What are the main conclusions in the report on AMR headed by economist Lord Jim O’Neill and commissioned by former UK Prime Minister David Cameron?
Specific steps to reduce antimicrobial demand are:
- A massive global public awareness campaign: this is to decrease the number of patients or farmers demanding antimicrobials as well as medical doctors and veterinarians prescribing them when it is not needed. O’Neill’s review estimates that the cost of such a global campaign would be between 40 and 100 million USD per year.
- Improve hygiene and prevent the spread of infection: hygiene is still a problem in the 21st century and is one of the essential steps to ensure a decrease in AMR. For the developing countries the focus will be on expanding access to clean water and sanitation. For countries that have already reached that stage the focus will instead be on hospital sanitation to prevent the rise of superbugs.
- Reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environment: here the focus is on stopping non-therapeutic use of antibiotics. In other words, ending usage to improve growth or for preventative use. Three steps are proposed for this action
- Follow the 10-year targets proposed in the AMR Review 2015
- Restrict the use of certain highly-critical antibiotics
- Improve transparency of the food sector when it concerns antibiotic use
- Improve global surveillance of drug resistance and antimicrobial consumption in humans and animals: surveillance is one of the cornerstones of infectious disease management, however it is under-utilised when it comes to AMR. After the Ebola crisis, several countries and organisations have begun to invest in this area which has created a model for other countries to build on. (Global Health Security Agenda for the US, Fleming Fund for the UK, and the Global AMR Surveillance System for the World Health Organisation). Cooperation between governments as well as open, transparent data sharing is critical for improving global surveillance.
- Promote new, rapid diagnostics to cut unnecessary use of antibiotics: Access to rapid and trustworthy diagnostic tools would limit the occurrences of wrongly prescribed antimicrobials and significantly reduce AMR. For O’Neill et al., it is rich countries that must lead the way here; he believes that by 2020 it should become mandatory for antibiotic prescription to follow informed testing. This would have the added benefit of providing incentives to diagnostic developers.
- Promote development and use of vaccines and alternatives: vaccines are already available today and can significantly reduce the occurrence of infections, thereby reducing the stress on antimicrobials. There are 4 main categories of vaccines relevant to AMR that we need to develop and these target: ‘community-acquired infections’ (prevent bacterial infections acquired by the general population); ‘hospital-acquired infections’ (prevent bacterial infections often developed in hospital contexts); viral infections (even though these do not require antibiotics, they are often misdiagnosed as such); and infections from animals (AMR Review 2016). However, other alternatives such as bacteriophages are also being developed. Actions needed are:
- Use existing vaccines and alternatives more widely in humans and animals
- Renew impetus for early-stage research
- Sustain a viable market for vaccines and alternatives.
Examples of needed vaccines for community and hospital-acquired infections (AMR Review 2016):
- Universal pneumococcal conjugate vaccine (against Streptococcus pneumoniae)
- A vaccine against certain coli strains (no vaccines at the moment and only 2 are in the early stages of clinical development)
- There are currently no licensed vaccines for bacteria considered by the US Centers for Disease Control and Prevention (CDC) to be our most urgent AMR threats – carbapenemase-producing bacteria (including Klebsiella (no vaccine candidates), E. coli (2 vaccine candidates in Phase I trials)), drug-resistant gonorrhoea (no vaccine candidates), and difficile (vaccines in clinical development).
Steps to increase the number of effective antimicrobial drugs to fight infections resistant to existing medicines
- Establish a Global Innovation Fund for early-stage and non-commercial research: The review proposes establishing a Global Innovation Fund endowed with up to 2 billion USD over 5 years by bringing together different initiatives of similar function that have emerged over recent years. (US via the Biomedical Advanced Research and Development Authority and Europe via the Innovative Medicines Initiative and Joint Programming Initiative for AMR programmes)
- Better incentives to promote investment for new drugs and improving existing ones: The antibiotic market is not very attractive to large pharmaceutical companies and the reduction of antibiotic usage necessary to tackle AMR will only compound the problem. Governments must play their part by, for example, resorting to national purchasing and distribution systems. The review proposes a “system of market entry rewards of around one billion USD per drug for effective treatments.”
A global coalition for action on AMR is needed for these steps to succeed. The review states that it could be done via the G20 and the UN.
Source: AMR Review 2016