Antimicrobial resistance. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance [Last accessed: November 2022]
2. OECD Forum Network: A Hidden Pandemic: The global response to antimicrobial resistance. Available at: https://www.oecd-forum.org/posts/a-hidden-pandemic-the-global-response-to-antimicrobial-resistance [Last accessed: November 2022]
3. Why drug-resistant tuberculosis poses a major risk to global health security. Available at: https://www.theglobalfund.org/en/blog/2020-11-19-why-drug-resistant-tuberculosis-poses-a-major-risk-to-global-health-security/ [Last accessed: November 2022]
4. WHO: HIV drug resistance. Available at: https://www.who.int/news-room/fact-sheets/detail/hiv-drug-resistance#:~:text=HIV%20drug%20resistance%20is%20caused,emergence%20of%20drug%2Dresistant%20virus [Last accessed: November 2022]
5. CDC: Drug Resistance in the Malaria-Endemic World. Available at: https://www.cdc.gov/malaria/malaria_worldwide/reduction/drug_resistance.html#:~:text=Drug%2Dresistant%20P.&text=falciparum%20first%20developed%20independently%20in,P . [Last accessed: November 2022]
6. ERS: AMR-Lung – AntiMicrobial Resistance in Lung infections. Available at: https://www.ersnet.org/science-and-research/clinical-research-collaboration-application-programme/amr-lung-antimicrobial-resistance-in-lung-infections/#:~:text=About%20AMR%2DLung,the%20world%20is%20currently%20facing [Last accessed: November 2022]
7. Suay-García B, Pérez-Gracia MT. Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections. Antibiotics (Basel) 2019;8(3):122
8. Challenges to tackling antimicrobial resistance. Available at: https://eurohealthobservatory.who.int/docs/librariesprovider3/studies---external/challenges-to-tackling-antimicrobial-resistance.pdf?sfvrsn=fe37b67f_3&download=true [Last accessed: November 2022]
9. Salathé M. Digital epidemiology: what is it, and where is it going? Life Sci Soc Policy 2018;14(1):1
10. Park HA, Jung H, On J et al. Digital Epidemiology: Use of Digital Data Collected for Non-epidemiological Purposes in Epidemiological Studies. Healthc Inform Res. 2018;24(4):253-262
11. Global Antimicrobial Resistance and Use Surveillance System (GLASS). Available at: https://www.who.int/initiatives/glass [Last accessed: November 2022
12. https://cdn.who.int/media/docs/default-source/antimicrobial-resistance/glass-infographic-%28web%29.pdf?sfvrsn=f2496120_2