20-21 - AMR: The silent pandemic

According to the World Economic Forum, antimicrobial resistance (AMR) could be more deadly than COVID-19.

These ‘superbugs’ have been a known threat for nearly two decades -- with the Infectious Disease Society of America alerting the general public to the global health risk in 2004. However, a dangerous combination of over-prescription of antibiotics, and lack of a coordinated, dedicated response and broad communication plan has led to this issue worsening each year – and we have continued to fall short on investing in technologies and programmes to address it.

With global attention still fixed on navigating the current COVID-19 pandemic, we must look back on how COVID-19 was handled by different entities, regions and nations to identify lessons that can inform a more proactive and effective response to drug-resistance before it becomes the next global pandemic.

COVID-19 treatment outcomes among hospitalised patients reveal a pattern of antibiotic overuse and misuse. A recent meta-study analysing COVID-19 patients revealed the prevalence of antibiotic prescribing to be 74.6%. The estimated rate of bacterial co-infection was significantly lower, indicating that antibiotics were prescribed unnecessarily in many cases.

This trend is not unique to the COVID-19 pandemic -- antibiotic consumption increased 39% globally between 2000 and 2015. Around the world, we’re seeing drastic variations in how antibiotics are prescribed and used by patients. These varied trends can be attributed to many factors, including practitioner behaviour, reliable access to outpatient care and consumer education around the already indicated uses of antibiotics. This is where a broader, more consistent education campaign could have an impact on reducing rates of over-prescription as well as driving a more complete understanding of these treatments among crucial patient populations.

On the clinical side, awareness and antimicrobial stewardship (AMS) strategies can be bolstered by introducing broader, molecular diagnostic testing panels into the standard of care for any patient where an infectious disease is suspected. Available polymerase chain reaction (PCR) tests can identify a high number of common pathogens and resistance markers, empowering doctors to wait for results before administering antibiotics. Many of these tests provide results in just a few hours, rather than days for conventional culture methods, encouraging responsible antibiotic use while also shortening the time to a more informed treatment course.

Introducing broader testing panels and more stringent, consistent AMS programmes across healthcare facilities, including urgent care centres, clinics and private practices, is only the first piece of the puzzle. Cloud-based software platforms simplify the outbreak identification, tracing, monitoring and response process.

Diagnostic test results and patient outcome data can be gathered by individual facilities and entered into a shared cloud-based database where the aggregated information is compared against data sets from other participating facilities, regardless of location.

Creating a repository of thousands of clinical isolates updated in real time enables genotypic and phenotypic analysis, creating a streamlined, reliable digital infrastructure. Broader health surveillance platforms offer crucial learnings on the origins of a transmission event, behaviours of new and emerging infectious disease strains and genetic resistance markers. Armed with expanded knowledge, clinicians and healthcare professionals can also assess and alter their infection control protocols to help avoid future outbreak events.

The above strategies have already demonstrated success in public- and private-funded pilot programmes and among specific patient populations. If there is any hope of addressing and mitigating AMR as a global threat, non-government organisations (NGOs) like the WHO must work alongside global governments, multilateral organisations, like the G20 and G7, and medical industry organisations such as the ICBA to commit to a series of long-term and short-term cross-disciplinary efforts and programmes.

What might that look like? Looking back on more than a year of COVID-19 response and existing AMR efforts, we can identify a few suggestions:

Establish consistent messaging – it’s been suggested that countries with the highest instances of AMR burden tend to be those with higher transmission rates, rather than higher rates of antibiotic over-prescription. In addition to patient, doctor and caregiver education on antibiotic stewardship, basic infection control practices need to be promoted by public and private entities in healthcare settings and across national media to help them to remain at the top of people’s minds. These groups must agree on common, accessible messaging that can be disseminated across cultures and borders to reach the broadest audience possible.
Enable democratised testing access – faster, more comprehensive PCR testing panels can be considered the gateway to responsible antibiotic use and informed treatment decisions. There are many tests available which can be easily integrated in laboratory facilities. However, to launch a more equitable response to AMR, these testing panels and analysis platforms need to be available in healthcare settings across low- to middle-income nations and regions, not just in affluent areas and for private-funded facilities. Prioritising regulatory approvals of these panels could help diversify the market. Vendors should also update sales and marketing strategies to be more inclusive of global customers.
Prioritise funding of non-drug solutions – currently, investors are not prioritising new antibiotic development projects. These drugs often end up unused on reserve lists or overused and rendered ineffective, so it’s no wonder these efforts are not considered lucrative. It’s time to pivot from primarily drug development targeted efforts to broader technology solutions as the dominant investment focus in the continued fight against AMR. This includes emerging technologies like rapid molecular diagnostics, AI-powered bioinformatics and digital surveillance platforms and cloud-based data solutions. Similar to broader testing access, if private and public sector entities are committed to supporting companies creating these technologies, they must also ensure these efforts include plans to introduce technologies and infrastructures globally.

AMR becomes a more pressing global threat each day and does not discriminate based on a nation’s wealth, a patient’s location, a hospital’s funding or whether proper testing is available. It falls to governments, healthcare and advocacy leaders to ensure our approach to tackling AMR includes awareness initiatives, investment incentives and legislative actions that address the global nature of the problem. As many countries begin to set their eyes on the end of the COVID-19 pandemic, the time to reform existing approaches to the global AMR crisis is now.

Taking action against the silent pandemic of AMR: three key steps

Prioritise antimicrobial stewardship and rapid diagnostics

Take a broader look with data sharing and informatics platforms

Adopt a truly global approach