Bhathiya Barukanda
Remember what happened the last time political leaders ignored warnings from scientists about an infectious disease threat? Well, for over the past two decades scientists have been clamoring for more urgent action to be taken against anti-microbial resistance or AMR. Otherwise, the next 25 years from 2025 to 2050 could see over 39 million deaths from AMR, according to a new study just published in The Lancet. That would be a lot of deaths, many of which can still be prevented if things change. Will this be the number that finally prompts much more urgent action from political and business leaders around the world? Or will it be yet another ominous statistics about AMR that’s ignored until we get to the holy-cow-how-did-we-get-here stage?
To get this 39 million number, a large team of researchers collected and used a range of different data from hospitals, insurance claims, surveys, pharmaceutical sales and other sources to calculate the number of deaths and amount of disability that resulted from a set of different antibiotic-resistance bacteria in 204 countries and territories from 1990 to 2021. They then used statistical methods to extrapolate what would happen if the same trends continued versus situations where healthcare quality and access to appropriate antimicrobials improved over the next quarter-century. The researchers found that AMR-related deaths among those 70 years and older increased by over 80% from 1990 to 2021. They forecast that the year 2050 could see around 1.91 million deaths directly attributable to AMR and around 8.22 million deaths associated with AMR around the world.
This certainly wasn’t the first study to show how bad AMR—or AR if you don’t want to say “M”—has gotten and how much worse it can get. In June, The Lancet published a whole special issue that endeavored to cut to the heart of this problem. The World Health Organization (WHO) has listed AMR as one of the top 10 threats for global health. And “CDC works continuously to increase education and awareness of the threat of AR across sectors and audiences, including the public, healthcare providers, policymakers, and global partners,” said Michael Craig, MPP, Director of the Antimicrobial Resistance Coordination and Strategy Unit at the Centers for Disease Control and Prevention. “CDC’s Be Antibiotics Aware and Get Ahead of Sepsis are two examples of educational efforts.” He added, “The interactive AR Investment Map makes information on CDC’s investments in the AR fight publicly available online.”
Many other studies, symposia and advisory bodies have sounded alarms. For example, in September 2023, I moderated a panel at the World Anti-Microbial Resistance Congress and Disease Prevention and Control Summit in Philadelphia, Pennsylvania, entitled “How can we push AMR to the forefront of preparedness,” which asked that exact question, as covered by Caitlyn Stulpin for Healio. Yet, where is the sense of urgency among political leaders? Why hasn’t AMR been part of the political discourse leading up the November elections in the U.S.?
This may sound like déjà vu all over again when many political leaders spent years before Covid-19 hit 2020 not listening to scientists warning about the possibility of another pandemic. But unlike Covid-19, the current AMR situation doesn’t just involve one pathogen and won’t improve with a vaccine and more exposure to the pathogen. AMR is whenever any microorganism like bacteria, viruses, fungi, or parasites is no longer susceptible to the currently available antimicrobial treatments. AMR has been more of a catastrophe in slow motion as more and more antibiotic-resistant pathogens have emerged over the years. There is an alphabet soup of different microorganisms that have developed AMR such as MRSA, VRE, CRE, and ESBLs. In fact, the situation has gotten so bad that researchers have had to come up with new acronyms such as MDROs (multi-drug resistant organisms) and XDROs (extensively drug resistant organisms) to describe the increasing level of resistance that has emerged among different microorganisms.
The danger is that our society could return to the infection Dark Ages when even simple infections could quickly became death sentences because humans lacked effective treatments. It’s easy to forget the years before 1928 when an accidental discovery by Alexander Fleming, MBBS, led to the development of the world’s first true antibiotic: penicillin. Before antibiotics became readily available, even small cuts could cut short a person’s life.
While penicillin was a game-changer, microorganisms were able to quickly adapt developing mutations to neutralize the effects of this antibiotic, sort of like those robot sentinels in the movie X-Men: Days of Future Past. When this happened, humans then countered with a new and improved antibiotic. But then bacteria essentially then came back with, “I see your new antibiotic and raise you this new mutation to counter that antibiotic.” Of course, bacteria don’t really talk in human language. But that’s essentially what bacteria and other microorganisms have done repeatedly since then. In the ensuing half century, humans were able to keep ahead of the microorganisms and their mutating ways in this arms race.
But by the time the 2000s came around, two things had been happening for a while. One is that people had been using antibiotics excessively for stuff like sore throats and various medical and dental procedures even when bacteria really weren’t the problems. Such overuse has further accelerated the development of antimicrobial resistance. The second issue is that antibiotic innovation slowed to a snail’s pace. “Major pharmaceutical companies have exited the anti-infective R&D space over the last 15 years driving pharma investments and technical know-how into other areas,” explained Mark Albrecht, PhD, chief of the Antibacterials Branch at the Biomedical Advanced Research and Development Authority (BARDA), which is part of the U.S. Department of Health and Human Services. That’s left very few new antibiotics entering the market over the past two decades. Both of these trends have helped pathogens start winning the arms race. The concern is that we may reach a point of no return.
Both Craig and Albecht mentioned how the complexities of AMR and dealing with it can make messaging about the problem complicated. Albrecht lamented, “After decades of access to effective antimicrobial drugs, we have taken for granted their lifesaving potential and underestimate how difficult it can be to treat infections that are resistant to existing treatment options.” And Craig urged, “Combatting AR requires a global One Health approach, working at the local, regional, national, and global levels to achieve optimal health outcomes for people, animals, plants, and our shared environment.”
Both mentioned the need for more attention, investment and innovation in addressing AMR. Craig warned, “Without sustainable funding, CDC is unable to maintain its current level of effort or expand domestic and global AR programs.” And Albrecht urged, “We need innovation not only in development but also in push and pull incentives that result in greater commercial sustainability for new antimicrobials. Antimicrobials need better financial and reimbursement models to provide a return on investment balanced with stewardship.”
At some point, this resistance to investing much more into developing more antibiotics and combating AMR needs to be overcome. Otherwise, our society will no longer be able to resist the catastrophe in slow motion that AMR has become.
SOURCE:forbes.com
