What can be done about drug resistance?

17 November 2022

Marking the start of World Antimicrobial Resistance Awareness Week (WAAW), UICC reiterates recommendations from an essential supplement on AMR to reduce misuse and improve infection control and research and development.

Since the discovery of penicillin by Alexander Fleming in 1928, antibiotics, antivirals, antifungals and other antimicrobial drugs have saved millions of people from dying from an infection. These medicines are the cornerstone of modern medicine: From hip replacements and difficult deliveries to organ transplants and chemotherapy, antimicrobials play a vital role in ensuring safe treatments.?

Antimicrobials are losing their effectiveness , however, through overuse and misuse as the microbes they are designed to kill grow increasingly resistant, this is called antimicrobial resistance or drug resistance. Alexander Fleming himself warned over 90 years ago that the irrational and inappropriate use of antimicrobial medicines would create superbugs capable of resisting them – and render them useless.

At the population level, antimicrobial resistance (AMR) is caused by over-prescription and providing medicines, such as antibiotics over the counter, which leads people to use them to treat illnesses such as common colds for which they were not designed and for which they have no therapeutic effect. They are also being used in farm animals to prevent disease and therefore passed on to the individuals who consume them. In this way, even people who have been careful and have seldom taken antimicrobial agents may encounter many problems to treat their infections.?

The issue of AMR is a global public health crisis – a silent pandemic because few are talking about it. In fact, the World Health Organization (WHO) has included AMR in the list of the ten greatest threats facing humanity . The world risks returning to a century ago when people died of routine infections.

This urgency and the fact that solutions exist to address this threat are the driving forces behind World AMR Week, celebrated 18-24 November every year.?

Antimicrobial resistance and cancer

AMR poses a particular threat to people living with cancer, due to their compromised immune systems resulting from chemotherapy and other treatment modalities for cancer, which makes them even more vulnerable to infections.

In fact,?infection is the second leading cause of death ?in people living with cancer, after the cancer itself. As many as?one in five cancer patients undergoing treatment hospitalised due to infection and antibiotics are the main line of defence for them.

AMR therefore risks undermining the enormous advances that are being made in treating cancer more successfully. It also considerably worsens the quality of life of people living with cancer, requiring more and longer hospital admissions and more intravenous antibiotics as well as broader spectrum antibacterial therapy (i.e medicines that act on many different bacteria).

UICC and the AMR taskforce

In 2019, UICC?set up a taskforce ?that combined experts from the cancer and infectious diseases communities, who selected three areas in which to focus their efforts and make policy asks:

1. Data collection and surveillance: Collect reliable data on the impact of resistant infections on cancer patients. If a patient dies from an infection while being treated for cancer, for instance, it can happen that cancer rather than infection is listed as the cause of death, even if that cancer may well have been treated successfully if the infection had been managed.?
2. Access to antimicrobials and diagnostics: Ensure the availability, affordability and sustained access to quality assured antimicrobial medicines as well as the diagnostics capability to see which antibiotic is needed – if it is needed – or whether infection is viral or fungal. Also ensure new research and development of new medicines and diagnostics.
3. Infection control and AMR in cancer treatment: Integrate AMR control into national policy documents, notably in national cancer control plans, ensuring adequate funding; and inspire UICC members to reach out to AMR advocates so that the cancer community works side-by-side with other health communities.

An essential report to address antimicrobial resistance

The taskforce supported the production of a wide-ranging and essential supplement that looks at?the impact of AMR on cancer care outcomes ?– at what can be done about it. Written by over 50 experts committed to researching the scale of AMR and finding workable solutions, the report was launched last October at the World Cancer Congress as a key resource for the cancer community, advocates and decision makers, which focuses on reducing misuse and overuse, data collection and surveillance.

Recommendations include:

• Improve?public awareness: The message that AMR concerns everyone must be conveyed widely to limit the misuse of certain drugs.
• Create visibility. As the COVID-19 pandemic illustrated perfectly, when numbers are reported daily, and everybody acknowledges the threat, powerful action follows.
• Engage the health workforce. Health-care personnel have an active role to play in drawing attention to AMR, ensuring the appropriate use of medicines and strong infection control practice in medical settings, as well as providing key input to national policy on AMR.
• Address over prescription. There needs to be stronger regulatory mechanisms to address over-the-counter sales of antimicrobials (including antibiotics), and to share best practices and encourage training among the healthcare community to ensure appropriate and prudent use of these medicines.
• Ensure access to diagnostics and treatment?
• Encourage the development of new medicines. As successful antimicrobials are destined to be replaced and to be successful, they must be used sparingly, innovative funding initiatives and reimbursement models for new medicines are needed, for example de-linking reimbursement from volume and paying instead based on social value. These concepts have been put into place now in the United Kingdom and have been endorsed by the G7 Health Ministers in 2022.?
• Design a?centralised and specialised surveillance system?for people living with cancer?to predict and prevent the emergence of antibiotic resistance. Finding better ways to predict, prevent, and treat antibiotic-resistant infections will have a major positive impact on the care of those living with cancer.
• Strengthen infection prevention and control?(IPC)

The next high-level UN meeting on AMR will be held in September 2024, offering the opportunity for the global health community to push for these recommendations.