"If the world does not take immediate action to address the issue of antimicrobial resistance (AMR), we will face a continuous increase in global deaths, with infants, the elderly, chronic disease patients, and those in need of surgical treatment at the highest risk." Recently, authors of an AMR special issue in The Lancet called for global efforts to urgently promote vaccination, safe drinking water, sanitation facilities, hospital infection control, expand access to existing antibiotics and new ones, and increase investment in new antibiotics, vaccines, and diagnostic tools to combat AMR.
A study estimated that in 2019, 7.7 million people died from non-tuberculosis bacterial infections, with nearly 5 million linked to bacterial AMR, and 1.3 million directly dying from bacteria pathogens resistant to the antibiotics used.
Increased Risks for Vulnerable Populations
Co-author of the special issue and professor at the University of Ibadan in Nigeria, Iruka Okeke, stated, "Access to effective antibiotics is crucial for patients worldwide. Failure to provide these antibiotics could hinder the achievement of the United Nations Sustainable Development Goals on child survival and healthy aging. Effective antibiotics can prolong life, reduce disability, lower medical costs, and make other life-saving medical interventions possible. However, antimicrobial resistance is on the rise, accelerated by the inappropriate use of antibiotics during the COVID-19 pandemic, threatening the foundation of modern medicine and leading to avoidable deaths and diseases."
The special issue emphasizes that infants, children, the elderly, and chronic disease patients are most susceptible to the impacts of AMR due to their higher risk of bacterial infections.
Statistics show that one-third of global neonatal deaths are due to infections, with half of these newborns dying from sepsis. The number of patients resistant to commonly used antibiotics is increasing among bacteria or fungi causing infections. For instance, in a study across 11 countries in Africa, Asia, Europe, and Latin America from 2018 to 2020, 18% of sepsis-infected infants did not survive despite receiving antibiotic treatment.
Furthermore, the elderly and chronic disease patients face significant risks from AMR, especially when seeking treatment in hospitals or long-term care facilities. AMR also jeopardizes the safety of treatments such as organ transplants, joint replacements, cancer chemotherapy, and the management of non-communicable diseases like cardiovascular diseases, diabetes, and chronic lung diseases.
Co-author of the special issue and member of the World Health Organization's AMR Survivors' Advocacy Group, Nour Shamas, highlighted, "While infants, the elderly, those living in poor conditions, or frequently hospitalized individuals are at higher risk of developing resistant infections, AMR can affect anyone. Policymakers, healthcare professionals, patients, and the broader community should advocate for global efforts to reduce the spread of infectious diseases and the development of resistance, strengthen research on issues like women's health, and ensure access to and appropriate use of antimicrobial drugs."
Continued Optimization of Existing Infection Control Measures
Co-author of the special issue and professor at the University of California, Berkeley, Joseph Lewnard, emphasized, "Attention must be focused on proven infection prevention interventions, which are at the core of global efforts to address AMR. Preventing infections can reduce antibiotic use, alleviate the selection pressure for AMR, and ensure drugs work when most needed."
Modeling analysis in the special issue estimates that by implementing existing infection prevention methods such as improving infection prevention and management in healthcare facilities, promoting safe drinking water and effective sanitation in communities, expanding the use of certain pediatric vaccines, and introducing new vaccines, 750,000 deaths related to antimicrobial resistance infections could be prevented annually.
"Public health strategies that prioritize infection prevention at the source are particularly crucial in addressing the issue of AMR, as these actions have the potential to significantly reduce the number of deaths caused by AMR-related infections. By focusing on improving infection control methods, safe drinking water, sanitation facilities, and vaccination in low- and middle-income countries, we could potentially reduce AMR-related deaths by 10% by 2030," stated Yewande Alimi, co-author of the special issue and from the Africa Centers for Disease Control and Prevention.
The special issue not only examined evidence for preventing infections at the source but also investigated evidence for preventing bacteria from developing resistance. Scientific management of antibiotics can alleviate selection pressure and prevent bacteria from becoming resistant, yet research in this area is still lacking.
However, evidence on the impact of scientific antibiotic management on AMR in low- and middle-income countries is limited. Dr. Esmita Charani, co-author of the special issue and from the University of Cape Town, emphasized that this does not mean scientific antibiotic management is an intervention to overlook. "On the contrary, the lack of research makes it challenging to predict the effects of scientific antibiotic management in these countries. Urgent research is needed to investigate the impact of this measure, providing insights for policy-making and interventions to address various scenarios in the future."
Rethinking Investment in Antibiotic Development
With more bacteria infections becoming unresponsive to existing antibiotics, there is an urgent need to increase investments to ensure global access to new antibiotics, vaccines, and diagnostic testing methods.
The traditional drug development model incentivizes investment through high profits, but this model is not viable in the field of antibiotics. Most new antibiotics are not registered in low- and middle-income countries, and even if they are, patients may not be able to afford them. The author team suggests that a government-funded model for developing new antibiotics based on public-private partnerships could increase the number of alternative options, reduce patient out-of-pocket costs, and improve access to antibiotics. They also advocate for increased funding for antimicrobial resistance (AMR) prevention programs.
Ramanan Laxminarayan, a co-author and senior research scholar at Princeton University, stated, "Failure to ensure the accessibility and affordability of drugs could lead to a continued rise in deaths from drug-resistant bacterial infections. Lowering drug development costs can help maintain reasonable antibiotic prices, as demonstrated in public-private partnerships for malaria and neglected tropical disease treatments. Similar strategies should be adopted for antibiotic development."
It has been revealed that the issue of AMR will be a topic at a United Nations General Assembly meeting, with a second discussion scheduled for a high-level meeting in September 2024. The author team proposes that the meeting adopt the "2030 10-20-30" targets within the framework of promoting antibiotics (i.e., reducing AMR-related mortality by 10%, decreasing inappropriate human antibiotic use by 20%, and reducing inappropriate animal antibiotic use by 30%).
Furthermore, the article calls for the establishment of an independent scientific body - the Independent Panel on Antimicrobial Drug Use and Resistance - to strengthen the evidence base for policy implementation and provide guidance for setting new targets.
Finally, Ramanan Laxminarayan emphasized, "The window of opportunity to treat bacterial infections is narrowing. For too long, people have either not seen AMR as urgent enough or too difficult to address. This is not the case. We need to act now, and the tools needed are already widely available. We hope that at the United Nations high-level meeting in September this year, there will be a global willingness to take unified action."
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