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The recent virtual event organised by the OECD Forum, titled "What Can We All Do to Help Prevent the Silent Pandemic", focused on the global implications of antimicrobial resistance (AMR), coinciding with the release of a new OECD report Embracing a One Health Framework to Fight Antimicrobial Resistance.
AMR poses serious threats to human, animal, plant and environmental health, food safety, food security, and pandemic prevention, preparedness, and response. AMR disproportionately affects low- and middle-income countries and globally, drug-resistant infections already contribute to at least 700,000 deaths a year. In Africa, the toll of AMR-related fatalities surpasses that of HIV/AIDS. The World Bank estimates that an additional twenty-four million people would be forced into extreme poverty by 2030 if no action is taken on AMR.
The gravity of this situation implies a potential regression to a pre-antibiotic era, where commonplace medical procedures, surgeries, and even childbirth become perilous due to heightened infection risks. Despite these alarming facts, a pervasive lack of awareness characterises this “silent pandemic”.
Malin Grape, Sweden’s AMR Ambassador, mentioned that 2024 provides an historic opportunity for the world to renew political momentum and commitment towards addressing AMR at the second high-level meeting on AMR convened by the UN General Assembly in the fall of 2024.
More on the Forum Network: Fight Antimicrobial Resistance for Safer Food and Better Health by Elzo Kannekens | Zoe Fourcade, Director Global Public Policy & Multilateral Affairs | Senior Specialist EU and Multilateral Public Policy & Government Relations , MSD Animal Health
The ability to reduce dependence on antimicrobials without compromising the management and control of animal disease offers profound benefits for human health and development, from ensuring the safety of our food to reducing the risk of bacterial animal-borne diseases to humans.
Malin stressed that more accessible and relatable communication is needed to mobilise collective action to address the profound crisis of AMR. The best way to do this is to inform about the broader implications of AMR in non-technical language that resonates with a wide-ranging audience, also highlighting the significant economic consequences, as according to Embracing a One Health Framework to Fight Antimicrobial Resistance current annual spending on treating resistant infections is a staggering 28.9 billion dollars, and this figure is expected to rise.
Francesca Colombo, Head of the OECD Health Division, highlighted that infants and the elderly constitute two-thirds of AMR-related deaths. She also explained that in healthcare facilities the combination of a large number of vulnerable patients and the widespread use of antibiotics creates an ideal environment for the growth of these resistant so-called super bugs.
Another significant factor is the overuse and misuse of antibiotics. In some instances, antibiotics may be used to treat conditions that are not bacterial infections, fostering resistance. Simultaneously, the lack of access to antibiotics poses a challenge, as it can lead to inadequate treatment and further contribute to the development of resistance.
To combat AMR, we need to embrace a One Health Approach, i.e., a collaborative, multisectoral, and transdisciplinary approach that promotes policy action encompassing people, animals, agri-food systems, and the environment, working at the local, regional, national, and global levels.
It is therefore essential to have widespread access to diagnostic tools that can quickly identify bacterial infections and differentiate them from other causes. Unfortunately, the lack of availability of these tests is a significant obstacle in the fight against AMR.
To combat AMR, we need to embrace a One Health Approach, i.e., a collaborative, multisectoral, and transdisciplinary approach that promotes policy action encompassing people, animals, agri-food systems, and the environment, working at the local, regional, national, and global levels. This includes optimising the use of antibiotics in human and animal health, scaling up investments in infection prevention and control in healthcare facilities, strengthening surveillance systems across sectors, mitigating climate change links, and significant investments in R&D and innovation of new medicines, diagnostics, and vaccines.
Elzo Kannekens, Director for Global Public Policy and Multilateral Affairs, MSD Animal Health, mentioned that there has been a decline in antimicrobial usage in animal health by about 50% since the year 2000. However, there are challenges to sustain this decline. To achieve this, key prevention factors such as surveillance, early detection, and the availability of alternatives are critical.
Stefan Pierini Lüders, Senior Vice-President, Corporate Affairs, Novo Nordisk Foundation, emphasised the broken pipeline for the production of new antibiotics, as commercial profitability is low due to their intended limited availability as last resort. In recent times, some early-stage companies have ventured into antibiotic development not just for financial gain but also in response to the global need for new antibiotics. Despite efforts by foundations and pharmaceutical firms to create funds aimed at promoting these efforts, the market trajectory is unfavourable, leading to discouragement. Comparing the current landscape to that of five years ago, the outlook for the emergence of new antibiotics has significantly deteriorated. This is further exacerbated by a declining interest from scientists in this critical field. It is absolutely crucial for the G7, G20, and EU to collectively prioritise efforts and highlight the economic value of developing and marketing new antibiotics.
Alex Pym, Director of Infectious Diseases, Wellcome Trust, mentioned that Wellcome has launched an initiative called the AMR Action Fund, which seeks out companies that have antibiotics ready for advanced stages of development. Wellcome Trust invests in these selected companies and acquires an equity share, going beyond traditional funding as a philanthropic organisation.
This strategic investment not only provides the financial impetus required for navigating the final stages of development but also aligns with the overarching goal of bringing these antibiotics to patients. The AMR Action Fund thus exemplifies a proactive approach to bridging the crucial gap between antibiotic discovery and making tangible medical advancements available to the broader public.
Alex also mentioned that leveraging the lessons learned from the COVID-19 pandemic response, especially in terms of surveillance, could contribute to building a more robust system for tracking and responding to AMR globally. This highlights the interconnectedness of health challenges and the potential for shared resources and strategies to address them.
Finally, the panel discussed the fact that climate change may further increase the spread of AMR. Changes in environmental conditions and increased human mobility due to climate change may contribute to the spread of resistance. There has been a concerning rise in resistance to malaria in Africa, which could be linked to shifts in vectors due to climate change-induced disruptions in communities. The connection between higher levels of air pollution and increased risks of AMR was explored in a recent Lancet Planetary Health article. The respiratory implications of air pollution may be driving an increased demand for antibiotics, potentially contributing to AMR. However, the exact causal mechanisms remain unclear and necessitate additional research to uncover the underlying factors.
There is no room for complacency in the fight against AMR. Let us hope that the high-level meeting on AMR convened by the UN General Assembly in the fall of 2024 leads to renewed political momentum and commitment towards addressing this worrying silent pandemic.
And read the OECD report: Embracing a One Health Framework to Fight Antimicrobial Resistance
Antimicrobial resistance (AMR) – the ability of microbes to resist antimicrobials – remains an alarming global health threat. This is despite the efforts made by OECD and EU/EEA countries to curtail it. Unless additional effective interventions are scaled up quickly, AMR rates are forecasted to increase in the next three decades across OECD and EU/EEA countries, with costs exceeding the healthcare expenditure on the COVID-19 pandemic. Using microsimulation and machine-learning techniques, this report analyses critical policy levers to inform the next generation of AMR initiatives.