COVID-19 is clearly a generation-defining public health crisis; one which could have a lasting impact on many facets of our lives for many years to come. While focus is placed on getting us out of this one pandemic, another one has been silently gaining momentum for decades now: antimicrobial resistance (AMR). The World Economic Forum recently announced that AMR could be even more deadly than COVID. The WHO’s latest report suggests that recently-approved antibiotics and those currently in development by themselves are simply not enough to address this threat. Drug resistance also earned a spot on the WHO’s list of top 10 global health issues to track in 2021.
This challenge is not going completely unaddressed — in April 2021 the UN General Assembly convened on AMR for the first time in five years. However, even with heightened awareness among certain groups, AMR is a global threat that currently lacks a dedicated, coordinated multilateral and indeed global response.
We just can’t afford to wait!
When broad spectrum antibiotics are administered in patient cases where they aren’t indicated, it is not only ineffective, but it can even give rise to multidrug resistant organisms (MDROs). A 2021 meta-study published in Clinical Microbiology and Infection revealed that three-quarters of patients with COVID-19 received antibiotics. This prescribing rate is significantly higher than the estimated rate of bacterial co-infection in these patients, indicating that unnecessary antibiotic use is likely to be high in patients with COVID-19. Further, a study in the Journal of Antimicrobial Chemotherapy suggested that the immense strain that the management and treatment of COVID-19 has inflicted on healthcare settings could result in the relaxing of measures that prevent the spread of MDROs, such as more comprehensive patient screening, isolation between infected patients and antimicrobial stewardship.
These findings and trends are particularly worrisome when you look at outbreaks in densely populated regions and countries, like India, where many patients may potentially receive antibiotics unnecessarily as doctors look to provide quick treatment. Researchers analyzed hospitalized COVID patient data across 10 facilities in India between June and August 2020. Incidence of secondary bacterial infections ranged from 1.7% to 28% across these hospitals, and in nearly half (47.1%) of the total hospitalized patients with secondary infections, the co-infections were found to be caused by MDROs.
What’s more, travel is a known spreader of MDROs — drug-resistant pathogens can be carried, often unknowingly, across continents by travelers who then infect others they come into contact with, particularly in shared transportation settings. This creates the potential for the spread of a truly global threat in several days or even in just a few hours. No pandemic in the 21st century will ever remain local or even regional, and common antibiotic administration practices intended to provide relief can actually exacerbate these pathogens, making other patients under care in the same facility vulnerable to transmission. We need a multilateral and ideally a truly global, cross-disciplinary strategy if we hope to successfully combat existing and newly-developed MDROs and avoid another costly pandemic.
Steps to prevent a pandemic of AMR
Governments, multilateral organizations, such as the G-7 and G-20, non-government organizations (NGOs) such as the WHO, industry associations, such as the International Council of Biotech Associations ICBA, health administrators and patients must all play a role in short- and long-term measures to address AMR. Establishing something akin to U.S.’s BARDA in Europe at a multilateral level would be a great next step! It starts with a more coordinated approach to education campaigns around infection prevention and responsible treatment of drug-resistant pathogens. Researchers have suggested that countries with the greatest AMR burden are those where pathogens spread more dominantly, rather than those where antibiotics are overused. Integrated education campaigns on infection control practices could make a huge difference. Public and private entities around the world need to collaborate on consistent messaging that can be adapted and shared across new and traditional media channels for maximum exposure.
On the treatment side, promoting more stringent antimicrobial stewardship (AMS) programs can be very effective — let’s look at India again; AMS is a key strategic intervention and has shown success in curbing AMR rates and lowering the economic burden of drug resistance. In order for these programs to be effective, everyone involved must be held accountable — this includes healthcare workers, pharmacists and the patients themselves. This is another area where public and private sector groups spanning different regions and nations must come together to establish a comprehensive, transparent approach to AMS. Guidelines, goals and messaging should be established by public health entities in ways that can be replicated across diverse patient populations, healthcare systems and cultures to establish a united front against antibiotic overuse and misuse.
Responsible antibiotic treatment decisions for infectious disease patients cannot occur without access to reliable and rapid diagnostic testing at the point of clinical need. COVID alerted many consumers to the benefits of molecular polymerase chain reaction (PCR) tests. Running comprehensive panels that can identify common pathogens and resistance markers is the first step to understanding whether a patient should receive antibiotics – and if so how and which ones. Many of today’s available tests are quick and easy to use, delivering results in just a few hours. Biotechnology industry and diagnostic executives need to work to get these testing panels in the hands of more global healthcare facilities. For this to happen in a timely manner, regulatory bodies must also prioritize the review and approval of these products so more options become available faster.
Right now, the antibiotics pipeline is depleted. Investors have deprioritized funding development of new antibiotics they believe will only be held as reserve or overused to the point they become ineffective. This has left many companies underfunded and funding often left to organizations such as CARB-X and others. This in turn has led to many pharmaceutical companies abandoning these programs. It’s high time for attention to turn to non-drug, technology solutions that can arm healthcare workers and researchers with bioinformatics data to fight AMR more strategically. Investments must be directed toward establishing an effective, global AMR monitoring and early warning system. This system will not be effective if it’s only established in affluent countries. With many AMR threats becoming more global each day, low- and middle-income countries must also be granted access to these technologies.
The Infectious Disease Society of America flagged drug resistance as a burgeoning public health crisis as early as 2004. Much like climate change, lack of conviction and follow-through on a coordinated, global response has led to the AMR threat continually worsening at an alarming and accelerating pace over the past two decades, while many epidemiologists have been watching in disbelief and dismay. It may be too late to reverse damage already done or neutralize pathogens that have become rampant. But coming out of the COVID-19 pandemic, with the global eye still fixed on public health issues, there’s no excuse to delay any further our global efforts to come together and join in the fight against AMR. Healthcare companies, national governments, investors, NGOs, supra-national and multilateral organizations and clinical leadership groups must commit to establishing coordinated efforts that include education, intervention and renewed investment into new diagnostic and therapeutic technologies if we are to have any hope of reversing the momentum of AMR around the world.
Oliver Schacht is the CEO of OpGen, Inc., a pioneering precision medicine, bioinformatics and genomic analysis company providing complete solutions for patients, hospitals, and network-wide infection prevention and treatment decisions.