New Series urges renewed focus to combat antimicrobial resistance, highlights lack of access to antimicrobial drugs

The global fight against antimicrobial resistance could be under threat unless the evidence base for policies to control resistance is radically improved, according to a major new Series, published in The Lancet.

The Series urges renewed focus on understanding which policies will work to combat antimicrobial resistance, but it also points out that globally, lack of access to antimicrobial drugs remains a major issue. Despite the huge advances made in access to medicines in recent years, thousands of people – particularly babies, children, and mothers – are still at risk of serious illness or death from treatable infectious diseases.

More people still die every year from a lack of access to antimicrobials than they do from being infected by resistant bacteria, and so global efforts to fight resistance must not inadvertently further restrict access to antibiotics, say the authors. Instead, the distribution of antimicrobial drugs needs to be focused on the people who need them most, at the same time as unnecessary usage is curbed when it is not medically needed and in other areas, particularly in agriculture and richer countries where antimicrobials are over-prescribed.

Existing policies to combat antimicrobial resistance – such as guidelines promoting responsible use of antibiotics in hospitals, or infection prevention measures – are poorly understood, say the authors, and it is not clear whether policies which are currently being implemented in many countries worldwide will work, or will provide value for money.

As a result, policymakers have little reliable guidance as to the best options for controlling antimicrobial resistance, and concerted action is needed to fully evaluate and research the best ways to control antimicrobial resistance, classified by the World Health Organisation as a major global threat.

The claims are made in a new Series of five papers, which provides a comprehensive look at how antimicrobial resistance is being tackled worldwide, and outlines future priorities for researchers and policymakers. The Series contains contributions from many of the world’s leading experts in the field, and was led by Professor John-Arne Røttingen, Executive Director of Environmental Health and Infectious Disease Control at the Norwegian Institute of Public Health and adjunct professor of Global Health and Population at Harvard University.

The Series authors reiterate that resistance will not be beaten unless a ‘One Health’ approach is adopted globally, recognising that the health of humans, animals and ecosystems are interconnected, and ensuring that any policies to tackle resistance address each of these areas.

Moreover, the authors suggest that the current incentives for pharmaceutical companies to develop new antibiotics – for which there is an increasingly urgent need – are simply not strong enough, and a radical overhaul of the finance and development mechanisms for new drugs are needed.

“At the moment, the economic value of new antimicrobial drugs doesn’t materialise until the old drugs have failed, by which time it is too late,” says Professor Røttingen. “We need to completely rethink the way that research into antimicrobials is funded, starting by decoupling innovation in drug development from sales. The funding of these drugs needs to be driven by public health needs, not by profit.”

Current global efforts to combat resistance are too modest, say the Series authors, and poorly coordinated. Providing a blueprint for ways in which international collaboration might be improved, the authors recommend the formation of a new UN-level coordinating body for tackling antimicrobial resistance, or an international treaty which can mandate implementation of some of the policies which countries will need to adopt to avoid the burgeoning threat.

According to Professor Røttingen:

The scale of the problem, and the complexity of the responses needed, means that this problem is simply too large for the World Health Organisation alone to be held responsible. The problem is also complex since we need action on three fronts at the same time: extending access, conserving existing antimicrobials and ensuring innovation of new ones. These three goals can only be met together by integrated solutions. We need concerted and coordinated global action from politicians, industry, and individuals, and this will only be achieved if we initiate cooperation and support for this issue on a global scale.

Outlining the mechanisms by which bacteria and other pathogens acquire resistance, the authors show that removing the evolutionary selection pressure for antimicrobial resistance doesn’t necessarily mean that resistance will be reversed. This has important implications for the global fight against antimicrobial resistance, as it means that the problem of resistance could remain for many generations to come, even if current usage of antimicrobial drugs were to be radically curbed.

“Our understanding of the mechanisms by which bacteria and other pathogens acquire resistance to drugs suggests that there will be no single solution to the global threat of antimicrobial resistance,” says Professor Alison Holmes, Director of the NIHR Health Protection Research Unit for Healthcare Associated Infection and Antimicrobial Resistance and Professor of Infectious Diseases at Imperial College London, and lead author of one of the papers in the series. “We need to tackle this problem synergistically, on multiple fronts, which will require an unprecedented level of international cooperation.”