Two years ago, the UK Government commissioned a Review on Antimicrobial Resistance in collaboration with the Wellcome Trust. The review group, led by economist Jim O’Neill, analyzed the pipeline of new antibiotic drugs, the use of infection diagnostics, surveillance, infection control procedures, alternative treatments and the impact of the use of antibiotics in agriculture. Recently, their final report on problems presented by antimicrobial resistance (AMR) and recommendations for tackling drug-resistant infections globally were released.
The recommendations have received widespread coverage. Among many other news outlets, The Economist dedicated their cover to antibiotic resistance, and covered the history and evolution of “superbugs,” the top threats and the process of antibiotic development, and the Financial Times looked at strategies for financing new antibiotics, including a “market entry reward” and levy for drugmakers proposed by the UK review.
The Economist pointed out that to find workable solutions, first, the scope of the problem needs to be understood. Drug resistance itself is a simple mechanism – in the battle of bacteria vs. antibiotics, over time, bacteria may undergo genetic variations that are “helpful” like the production of enzymes that destroy the drug, or changes to their shapes that make it difficult for the drug to attach. When the survivors proliferate, the population can be considered drug-resistant. But people are more concerned about emerging disease threats, and know less about the everyday consequences of antibiotic resistance:
“When people hear about antibiotic resistance creating “superbugs”, they tend to think of new diseases and pandemics spreading out of control. The real threat is less flamboyant, but still serious: existing problems getting worse, sometimes dramatically. Infections acquired in hospital are a prime example. They are already a problem, but with more antibiotic resistance they could become a much worse one. Elective surgery, such as hip replacements, now routine, would come to carry what might be seen as unacceptable risk. So might Caesarean sections. The risks of procedures which suppress the immune system, such as organ transplants and cancer chemotherapies, would increase.”
The scope of losses due to AMR is already extensive. In the introduction to the UK review, O’Neill estimated that over a million people died of AMR globally while the report was being prepared. In addition to these human costs, O’Neill stated that lost global production between now and 2050 would be an $100 trillion if we take no action against AMR. As O’Neill cited, the prevalence of these infections is often the worst in healthcare settings, particularly within intensive care units. One direct quote from the report reads, “[I]nfection prevention and control (IPC) is too often seen as a cost pressure, rather than a means to deliver better value and better outcomes for patients;
managers and senior clinicians often give it insufficient focus as a result.” Rather than being seen a cost pressure, infection prevention needs to be seen as a way to mitigate these human costs and lost production costs.
Research like the Review on Antimicrobial Resistance is critical, as it generates broader public awareness and spells out measureable steps which are critical for driving real solutions to this problem. While there’s still a significant focus on the creation of novel drug treatments – which are needed and critical for when infections do occur – it emphasizes the requirement for a multi-pronged approach which additionally focuses on preventative techniques that reduce our dependence on antibiotics in the hospital and other environments, as well as tech-savvy solutions for surveillance and diagnostics, recognized subject-matter experts, and international cooperation. By generating international awareness and bringing together these important forces, we get closer to a solution to this problem that has such a deleterious impact on human health.