Antimicrobial Resistance: The End Of The Antibiotics Era

Dr. Ramanan Laxminarayan speaks to Asian Scientist about the World Health Organization’s plans to combat antimicrobial resistance and the challenges ahead.

Ramanan Laxminarayan
Director for Center for Disease Dynamics, Economics and Policy (CDDEP)

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AsianScientist (Jun. 3, 2015) – Antimicrobial resistance (AMR) has been touted to be a bigger threat to the world than the next viral outbreak. The World Health Organization (WHO) has said that this is a “problem so serious that it threatens the achievements of modern medicine,” and that humankind is shifting into a post-antibiotic era, in which minor infections and injuries can kill. While this all sounds acutely exaggerated, facts suggest otherwise.

In a report published in 2014, the WHO pointed out that last-resort antibiotic treatments have failed to work in ten countries. For instance, in India and Pakistan, up to a shocking 95 percent of adults have bacteria that are resistant to β-lactam antibiotics. In Nigeria, 88 percent of Staphylococcus aureus infections cannot be treated with methicillin any longer. This all can be attributed to the fact that antibiotics are extremely overused among both humans and livestock, which hasten the evolution of resistant microbes. In light of this report, the WHO is currently working on a plan to tackle antimicrobial resistance, which has been endorsed at the 68th World Health Assembly (WHA).

The WHO plans to combat AMR in several ways: to improve awareness and understanding of AMR, to increase surveillance and research efforts, and to optimize use of antimicrobial agents. The goal of the plan is to ensure that successful treatment and prevention of infectious diseases are continued, and are accessible to all those in need. Dr. Ramanan Laxminarayan, who also serves on the advisory committee at the WHO, Center for Disease Control and Prevention and Institute of Medicine, speaks to Asian Scientist about the key takeaways of the AMR plan, the challenges of implementing this plan, and the role of big pharmaceutical companies in fighting AMR.

What are the main messages that you want the general public to take away from the WHO plan against antimicrobial resistance?

For the general public, the important message is that they have a role that collectively is equally or more important than the role that all the professionals have. Other than aspirin and other pain relievers, antibiotics are the most familiar and commonly used class of drug. Aspirin will never lose its power to cure headaches, no matter how much we use it, but antibiotics already have lost a lot of effectiveness. We would never suggest withholding antibiotics for bacterial infections that can be cured by them, but we challenge everyone to hold themselves and their doctors accountable to use antibiotics responsibly.

We also want people to understand that antibiotic stewardship in its broadest sense—using antibiotics wisely—pays off in actually lowering antibiotic resistance rates in many, though not all, cases in the local area. Without sacrificing any health benefit, people can help the community, including their own friends and relatives.

Finally, people should understand that no matter how good we are as antibiotic stewards, antibiotic resistance is a natural evolutionary phenomenon that will proceed, albeit at a slower pace. But nonetheless, we will need better tools to fight infection, so research for new antibiotics, diagnostics and vaccines is still very important.

Who is the target population for this plan?

This plan targets everyone including governments, policy makers, hospital administrators, doctors, pharmaceutical companies, patients and the general public.

New research is essential to fighting antimicrobial resistance. How will this new research be funded? Will it be funded by research institutes or pharmaceutical companies?

The WHO’s current plan does not address where research funding will come from. What it does is place the spotlight on governments across the world, saying that it is their responsibility to ensure the safety of their citizens. According to this global action plan, governments need to design appropriate plans that would be effective in their local settings and mobilize resources to put into effect their plans. Hence they need to get all stakeholders to participate effectively, including research institutes and pharmaceutical companies, amongst others.

How will the work be implemented at the grassroots level i.e. among the people?

Increasing awareness and understanding of antimicrobial resistance among people is one of the key objectives of the plan. This can be done through intensive public communication programs. Inclusion of the use of antimicrobial agents and resistance in school curricula will promote the awareness from early age.

What are some of the key challenges that the world faces in dealing with antimicrobial resistance?

First, in all settings—low- and high-income countries—there generally isn’t adequate awareness and understanding of AMR, even though with the recent media coverage people with access to the media are more likely to have come across it. Even if there is awareness and understanding, we, as humans, often fail to take into account the costs we are imposing on our future selves, future generations and everyone else around the world as consequences of our (in)actions.

In terms of our actions, it is the inappropriate use of antibiotics for medical conditions in which they have no role to play, or their non-therapeutic use in animals for short-term economic profits, that contribute to antibiotic resistance and that can avoided with no loss of health or life. Convincing ourselves as patients, producers and consumers to not act in ways that increase the severity of antimicrobial resistance unnecessarily is perhaps the biggest challenge we face.

In addition, while there are a number of surveillance systems across the world to monitor AMR, this information does not seem to have been widely accessed and analyzed. Many countries don’t have surveillance systems in place at all. In order to tackle the problem most effectively, we need to first collect sufficient information on antibiotic use and resistance so we know where specifically the biggest threats lie and we can track our progress as well.

The rapid decline in the discovery of new antibiotics and the increasing lack of pharmaceutical sector investments in their development is also a major challenge we face. New concepts to incentivize innovation and promote cooperation between public sector, academia and pharmaceutical industry are needed.

Ramanan Laxminarayan speaking at TEDMED 2014 on approaching antibiotic resistance as a natural resource. Credit: CDDEP.
Ramanan Laxminarayan speaking at TEDMED 2014 on approaching antibiotic resistance as a natural resource. Credit: CDDEP.

How will this plan be rolled out and are there any specific target countries?

All Member States are expected to have their own national plans, based on the global plan, in the next two years. The plan targets all countries, and it is up to the countries to decide how to roll out their plans. Although not stated, the most important target countries are those that do not have plans already, and those tend to be the poorest countries. CDDEP has experience over the last six years of helping such countries develop capacity and strategies to address AMR through its Global Antibiotic Resistance Partnership.

Tackling the latest strains of drug-resistant typhoid and malaria are also compounded by the fact that these diseases co-exist among other infectious diseases such as HIV and TB. How does the WHO action plan intend to account for these factors?

Countries must assess their own situations as part of developing their plans, taking the entire infectious disease burden into account. The same strategies and actions apply, but emphases may differ depending on the burden of other diseases.

What are some of the future technologies for rapid field testing?

We can expect to see more developments in this area, with initiatives such as the Longitude Prize and the US Department of Health and Human Services encouraging research groups to develop rapid, point-of-care tests to identify bacterial infections or their resistance patterns.

What role do you think big pharmaceuticals play in antimicrobial resistance, and how will they stand to benefit from the plan?

Large pharmaceutical companies continue to have a major role and responsibility to bring new antibiotics, diagnostics, vaccines and innovative technologies to market, despite their lagging interest and investment over the past several decades. Through new antibiotic discovery and development, big pharma formerly brought to the market new antibiotics that cured infections resistant to available antibiotics and gave us an upper edge in our continuous battle against bacterial pathogens. However, with poor return on investment for pharmaceutical companies on antibiotics when compared to other classes of drugs, their role in new antibiotic development and the resources they’ve put into this have both largely diminished since the 1990s.

There is an urgent need to increase investment into antibiotic research and development, not just through large companies, but through innovative mechanisms that will attract support from many actors, including but not limited to, traditional pharmaceutical firms. The impetus of the WHA resolution makes this a good time to renew the push to increase innovation.

This article is from a monthly series called Asia’s Scientific Trailblazers. Click here to read other articles in the series.


Copyright: Asian Scientist Magazine; Photo: Gavi, the Vaccine Alliance/Flickr.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

Annabel is currently a 2nd year Masters in Public Health student at Yale University. She received her MEng in biomedical engineering from Imperial College London in 2010. She spent the summer of 2014 researching substance abuse in Tanzania. She has a keen interest in food, yoga and metal music.

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