“By the year 2050 … we would have up to 10 million people a year die from multidrug-resistant infections at a cost of potentially up to $100 trillion. That would be more people dying from AMR superbugs than from cancer and other major diseases combined.”

Oliver Schacht,
CEO of OpGen

Introduction

Antimicrobial resistance (AMR) is considered one of the top ten major threats to global health according to the World Health Organization (WHO). Worldwide, 700 000 people lose their lives due to AMR each year, and experts predict this tally could reach 10 million by the year 2050 without intervention (Charlton, 2020). To reduce this risk, immediate action on a global scale is needed.

In episodes 89 and 90, the PHI team chats with Oliver Schacht, the CEO of precision medicine company OpGen, about rising rates of AMR and steps that healthcare providers, policymakers, and individuals can take. Today’s blog post will discuss:

• Understanding antimicrobials and antimicrobial resistance
• The acceleration of AMR: Causes and consequences
• Taking action: Collective approaches to tackling AMR

Understanding antimicrobials and antimicrobial resistance

Antimicrobials embody a broad range of medicines – including antibiotics, antivirals, antifungals, and antiparasitics – that are used to prevent and treat infections in humans, animals, and plants (World Health Organization, n.d.). Your doctor has likely prescribed you with an antimicrobial at some point – be it a course of antibiotics for a bout of strep throat or an antifungal medication to treat a case of thrush. When taken properly, antimicrobials can clear most infections within a matter of days or weeks.

Some infections, however, do not respond to antimicrobials. This resistance occurs when a known bacteria, virus, fungus, or parasite changes overtime to the point where medications that were previously effective no longer work (World Health Organization, n.d.). As a result, certain germs become immune to treatments, causing infections to persist within the human body. 

Antimicrobial resistant infections – often dubbed “superbugs” – are gravely concerning to healthcare professionals. Without treatment options, the infection can cause significant damage to the body and may even result in death. Moreover, the uncontrolled infection can spread onwards to others, putting populations at significant risk of harm.

The acceleration of AMR: Causes and consequences

AMR  is, in reality, a naturally occurring process (Centers for Disease Control and Prevention, 2021). But global rates of AMR are accelerating much faster than normal. Why is this so? 

Many experts primarily attribute the rising incidence of AMR to widespread overuse and misuse of antimicrobials, which accelerate the natural microbial evolutionary process (World Health Organization, 2020). An antibiotic, for example, usually kills most bacteria but some will inevitably survive and multiply (Australian Government, 2017). The risk of these resistant bacteria surviving and spreading increases the more often antibiotics are used, especially when used incorrectly. Indeed, many patients are prescribed medications that do not properly target their infection (for instance, the prescription of antibiotics to treat viral infections like the flu), providing even more opportunities for resistant strains to gain traction. These superbugs can quickly spread throughout a population.

Lack of clean water, sanitation, and hygiene (WASH) also plays a significant role in the acceleration of AMR. Proper access to WASH facilities is proven to prevent and slow the onward transmission of many diseases (World Health Organization, 2020). When these services are unavailable – especially in shared spaces like healthcare facilities and community settings – superbugs are more likely to spread. This issue is prevalent in many rural and impoverished areas worldwide, making these populations much more susceptible to illness.

The recent COVID-19 pandemic has also led to an increase in the use of antimicrobials. Several factors may explain this phenomenon including increased prescription of antibiotics to prevent bacterial co-infections, difficulty in differentiating COVID-19 and bacterial infections early on in the pandemic, general disruption in healthcare services, and the diversion of human and financial resources away from AMR (Pan American Health Organization, 2022). This has likely slowed global progress on addressing AMR, the consequences of which will be felt in the years to come. 

Taking action: Collective approaches to tackling AMR

One country’s public health threat today may easily become another country’s tomorrow. In today’s interconnected world, collective action and cooperation is necessary to protect populations from infectious diseases, including AMR. 

Oliver Schacht shares the following suggestions to bolster progress and cooperation on AMR: 

Limit the incorrect use of antimicrobials, especially broad-spectrum antibiotics

In many regions, patients often receive antimicrobials, particularly antibiotics, when they are not necessary. The Pan-American Health Organization estimates that more than half of all antibiotics used worldwide are prescribed, distributed, or sold inappropriately (Pan American Health Organization, 2022). This overuse increases the chances that a drug-resistant superbug may emerge and quickly spread.

To prevent this, healthcare professionals, drug distributors, and patients can take greater care to ensure antimicrobials are only used when medically necessary. This can be achieved by: 

• testing patients to ensure they receive the correct medication from their doctor;
• limiting the use of high-strength antibiotics unless required; 
• preventing the sale of over- and under-the-counter antibiotics without a medical prescription; and 
• educating healthcare workers and patients on the proper use of antibiotics and the risks associated with overuse.

Allocate funding for, and incentivize the development of, new treatments and diagnostic tools

Did you know that the last time a novel antibiotic made it to the market was 1984? (PEW, 2021). Antibiotics were heralded as miracle drugs when they were first discovered in the early 20th century, and scientists desperately searched for new classes of antibiotics in the years that followed. So why the disinterest nowadays when antibiotic-resistant bacteria are on the rise?

It ultimately comes down to a matter of incentives. If prompted, drug and precision medicine companies have the capacity to quickly expedite the development and mass production of drugs and therapeutics – COVID-19 has proven as much. But in the case of the pandemic, there was a large and immediate incentive to develop new technologies as fast as possible. No such incentive presently exists for AMR – antibiotics do not produce high profits and are not used regularly by most patients, thus making them an unattractive investment for most companies. This in turn discourages research and development, leaving room for AMR to skyrocket.

Action must therefore be taken to create positive incentives to invest in AMR research and drug development. The most direct way to achieve this is to create government funding and insurance programs to give companies the financial assurance they need to invest in new technologies. It is also important that the review process for new products be expedited to allow potentially life-saving treatments to make it to the public as soon as possible. 

Adopt a global multilateral approach

Global problems like AMR require global solutions, but international cooperation on the issue is surprisingly sparse. Increased coordination across governments, NGOs, and international organizations around the world could be used to consolidate and enhance the global AMR strategy.

Such a network would be beneficial on numerous fronts. For one, it could help make antimicrobials more accessible for those who need them through trade partnerships and advocacy, particularly in low- and middle-income countries. International data sharing and partnerships could also facilitate the development and global production of new drugs and diagnostic tools. These efforts would help foster a sense of global responsibility and solidarity when it comes to combating AMR.

In summary:

• AMR occurs when a bacteria, virus, fungus, or parasite evolves to become immune to common drug treatments. This means that infections that were once treatable persist in the human body and can be passed on to others. 

• While a natural phenomenon, AMR is rising at an unusually high rate due to numerous factors. The overuse and misuse of antimicrobials is often cited as a key contributor, as they provide additional opportunities for resistant bacteria to emerge and spread. Poor access to WASH and the increased use of antibiotics during the COVID-19 pandemic are also contributing factors.

• Governments, healthcare providers, and individuals can take a range of actions to slow the progression of AMR. These may include limiting the use of antimicrobials, creating positive incentives to invest in research and development, and collaborating on a global level to tackle the issue.

Written by: Claire Borgaonkar