While one public health threat takes a bow, another takes center stage. Less than a year after the end of the federal COVID-19 public health emergency, a group of international political, public health and biomedical leaders are warning of a new threat to human life that could also lead to economic loss.
Antimicrobial resistance (AMR) – which occurs when certain pathogens survive the drugs designed to eradicate them – is on track to reduce global life expectancy by an average of 1.8 years by 2035, according to a new report from the Global Leaders Group (GLG) on antimicrobial resistance. Resistance. For some low- and middle-income countries, life expectancy could fall by as much as 2.5 years.
AMR is also poised to have “a catastrophic impact on the global economy,” the report says, with projected losses totaling $855 billion per year through 2035. About $412 billion is responsible for healthcare costs for treating drug-resistant bacterial infections; the remaining $443 billion represents productivity losses and lower labor force participation due to increased morbidity and mortality.
The GLG on AMR report, released earlier this month, calls on United Nations member states to aggressively limit the global health threat. This includes, according to an accompanying press release, securing funding “to address the dwindling research and development pipeline for new antibiotics.” Eight years after the first UN high-level meeting on AMR, the UN General Assembly will convene for its second session in September.
“We have the tools to mitigate the AMR crisis and this data points to a devastating future if we do not take stronger action now,” Mia Amor Mottley, Prime Minister of Barbados and Chair of the GLG on AMR, said in the press release. “That’s why the Global Leaders Group is making recommendations and proposing targets to achieve a strong global response to AMR and save millions of lives.”
Why is AMR a global public health threat?
Fungi, parasites, viruses and bacteria can cause infections in plants, animals and people. They can also progress to a point where they no longer respond to antimicrobial medications: antifungals, antiparasitics, antivirals and antibiotics. The term “superbugs” refers to microorganisms that develop AMR, according to the World Health Organization (WHO).
“This gets worse when people overprescribe antibiotics,” says Jamie Alan, PharmD, PhD, associate professor in the Department of Pharmacology and Toxicology at Michigan State University. Fortune. “Often people don’t actually need an antibiotic.”
For example, if you have an ear infection, it could be viral or bacterial, Alan explains. You feel terrible, you took the time to go to the doctor and you expect to walk away with an antibiotic. If you have a bacterial infection, chances are you’ll already be on the road to recovery by the time you seek medical care, she says. If your infection is viral, antibiotics will not only not treat your disease, but will also allow your insect to mutate. You can then spread the mutated bug to others.
“That ultimately culminates in an effect where we have superbugs that are resistant to many antibiotics,” says Alan. “If people become infected with those insects, they are more likely to die, simply because many of our antibiotics now will not work.”
AMR contributed to 4.95 million deaths in 2019 alone, according to an analysis published in the medical journal The Lancet. AMR was directly responsible for 1.27 million of these. The WHO identified AMR as one of the greatest global threats to public health and development, and the GLG for AMR proposed a 10% reduction in global deaths by 2030.
While the magnitude of the problem may seem insurmountable, it should be treated as the global dilemma that it is, says Dr. William Schaffner, professor in the Division of Infectious Diseases at Vanderbilt University Medical Center.
“We are a global village. What is there can be here in an instant,” says Schaffner Fortune. “Like [people] If they get sick here in the United States and they come from abroad and they brought those antibiotic-resistant bacteria with them, we have to treat them here. And this appeals to our own citizens who travel abroad.”
He adds: “We need to look at this as both a local problem and a global problem.”
Rodolfo Parulan Jr. – Getty Images
Drug manufacturers need incentives to develop new antimicrobials
Practicing antibiotic stewardship, which means prescribing fewer antibiotics, is the first step in reducing AMR, says Schaffner: “The less we use, the more sensitive the bacteria will remain to the antibiotics we currently have.”
Overprescription also applies to pediatric patients, Alan points out. As a parent she tells herself Fortune she understands the instinct to seek medication for your sick child, but that antibiotics are not appropriate for every condition.
The pharmaceutical industry also has a crucial role to play in the solution. Developing new antibiotics is more complex and expensive than ever, Schaffner says. Furthermore, demand for antibiotics is volatile; you take them here and there throughout your life, unlike, for example, blood pressure medications that you take for years. The bottom line is that pharmaceutical companies are presented with a significant investment that will likely yield little return.
Further dampening the incentive is a counterintuitive business model, Schaffner explains. “I can’t think of any other circumstances in the entire trade [where] a new product comes onto the market—in these circumstances, a new antibiotic—and the first thing the infectious disease community says is, “Don’t use it.” Save it. Only use it if the others don’t work. ”
That’s because even if a new antibiotic were to hit the market tomorrow, it would have to be prescribed sparingly to ensure it can fight bacteria for years, Schaffner says. As such, the GLG on AMR report outlines how public and private funds can be used to incentivize pharmaceutical companies and drive drug development.
In the US, the proposed Breakthrough Antimicrobial Subscriptions to End Emerging Resistance (PASTEUR) Act of 2023 calls for the creation of the Critical Antimicrobial Needs Committee. The PASTEUR Act would provide $6 billion to combat AMR and create subscription contracts with drug developers. However, despite bipartisan support, the bill remains stuck in the Senate.
Another GLG goal in the field of AMR is to reduce the number of antimicrobials used in agriculture by 30-50% by 2030. Implementing all of the group’s proposed global interventions would cost approximately $46 billion annually. Still, every dollar spent in 2050 would yield an estimated return of up to $13.
Until more concrete action is taken, controlling AMR with the antibiotics currently at our disposal is a collective effort, Schaffner says.
“A big part of it is up to us – the general public, the medical profession, the veterinarians and the agricultural industry – to work together to ensure that these antibiotics will continue to be active in a way that we can manage and treat people who are sick . sick animals,” he says.
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