Imagine a world where the medicines we rely on to treat infections no longer work. Something as small as a cut on a person’s arm can become dangerous when it gets infected and there is no antibiotic that can treat it. This is the reality of antimicrobial resistance (AMR), a global health threat with the potential to increase the risks of future pandemic diseases. Bacterial AMR alone is estimated to have contributed to 4.95 million deaths and directly caused 1.27 million in 2019. With the world still reeling from the devastating impacts of the COVID-19 pandemic, we simply cannot afford to ignore the growing threat of AMR and its relevance to pandemic preparedness, prevention and response (PPR). As such it is imperative the UK Government consider the seriousness of connecting the dots between, and finding solutions for, both AMR and pandemics.
What is antimicrobial resistance and why is it a global health threat?
AMR occurs when germs like bacteria, viruses, fungi and parasites are no longer treatable by the medicines designed to kill them. Known as antimicrobial medicines, these are used to treat infectious diseases in humans, animals or plants. When infections become resistant to treatment they can spread more easily, they become harder or impossible to cure and can lead to more severe illness or ultimately death.
There are a number of factors that contribute to creating AMR. These include poor sanitation and unclean water, slow or inaccurate diagnosis of infectious diseases, overprescription of antibiotics in both humans and animals and patients not completing a full course of treatment.
Furthermore, AMR is a huge strain on healthcare systems. Treating resistant infections is more expensive and requires more intensive care. This leads to longer stays in hospital and can affect patients’ long term ability to work. In fact, the World Bank estimated that AMR will cost the world an additional US$ 1 trillion in additional healthcare costs by 2050.
How is AMR relevant to pandemic preparedness, prevention and response?
AMR will exacerbate the harms of any future global pandemic. Because AMR happens when germs become resistant to the medicines used to treat them, this could lead to a “superbug,” a type of bacteria that can’t be treated with existing medicines. This could in and of itself become a bacteria that causes a global pandemic. While our most recent pandemic experience – COVID-19 – was caused by a virus, bacterial diseases such as cholera have been responsible for several pandemics in the last 200 years. A current example of an on-going AMR bacterial pandemic is Drug-Resistant Tuberculosis (DR-TB). DR-TB is a more severe form of tuberculosis (TB) that does not respond to the usual TB treatments. DR-TB poses a major global health threat. In fact, one-third of all deaths caused by antimicrobial infections are due to DR-TB. In 2022, there were around 410,000 cases of DR-TB worldwide with roughly 160,000 people dying of this preventable and curable disease.
AMR can also cause secondary infections during a pandemic, increasing the risk of death. For example, during the COVID-19 pandemic, US hospitals saw a 15% increase in resistant-related infections and deaths that were picked up during hospital care. Therefore, even if the next pandemic is not directly caused by AMR, secondary infections from AMR bacteria could become a ‘complimentary killer’ increasing the mortality rate of a pandemic tenfold.
Additionally, the strain a global pandemic places on healthcare systems makes it easier for AMR to spread. This is not only because there is a greater immediate reliance on antibiotics, but also because a public health emergency can disrupt the health system’s normal approach to control AMR. When this is considered then in the context of healthcare systems in low-income and middle-income countries that are already under-resourced and lack access to vital medicines and technologies, it’s easy to see how a global pandemic can make a country’s struggling capacity to deal with AMR that much worse.
How can we combine solutions to fight AMR and future pandemics?
There are a number of ways to improve global cooperation to combat both AMR and the risks of global pandemics:
- Stronger healthcare systems – Creating stronger healthcare systems are essential for identifying and treating AMR while building resilience to global health threats.
- A cross-sector One Health approach – This means considering how different sectors, such as animal farming, and different crises, such as the climate emergency, are relevant to both combating pandemics and AMR when designing policy. For example, reducing antibiotic use in farming can prevent microbes developing in animals and then spreading to humans.
- Support for global health initiatives – Sustained funding for global health initiatives, such as The Coalition for Epidemic Preparedness (CEPI), is essential. These initiatives help create new and accessible vaccine technologies that reduce infections and the need for antibiotics, slowing the spread of AMR
Results UK have recently published a briefing outlining in greater detail why there must be collective action on AMR and PPR together and what solutions the UK government must focus global attention on.Â
In September this year, Member States will gather at a United Nations High Level Meeting (HLM) on AMR. A HLM on a particular issue is convened only in exceptional situations with its purpose being to encourage collaboration and develop solutions to critical global problems among Heads of State and government leaders. This is therefore a vital opportunity for the UK government to connect the dots between AMR and PPR. They must show leadership, with support from grassroots and advocates to call on strong global political action to address the existential threat to the world’s health and wellbeing that AMR and global pandemics pose.