Humankind versus microbes; all bets are off

Humankind has a gift for adapting to a variety of environments, from accommodating to hostile, in order to survive and thrive. The same can be said of microbes. And, in a race for survival between the two, all bets are off in terms of who will win in the end; humankind or microbes such as bacteria or viruses. If I had to bet today, my money might not be on humankind. But let’s not speculate and instead, let’s stay optimistic as the story unfolds. Since the first patient was treated with penicillin just 80 years ago, bacteria have been more-or-less successfully under attack by antibiotics, but they also have been quick to develop resistance to a growing number of counter measures. In fact, each year, antibiotic-resistant infections are responsible for 50,000 deaths in the US and Europe alone; of late that number grew to 700,000 globally. We are only making the problem worse by allowing for the indiscriminate use of antibiotics; by allowing people to access antibiotics over the counter in many countries and by giving in to demands for antibiotics to treat the common (viral) cold. Clearly, action is needed. While many proposed solutions are focused on the development of new technologies (e.g., new antibiotics,  rapid diagnostic tests, and alternative therapeutic approaches, such as monoclonal antibodies), there is also a need to acknowledge and better support the role that vaccines can play in controlling antimicrobial resistance (AMR); today and in the future.

To better understand the urgency of the situation, one only needs to look back to the time when antibiotics did not yet exist. To make my point, I could of course cite numbers proving that infectious diseases were a major killer, with millions of deaths every year. But, I would rather tell you the story of one individual, a British Police Constable who scratched his face while (allegedly) pruning roses. His name was  Albert Alexander and back in 1941, he was the first patient to be treated with penicillin. By the time researchers started treating Albert, he had already lost an eye, was covered in abscesses, and was deteriorating fast. Remarkably, after only 5 days of treatment, Albert made a speedy recovery and it seemed that a cure was possible…until the researchers ran out of initial penicillin doses. Unable to quickly make more, Albert relapsed and ultimately died. Although it later turned out that the infected cut resulted from a bombing raid, the story of the rose bush continues to dominate even today because before antibiotics, people could really die from scratches – or in the case of one US President’s son, a blister resulting from a game of lawn tennis. And, with the rise in AMR those days are returning faster than we think.

I recently spoke at the World Economic Forum (WEF), where the Access to Medicines Foundation released their 2020 AMR Benchmark. While it was a great honor to speak on behalf of GSK, who topped the industry ranking, this was not a moment for celebration. The reality is that so much more work is needed if we really want to make a difference in combatting AMR and changing the odds of my hypothetical bet. All stakeholders – including industry – must work together in increasing progress against antibiotic resistance, in a way that is sustainable.

During the Davos meeting, it was widely agreed that changes are urgently needed in order to make investing into R&D for antibacterial products (i.e. new antibiotics) economically viable. For example, new, innovative antibiotics are desperately needed to fight resistance overall, to fight specific diseases with high resistance like tuberculosis, and to avoid hospital infections. However, these future, novel antibiotics should be used very sparingly, with tight restrictions and guidelines for use put in place to slow down the development of new resistance patterns. Unfortunately, there is a fundamental flaw in this equation. The current economic sales model for antibiotics is based on high volume in exchange for lower prices -  the opposite of the restricted use required to tackle AMR. Governments and Industry are now tasked with identifying alternative models, ones which will hopefully reverse the trend of industry leaders pulling out of the field and start-ups going bankrupt, both of which are putting the development of new antibiotics at risk.  

However, there is more we can do. During the meeting, I shared my thoughts on how we can make better use of current and future vaccines to progress against this growing threat, a topic close to my heart and in my opinion, underappreciated in terms of its current and future implications.

Current vaccines

The value of vaccination, using existing vaccines, becomes quite clear when you consider that vaccine-preventable bacterial and viral infections, such as diphtheria, meningitis, pneumonia and whooping cough, are major drivers for antibiotic prescriptions. Simply put, if you can help prevent the diseases that are treated with antibiotics, you can help reduce antibiotic usage in a big way, helping slow down the further development of antibiotic resistance. Even vaccines for non-bacterial infections, such as influenza and rotavirus, help prevent diseases that are often associated with the inappropriate use of antibiotics.

Future vaccines (vaccines in development)

In the future, the value of vaccines in the fight against AMR will only grow. Fortunately, candidate vaccines are under development aiming to help prevent more infectious diseases throughout the life course, which in turn can reduce excess antibiotic use and the likelihood of resistance in the years to come. These include vaccines to help prevent Shigellosis, Tuberculosis, Malaria, RSV, and C. difficile, to name just a few being developed by the vaccine industry as a whole.

However, understanding the role played by vaccines in AMR is only a first step – action is also needed before we can see any results. So, to close, here is my call to action for the various stakeholder and decisions makers involved in preparing us for the future of AMR, which I hope includes some of the people reading this post:

• Build a larger body of data on the impact of vaccines on AMR through research and surveillance, and in so doing, support the decision-making process by policymakers for the broader use of vaccines; current and future ones.
• Create incentives for the development of new AMR-related vaccines (and medicines, see above). For example, consider AMR-related benefits in regulatory submissions and health technology assessments; or new funding models, such as partnerships that share the costs of development or faster recommendations of vaccines post licensure.
• And last but certainly not least, prioritize vaccination! For example, by supporting increased recommendations, coverage and access points (i.e. at the pharmacy). And ensure that initiatives are sustainably funded for impact over the long term.

Some of my readers might question this message as it comes from an executive who has a vested interest in increasing vaccine coverage. However, as in my other posts, public health impact is my main driver - and AMR is a problem of great personal concern. So, to drive the message home once more; AMR is a serious matter and humankind is running out of options. While all bets are off considering the endgame, the odds are currently not in favor of humans. None of us wants to return to a world where daily activities like gardening and exercise, a minor accident, or hospitalization can develop into life-and-death battle against infectious bacteria. So now really is the time to act decisively and proactively – using all the tools in our toolbox, including existing and future vaccines.