Antimicrobial Resistance: A Threat Not To Be Underestimated

Antimicrobial Resistance: A Threat Not To Be Underestimated
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The UK's Chief Medical Officer Sally Davies recently described the world's current capacity to tackle antimicrobial resistance (AMR) as a risk as 'big as terrorism'. Bacteria is becoming increasingly resistant to modern medicine, and she warned that if there is not significant and urgent action, we will be left with a health epidemic where even the smallest of infection could kill.

In a modern world, with agendas driven by headlines and sensationalism, health threats are sometimes exaggerated. Yet in this case, it cannot be overstated. Sally Davies is exactly right. The threat is very real and it is serious.

AMR has been high on the world health agenda for some time (though arguably not high enough) and yet global efforts have not moved forward fast enough. The speed of the threat is outpacing our ability to learn and protect by a considerable rate. Up to 2 million people are infected by antibiotic resistant bacteria every year, and unchallenged antibiotic resistance could cost 10 million lives and as much as $8 trillion each year by 2050.

But there are very promising signs that the world is taking notice. For the first time, the UN convened a high-level meeting on the subject at the General Assembly in New York last month. Global consensus and global action must flow from this session.

The Netherlands has used its Presidency of the European Council to convene special efforts on a pan-European approach to AMR. The UK Government now ranks AMR alongside terror attacks and major floods in official contingency planning, and it is now formally on the national risk register. Others should take similarly vigilant approaches.

The World Health Organization, however, has been criticized for its sluggish response to this danger. Work has begun and there has been some progress, but my deep concern is that it is not fast or focused enough.

If we, as a global community, do not make significant inroads into this fight soon, we are leaving many citizens around the world exposed to dangers that we have already spent many years successfully combating.

Over the years, I have worked on programs in Africa and around the globe to combat malaria, tuberculosis and HIV. I have been witness to incredible progress in these fights. Many initiatives focused on these diseases can and should be replicated to tackle AMR. We need global leadership and cooperation and a substantial uptick in surveillance, as well as a revolution in research and development.

It is of great concern to me that some of the tremendous gains made in reducing the number of HIV, malaria and TB infections globally may start to unwind. TB, for instance, is one of the diseases that is showing particular power and resistance to antibiotics.

In 2014, the WHO published its first global report regarding AMR surveillance. It worryingly pointed out that the multi-drug resistant form of TB (MDR-TB) - the strain that is resistant to the two most powerful anti-TB drugs - was growing quickly. And it noted that the emergence of MDR-TB is "largely under-reported, compromising control efforts."

WHO estimated there were almost half a million new cases that year, yet only about a quarter of these were detected and reported. This is a stark admission that the current monitoring efforts are falling well behind what is necessary and are hampering global efforts in combating the rise of this threat.

The New England Journal of Medicine published its twenty-year review of MDR-TB surveillance this month. It warns that in many parts of the world there are significant challenges ranging from in-country awareness to routine testing.

We have to do better. We cannot and must not underestimate the scale of this threat. We could soon face a new modern era where common infections and minor ailments - all of which we've been treating with relative ease for decades -become lethal.

Access to the right medicines and incentives for research and development of drugs to overcome AMR is lacking. As this month's report from the UN General Secretary's High Level Panel on Access to Medicine very pointedly stated, there is simply not the commercial return on investment for many antibiotics today. And this year's report from Médecins Sans Frontières asserts that "pharmaceutical companies deem investment in antibiotics to be financially unattractive ... In the absence of appropriate incentive mechanisms that need to be put in place by governments, the medical priority remains unanswered."

The system is currently ill-equipped to respond and is mostly driven by the lack of purchasing power of the people disproportionately affected. So much more needs to be done and it requires government intervention. The AMR session at the UN General Assembly may well be the moment we've been waiting for.

As the NEJM highlights, the situation is continuing to evolve, and as we make strides to better monitor the situation and collect data, we will be better equipped to drive forward a new era of research and development. As governments and agencies around the world begin to take greater notice, so do the world's best universities and research institutes. The recent dynamism that has been injected into this debate is a step in the right direction. The race is not lost and there is plenty we can do and much yet to discover.

My hope is that in the future we will look back at 2016 - at this meeting that just happened at the UN and at the leadership of WHO - as the turning point and the catalyst to saving lives.

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