HOW WE REBUILD THE ARSENAL
By now, you are probably aware of the devastating impacts of antimicrobial resistance (AMR), and how COVID-19 is exacerbating this health emergency. My previous blogs have elaborated on such cheerful themes.
Well, you’ll be pleased to know that I finally have some good news, about antibiotic development. Sandwiched between more bad news, illustrating why we need these miracle drugs more than ever.
“Currently, the COVID-19 pandemic is causing immense suffering and loss of life across the globe, but AMR has been - and will remain - one of the most significant threats to global human health.”
A recent UK study has suggested the mass use of antibiotics in COVID-19 patients could result in increased drug-resistance among the wider population.
In the UK, as in other countries, the majority of patients with COVID symptoms have been prescribed antibiotics to treat or prevent possible secondary bacterial infections, which can be very hard to diagnose alongside coronavirus symptoms.
Research by the University of Plymouth and Royal Cornwall Hospital Trust suggests this surge in drug-use could be placing an additional burden on waste water treatment works which, in turn, could lead to raised levels of antibiotics within rivers and coastal waters. Such levels could drive an increase in antimicrobial resistance (AMR) amongst a significantly larger group of people.
"COVID-19 has had an impact on almost every aspect of our lives," says Sean Comber, Professor of Environmental Chemistry in Plymouth and the article's lead author. “But this study shows its legacy could be felt long after the current pandemic has been brought under control. From our previous research, we know that significant quantities of commonly prescribed drugs do pass through treatment works and into our water courses.”
Such leaching of antibiotics into our rivers and oceans is a major problem: one that isn’t unique to the UK. A global study on antibiotic pollution across 72 countries last year found that hundreds of rivers were already awash with antibiotics, pre-COVID. This drug pollution in our waters means environmental bacteria can develop drug resistance, rendering the antibiotics useless. Which is why a young child who has never taken antibiotics can still have resistant bacteria in their bodies. The coronavirus pandemic is accelerating this crisis.
And yet, no new drugs are in sight.
“We are witnessing the effects of one global pandemic, which has highlighted the threat of communicable disease. Alongside the threat of coronavirus is the increasing risk posed by antimicrobial resistance, exacerbated by a sparse antimicrobial development pipeline.”
Our continued failure to research and develop new antibiotics is the next catastrophe-in-waiting. The current market model is broken: we know that. Antibiotics’ exorbitant R&D costs and uncertain financial return make their development commercial suicide.
Which is why no new classes of antibiotic have been brought to market in more than three decades.
Like other drugs, antibiotics are only paid for by customers once trials are completed and they have been deemed safe: to make money, you need to sell large volumes of them. However, given any new antibiotics will be fiercely restricted to preserve their efficacy, and prevent bacteria developing resistance, the numbers game simply doesn’t add up.
Which is where the good news comes in. The UK government, in partnership with the NHS, is leading the way on new models for development.
This summer, the UK launched a subscription-style payment model for new antibiotics, which is targeting new drugs for those pathogens which are becoming resistant to multiple or indeed all current antibiotics, such as certain bloodstream infections, sepsis and pneumonia.
New antibiotics will be paid for up-front with an annual ‘subscription fee’ based on their public health value to the NHS, as opposed to how many they sell, to give financial guarantees to drug-developers. The scheme hopes to incentivise companies to invest in researching and developing new classes of antibiotics in the face of growing drug resistance, whilst maintaining antibiotic stewardship and reducing unnecessary or inappropriate prescriptions.
“Antibiotics underpin modern medicine and are integral for global health security. Governments and industry must work together to produce new antibiotics and ensure that we can continue to treat common diseases.”
Whilst the UK’s model is a major step forward, as Dame Sally points out, tackling AMR will require a global effort. Other countries need to step up and get policies and incentives in place in their own markets, which requires academia, industry and the public sector to cooperate.
More good news: there have been some pipeline funding initiatives. The AMR Action Fund was launched in July, financed by biopharma companies, and the global non-profit partnership CARB-X, led by Boston University, provides scientific and financial support to accelerate early stage drug-development. But these are not enough.
Dr. Manica Balasegaram serves as executive director of the Global Antibiotic Research & Development Partnership (GARDP), a not-for-profit organization based in Geneva focused on developing new treatments to counter the emergence of dangerous drug-resistant bacteria.
“COVID-19 has taught us that it is much preferable to prepare in advance rather than waiting until we’re in crisis mode,” she said in an interview with The Pew Trusts. “This is not theoretical. Antibiotic resistance is very real. It’s a slower burn than COVID-19, but the threat of resistant bacteria is magnifying, and we know it’s coming.”
And the US is no exception.
Every year, more than 2.8 million Americans contract an antibiotic-resistant infection. Over 35,000 of those people die, according to the Centers for Disease Control and Prevention (CDC). However, researchers at Washington University in St. Louis estimate the true annual number may exceed 162,000 people. And that’s before COVID-19 impacts are taken into account.
During the current pandemic, 21% of hospitalised US COVID-19 patients sustained a secondary bacterial infection. We do not know the figures for how many of those infections were resistant to drugs: accurate reporting is part of the problem. And yet, despite discussions and draft bills, there are no US government-led market incentives for antibiotic R&D in play.
The US House of Representatives recently passed a bill that included crucial funding increases for the Biomedical Advanced Research and Development Authority (BARDA) and the Centers for Disease Control and Prevention (CDC) to develop new antibiotics and preserve the effectiveness of existing drugs for the patients who need them most.
The country now needs the Senate to do the same.
“Unlike our coronavirus experience, we know the superbug pandemic is coming and (we) can start to develop needed medicines now. But if we delay any longer, untreatable superbugs could make the coronavirus look like a walk in the park.”
As COVID-19 has shown, there are no national or individual boundaries for disease.
Bacteria, viruses and fungi have no political allegiances, no social preferences, no class barriers.
Pathogens may affect some genetic profiles or age groups more than others; their transmission may favour certain environments or conurbations, but ultimately, we are all vulnerable.
It is in our collective best interest to restock our drug arsenal and address antimicrobial-resistance together. While we still can.
My debut novel, The Waiting Rooms, is a speculative thriller set during the advent and aftermath of an antibiotic crisis.
Out now in the UK, the paperback launches in the US and Canada in October and the e-book is available now. What’s more, for the month of September, US and Canada readers can purchase The Waiting Rooms on Amazon Kindle for just 99 cents. That’s less than a loaf of bread.
I’ve never been one to shun a deal, so go for it. I hope you enjoy.
