Antimicrobial resistance (AMR) is a major challenge to global health. It has been estimated that if no action is taken against AMR, it will be the leading cause of death with 10 million victims per year by 2050. Therefore, countries all over the world have been developing approaches in line with One Health principles to tackle AMR. Important key messages can be taken from the 2016 report from the Review on Antimicrobial Resistance, which was prepared by world-leading specialists in the field with recommendations on how to tackle AMR from 10 different perspectives:
- A global public awareness campaign
It is crucial to educate our societies about the danger behind the overuse and misuse of antimicrobials, as patients still commonly demand them from doctors or buy them over-the-counter. An efficient and well-delivered public campaign in a long-term perspective could reduce the number of prescribed antimicrobials by 36%.
- Improve sanitation and prevent the spread of infection
Prevention is better than cure – by improving healthcare systems and living standards we can markedly reduce the demand for antibiotics and therefore give less chance for new resistance strains to develop. It is estimated that improving sanitation in low-income countries would decrease the use of antibiotics to treat diarrhea by 60%.
- Reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environment
The vast majority of global antimicrobial consumption comes from agriculture and aquaculture. In the USA, over 70% (by total volume per year) of medically important antibiotics are used in agriculture. The use of antibiotics solely for infection prevention and more importantly, growth promotion, should be considered dangerous and unnecessary. Moreover, recent data suggest that 75-90% of antibiotics are excreted from animals unmetabolized and leak into the environment.
- Improve global surveillance of drug resistance and microbial consumption
For scientists and physicians to elucidate the mechanisms of acquiring new resistance, monitor the cases already present and to anticipate future threats, they need to have better insight into current and past AMR-related data. Therefore, three areas require better structure and information: antibiotic consumption among humans and animals, resistance rates for the available drugs and research knowledge on the molecular foundations of AMR.
- Promote new and rapid diagnostics
Every year, 27 million patients in the USA are given antibiotics unnecessarily due to misdiagnosis, which is over 67% of all prescribed antimicrobial therapies. The data is striking, and only development of rapid and accurate diagnostic tests would allow doctors to target antimicrobials to those patients who actually need them.
- Promote development and use of vaccines and alternatives
With increasing vaccination, the number of infected people needing antibiotic treatment would reduce. Although there are currently no licensed vaccines against the most urgent pathogens, there are promising clinical candidates coming up against Clostridium difficile and Pseudomonas aeuroginosa. However, greater investment in early stage research for development of new vaccines is recommended. Alternatives to antibiotics are being developed, which include phage therapy, probiotics, antibodies and lysins, to name a few.
- Improve the number and recognition of people working with infectious disease
Addressing AMR requires a qualified workforce to implement them. There is a shortage of key professional figures such as microbiologists, infectious disease specialists, infection control specialists, pharmacists, nurses, veterinarians and epidemiologists, for example. Therefore, countries need to invest in training and rewarding these specialists.
- A global innovation fund for early stage and non-commercial
Higher private and public investment in early-stage research in drug discovery is crucial for development of new treatments. However, it is less attractive for commercial funders because of substantial risks. Therefore, a global innovation fund for support of less commercially attractive research is needed.
- Better incentives to promote investment for new drugs and improving existing ones
The development of new antibiotics is not very attractive for pharmaceutical companies since there are still (relatively) effective antimicrobial compounds on the market. It is difficult to predict exactly how and when AMR will develop, leaving pharmaceutical companies in uncertainty when making business decisions. The challenge is to introduce rewards for successful introductions of new antibiotic therapies on the market.
- Build a global coalition for real action
Global action is essential to make meaningful progress in tackling AMR. Putting AMR on the international political agenda and tackling it using One Health principles is important for impacting change. For example, actively engaging with the G20 or the United Nations could help to put AMR on the political agenda.
If you are interested in learning more about AMR and global health, get involved in our Fighting AMR and One Health campaigns. You can also keep updated on current research developments in AMR by reading our journal special issues in One Health, Antimicrobial Therapy and Vaccines.
For researchers, there is a current funding call from the BBSRC for ‘One Health Approaches to Accelerate Vaccine Development’. The call aims to support comparative ‘One Health’ research which will promote understanding of disease pathogenesis and vaccine development for animal and human health in low/middle income countries.