Antimicrobial resistance (AMR), or the resistance of pathogens to antibiotics, antivirals, antifungals and antiparasitics has been declared by the World Health Organization (WHO) as one of the top 10 global public health threats and was associated with the death of some 5 million people in 2019. The latest WHO report on AMR reveals increased resistance to both common and more dangerous bacteria and the need for reliable data in all countries to correctly monitor AMR.
Antimicrobial resistance undermines modern medicine and puts millions of lives at risk
Dr Tedros Adhanom Ghebreyesus, WHO Director-General
A major health threat
According to the Centers for Disease Control and Prevention (CDC) in its 2019 report, in the US alone, 2.8 million antimicrobial-resistant infections occur each year and over 35,000 people die as a result. In the EU, the European Commission (EC) estimates around 33,000 AMR-related deaths per year. In addition, AMR represents an economic burden the EC estimated at around EUR 1.5 billion per year in healthcare costs and productivity losses within the EU.
In response to the AMR threat, the WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to track and collect AMR-related data. Using the GLASS system, the new WHO report analyses AMR rates within the context of national testing, AMR trends since 2017, and data on antimicrobial consumption in humans in 27 countries.
A few of the report’s findings are especially alarming.
Increased resistance in common bacteria
According to the report, common bacterial infections are becoming more and more resistant to treatments. Among these, Neisseria gonorrhoea, a common sexually transmitted disease which has shown a 60 percent resistance rate to one of the most used oral antibacterials, ciprofloxacin. For E.coli, another common pathogen and the most common one in urinary tract infections, a 20 percent resistance rate was found to both first-line drugs (ampicillin and co-trimoxazole) and second-line treatments (fluoroquinolones).
The report also shows levels of resistance above 50 percent in life-threatening bloodstream infection-causing bacteria like Klebsiella pneumoniae and Acinetobacter spp. These infections often require “last-resort antibiotics,” like carbapenems, with as much as 8 percent of bloodstream infections caused by Klebsiella pneumoniae were reported resistant to carbapenems.
Gaps in low- and middle-income country data
The report calls for more reliable data from low- and middle-income countries (LMICs) where AMR rates remain difficult to interpret because in many of these countries the number of hospitals that report to GLASS is limited. Moreover, these hospitals often care for the sickest patients who may have received previous antibiotic treatment.
“To truly understand the extent of the global threat and mount an effective public health response to AMR, we must scale up microbiology testing and provide quality-assured data across all countries, not just wealthier ones,” said Ghebreyesus.
To bridge the gap, WHO plans to follow a two-pronged approach aiming at short-term evidence through surveys and long-term capacity building for routine surveillance.
This will entail the creation of representative national AMR surveys and an increase of quality-assured laboratories reporting representative AMR data.
What is being done to tackle AMR?
In the US, the CDC has put in place the Antimicrobial Resistance (AR) Solutions Initiative, which invests in detecting, containing, and preventing resistant infections. The EU launched its One Health Action Plan against AMR in 2017 and contemplates AMR in its recent EU4Health programme, adopted in response to the COVID-19 pandemic. China has strengthened its AMR governance in recent years whereas Japan set forth a national action plan on antimicrobial resistance.
But despite the fact that 148 countries have national AMR action plans in place, implementing these plans remains a challenge, particularly for many low- and middle-income countries (LMICs). These countries suffer from competing public health priorities and a lack of funding to turn plans into action. In 2021 the WHO, with the help of the Kingdom of Saudi Arabia’s USD 21.6 contribution in support of the WHO’s work in the area, chose an initial seven countries to benefit from a comprehensive technical package for the implementation of national AMR action plans. These countries include Egypt, Ethiopia, Jordan, Indonesia, Nigeria, Pakistan and Sudan.
As for innovative drug developers, organizations such as the Biotechnology Innovation Organization (BIO) in the US are pushing for legislation such as the Pioneering Antimicrobial Subscriptions To End Up-Surging Resistance (PASTEUR) Act, that would establish an outcomes- and value-based payment model in which the government would pay companies set amounts for antimicrobials based on their public health value.
Under the AMR Action Fund, launched in 2020, 20 biopharmaceutical companies, including Bayer, Lilly, Pfizer, Novartis, Merck and GSK, have invested nearly USD 1 billion to strengthen and accelerate antibiotic development with the aim of bringing two to four new antibiotics to patients by 2030.