Optimism despite COVID-19 impact on antimicrobial resistance 

Vaccines against the coronavirus are causing optimism across the world. The COVID-19 pandemic will eventually be over, but the lesser-known antimicrobial resistance (AMR) epidemic has only been accelerated by COVID-19. We should use the current momentum from the coordinated worldwide response to defeat the AMR pandemic. Like viruses, resistant bacteria know no borders, and no country can tackle the challenge on its own.

Antimicrobial resistance is a top 10 global public health threat, according to the World Health Organization. Every year, more than 700,000 people die globally from antimicrobial-resistant infections. This corresponds to approximately 2,000 fatalities a day. According to projections from various thinktanks, by 2050 this death rate may reach 10 million a year, unless we manage to solve the problem of antimicrobial resistance. We rely on the availability of effective antibiotics to treat patients throughout the healthcare system, including infections related to COVID-19, leaving nearly every aspect of modern healthcare treatment at risk.

COVID-19 has added another layer of complexity, with antibiotics being overprescribed to COVID-19 patients around the world—as symptoms are similar to those of bacterial pneumonia—even though it is caused by a virus and not by bacteria. Effective antimicrobial stewardship is already under pressure, and one thing is certain: the problem will continue to grow until we find a solution. In other words, we are dealing with an invisible problem of similar proportions to the COVID-19 pandemic.

The pipeline of new antibiotics is running dry, because the market for antibiotics is broken. The development costs for newly approved antibiotics cannot be covered through sales. Most of the major pharmaceutical companies have stopped developing new antibiotics, and many smaller enterprises have folded due to the lack of a sustainable economic model.

The main reason is that newly developed, effective antibiotics are being used as a ‘last resort’ in the hospital sector: they are sensibly kept locked away in the medical cabinet, only to be used if the cheap generics fail. Of course, this is damaging to the manufacturers’ incentive, as it undermines the possibility to make revenues from new antibiotics.

The solution requires political intervention to reconstruct the market and make the development and production of antibiotics profitable again. We need to change the way we value antibiotics to make-up for costly development.

Meanwhile, we need to buy ourselves time by preventing overuse of existing antibiotics to avoid further resistance developing over time. AMR stewardship is already under pressure from limited restrictions of usage around the world, and the COVID-19 pandemic has accelerated the problem. The prevalence of AMR will likely increase through the heavy use of antibiotics in COVID-19 patient treatment.

Studies reporting on patients hospitalized with COVID-19 show widespread use of antibiotics as part of the general clinical care package, and data suggests that patients receive antibiotics even when it is not clinically indicated. In fact, a review of studies identified that while 72% of patients received antibiotics, only 8% demonstrated bacterial infections. A Nature article published in May last year concludes that many COVID-19 patients are meaninglessly getting antibiotics.

The COVID-19 pandemic has hugely impacted the public understanding of healthcare prevention. All over the world, people are improving their hand-washing techniques and using antiseptic measures to prevent infections. At the same time, vaccine development efforts have shown cross-national cooperation in the race for an effective vaccine.

As such, the COVID-19 pandemic has made it obvious that global health challenges need to be addressed through a concerted effort by the international community. We must use this realization to intensify the battle against antimicrobial resistance, and it is actually a much easier and cheaper fix than COVID-19.

We have an opportunity to prepare ourselves on a global scale and (unlike viruses) when it comes to resistant bacteria, there is nothing new under the sun. As previously mentioned, 2,000 people die every day due to antimicrobial-resistant infections. Even if we start doing everything we can today, this number will increase before it will drop. If we fail to act a catastrophe is looming, but by pulling together and learning from the COVID-19 pandemic responses, we can mitigate the effects.

1. Introduction in the US of the PASTEUR Act, which aims to kick-start the development of urgently needed new antibiotics by changing the way the US government pays for them.

2. Progress on Swedish and UK government models implementing new AMR payment structures targeted at rebooting the broken marketplace.

3. The EU is to address several AMR challenges, including the lack of investment in antimicrobials and inappropriate use of antibiotics, as appears from the recent Pharmaceutical Strategy for Europe adopted by the Commission in November 2020.

4. The AMR Action Fund has raised US$1 billion from major pharmaceutical companies and foundations to invest in biotech. The aim is to bring as many as four new antibiotics to patients by 2030.

The solution to the AMR crisis is better stewardship of the miracle drugs that we call antibiotics as well as the introduction of one or two novel products per year. The cost for all of this is in the single-digit billion dollars range per year, or the equivalent of introducing a single successful cancer drug. The value to society in preventing the next pandemic is all too obvious. I call on the leadership of attendees of the World Economic Forum to seize the moment and continue to collaborate on pandemic preparedness including AMR in the coming years.