By coming together, we can overcome antimicrobial resistance

Reflections on World Antimicrobial Awareness Week 2022 from Dr Amit Aggarwal, ABPI Executive Director, Medical Affairs.

This year’s World Antimicrobial Awareness Week (WAAW) is ending, but the work against antimicrobial resistance (AMR) does not stop. AMR is the silent pandemic that we must all play a part in stopping.

Many people know that the first antibiotic, penicillin, was discovered in 1928 by Alexander Fleming, and then first used in patients 13 years later in 1941. Less known is that the first penicillin-resistant bacteria emerged in 1942 – just one year after its first clinical use in humans. With no new classes of antibiotics discovered since the 1980s, we are at an ever-increasing risk of losing the race to stay ahead of antimicrobial resistance.

AMR occurs over time as part of a natural evolutionary process. Bacteria replicate very quickly, producing new genetically different versions in each new generation. To put this into perspective, over 6000 years, there have been around 300 generations of humans, in comparison, the common bacteria E. coli, produces the same number of generations in just over 4 days.  

This means that bacteria can change and adapt very swiftly, finding different ways to evade human immune systems through the natural selection of those bugs which survive. These new generations can also quickly become resistant to the antibiotics we have available for use. The consequence of this resistance means we could reach a time when we are unable to treat everyday infections or diseases with antibiotics.

For example, if someone develops a bad chest infection, their healthcare professional may prescribe them a course of antibiotics to clear the infection. If the bacteria causing the condition has developed resistance to the antibiotics, the treatment will fail, and they may not get better. In the worst case, if the infection is resistant to multiple antibiotics, they may become very ill or even die.

This does not only apply to chest infections, but also for minor and major surgeries, cancer treatments and many other day to day procedures which rely on the availability of effective antibiotics. Without them, routine treatments would become high risk, and potentially life-threatening.

Certain factors can speed up the occurrence of AMR:

• the misuse of antibiotics, e.g., overprescribing or overuse of antibiotics or patients not completing the course, increasing the chance that resistant microbes emerge and spread
• lack of infection prevention and control, e.g., poor hygiene increasing disease spread
• spread of resistance through travel

Unfortunately, we are already seeing the direct consequences of AMR more and more often across the world, recently published data shows that in 2020, around 35,000 people died from infections due to resistant bacteria within the EU. Globally, it is estimated that over 1.2 million people die from infections resistant to antibiotics each year.

The difficulty with AMR is that there is a constant battle between the need for developing new antibiotics and ensuring the responsible use and protection of the antibiotics that we already have.

The UK has the ambition to lead the world in discovering new antibiotics, making it a key focus of its G7 Presidency. The five-year National Action Plan was launched to combat AMR through a unified global approach. This plan, alongside the 20-year vision for AMR, sets out how Britain will achieve its vision for a world where antibiotic resistance is contained and controlled by 2040.

In 2020, the AMR Action Fund launched a $1 billion pharmaceutical industry-led investment fund which aims to bridge the funding gaps facing antibiotic developers and aid the development of two to four new antimicrobials by 2030. This vital initiative demonstrates how the pharmaceutical industry is stepping up to the challenge of tackling AMR.

But countries cannot act alone to make these visions a reality. Governments worldwide must prioritise tackling AMR by collaborating with each other, healthcare systems and the pharmaceutical industry.

The ABPI wants the public, governments, and industry to recognise the full value of antibiotics to global health and why urgent action is needed. Everyone has a part to play. If we protect the antibiotics that we already know and find new ways of discovering new effective antibiotics, we’ll soon reduce the impact of AMR.