By World Healthcare Journal-
Professor Dame Sally Davies, UK Chief Medical Officer and global advocate for fighting AMR, outlines the need for urgent international collaboration to avoid a worldwide disaster.
AMR or anti-microbial resistance is one of the greatest threats to human health at the moment. As bacteria increasingly develop resistance to antibiotics, the world is facing the prospect of an estimated additional 10m deaths by 2050 as a result of previously treatable infections.
Sir Alexander Fleming himself knew that this resistance was only a matter of time, but like all scientists he hoped that new techniques would be developed to mitigate the threat. According to the Review on Anti-Microbial Resistance chaired by Lord O’Neill in 2014, antimicrobial-resistant infections currently claim more than one million lives a year worldwide, but the true undocumented figure could be much higher. https://amr-review.org/
Professor Dame Sally Davies, UK Chief Medical Officer and global advocate for fighting AMR, is more aware than most that the world is returning to an age where simple treatable infections will once again become killers.
“AMR threatens modern medicine – cancer treatments, routine surgery, caesarean sections – these all rely on working antibiotics,” she says. “A recent OECD report shows that across OECD countries, AMR results in over 700 million extra hospital days, putting substantial pressure on health systems.
“AMR doesn’t just threaten human health; it puts agricultural livelihoods, global food security and the economy at risk too. The World Bank predicts, under a high-impact scenario, AMR will cause a reduction in global GDP of 3.8%, bigger than the financial crisis of 2008. http://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future
“And finally, AMR threatens our ability to achieve the UN Sustainable Development Goals and ultimately, it is those living in low-income settings that will be hit the hardest. The World Bank predicts AMR to cause greater drops in economic growth in poor countries than wealthy countries, leading to a further 28.3m people pushed into extreme poverty. ”
How healthcare professionals can help
With such a Doomsday scenario, it would be reasonable to assume that the use of antibiotics on a previous scale would be reduced drastically already. According to the Review, the variation in the AMR problems of individual countries is linked to differences in how heavily they use antimicrobial drugs. Overuse and misuse of antimicrobials is facilitated in many places by their availability over the counter, as well as the existence of counterfeit and substandard microbials.
For Dame Sally, healthcare professionals have a vital role to play in slowing down the emergence and spread of AMR. “Healthcare professionals who prescribe antimicrobials have a responsibility to do so appropriately which means only when a patient really needs them. This is a real challenge as we know patients can often be demanding for an antibiotic prescription,” she says.
“Healthcare professionals also have a responsibility when it comes to Infection, Prevention and Control (IPC), especially in hospitals where a crucial component of tackling AMR is by preventing infections occurring in the first-place and preventing transmission when they do arise. This means simple things like adhering to hand-washing protocol. ”
In her opinion, developing new treatments to tackle AMR doesn’t just mean new antibiotics but also improved diagnostics and alternative therapies. “We also need to ensure a resilient supply of old antibiotics globally,” she says. “This requires investment from industry into R&D and access which so far has been difficult to secure as many pharmaceutical companies have left antibiotic R&D space. Tackling this involves both push and pull incentives, both working domestically and as a global partner through the G7 and G20. The aim of these incentives is get pharmaceutical companies investing in replenishing the antibiotic pipeline which has run dry. ”
The role of the private sector
Scientists are beginning to work together internationally to try to resolve this impending crisis, while at the same time industry is investing in infection and control programmes along with software automation to analyse and report on relevant data.
An example of international partnership announced in January this year between the UK and China across academia and industry resulted in 13 projects to develop solutions to address AMR, of which nine are led by SMEs.
“The private sector has a crucial role to play,” says Dame Sally. “Not just pharmaceutical companies but SMEs, investors, banks, insurance companies, and not just the health sector but those involved in agriculture and the food chain.
“Incentivising investment into new antibiotics (and alternative therapies) is difficult as we have a situation called ‘market failure’. Antibiotics become less effective the more they are used and so it is hard to incentivise companies to invest in producing them when we don’t want them to be selling them at high volume and the science is really difficult. That is why we need to investigate a new model that allows pharmaceutical companies to receive payment based on the value an antibiotic has to society, rather than linking payment to volume of sales. I am excited that a pilot of a potential new payment model is included as an action in the UK’s new AMR action plan. ”
International travel enables the mixing of different microbes to create new antimicrobial-resistant strains, therefore it is imperative the international healthcare community works together to tackle the problem.
Working across borders is the most direct way of tackling such a vast threat to human health. The Fleming Fund is a £265m UK fund set up to support low and middle-income countries tackle AMR, primarily through surveillance. The projects funded are not just focused on human health but also on agriculture and the environment, so this will provide important data but will take time to build the capacity and capability in a sustainable manner with countries and tailored to their needs.
The UK Department of Health and Social Care also has a collaboration with Canada’s International Development Research Centre (IDRC) which has recently funded £17m of research across multiple consortium to find new vaccines for animals and alternatives to antibiotics for growth promotion.
The UK’s government’s new 20 year vision and 5 year plan spans not just healthcare but all sectors and stakeholders, relating to reducing infection rates, promoting responsible and prudent use of antimicrobials in humans and animals, incentivising innovation of new drugs, alternative therapies and diagnostics, being an effective global leader and partner and much more.
“I think people are slowly but surely waking up to the threat that AMR poses, not only to human health but to agricultural livelihoods, food security and the economy,” Dame Sally says. “This year is an important year – the UN Inter-Agency Coordination Group on AMR, of which I am a co-convener - will be submitting their recommendations around April time to the UN Secretary General outlining next steps to sustain effective action globally. This is needed now more than ever; currently there is an ongoing outbreak of drug-resistant typhoid Pakistan – there have been over 5000 cases so far.
“Following the submission of the IACG’s recommendations, I hope that AMR will be raised at the UN General Assembly in September and other international fora to highlight the urgency of tackling this unfolding tragedy and we can start to focus on implementing these recommendations.
“I really hope this won’t just be another report on the shelf but will result in real change on the ground. ”