So far this year the rise of the Zika virus, and its similarities or differences to the Ebola pandemic, has held the health security spotlight. As such, you may have missed that last month also included the Food and Agriculture Organisation of the United Nations calling for international action on a different issue that is 'threatening to reverse a century of progress in human and animal health': antimicrobial resistance (AMR).
Experts have been warning of the dangers of drug-resistant superbugs for years. Unfortunately, the absence of panic-inducing images of masked doctors and menacing mosquitoes makes it harder to securitise this threat, and as a result the issue is generally not well understood.
AMR refers to drug resistance in bacteria, viruses, fungi and parasites, but it is specifically bacterial resistance to antibiotics that poses the most significant threat to global health.
The introduction of antibiotics in the 1930s revolutionised human health. They fight off deadly infections and facilitate safe surgeries and chemotherapy. Antibiotic sensitivity varies across a bacterial population, and after treatment it is the drug-resistant bacteria that survive to multiply. So unfortunately, every time antibiotics are taken, AMR becomes more prevalent, and the drug is rendered less effective.
In 2013, more than 29 million antibiotic prescriptions were written in Australia, for a population of only 23 million. In fact, Australia's overuse of antibiotics is 'one of the highest in the developed world'. These medications are also used in agriculture around the world to control animal health and fatten up livestock. Shockingly, 70% of all antibiotics used in the US are given to animals. This has exacerbated the issue, allowing drug-resistant bacteria to flourish in animal populations that are then passed onto humans via the dinner table.
This has also been paired with a low level of advancement in the antibiotic field. The most recent antibiotic developed, teixobactin, was the first new arrival on the market in 25 years. Antibiotics are not as profitable to develop as medications for chronic conditions because newer antibiotics are held back as 'last-resort' drugs, until more popular antibiotics fail. As such, strains of resistant bacteria are consistently catching up with the available drugs.
This resistance creep is being seen around the world. In December, Britain's Chief Medical Officer raised the concern that Gonorrhoea may soon become 'untreatable'. Even worse, a new superbug gene recently discovered in China and Canada, MCR-1, has the ability to immunise bacteria such as E Coli against even our most powerful last-resort antibiotics.
The spread of AMR will only worsen in the context of a growing global population, an expanding meat-eating middle class and accelerating urbanisation. The resulting threat of a 'post-antibiotic era', where common infections and minor injuries once again kill, has been likened in severity to that of terrorism and climate change.
In response, Australia released an AMR strategy report for 2015-2019, proposing better national coordination of antimicrobial stewardship. In fact, the last five years has seen the US, UK, EU, Canada and others release similar strategic action plans. Increasing public awareness, infection prevention, responsible antibiotic distribution, encouraging innovation and international collaboration are common themes across these reports.
These strategies have borne fruit on the national level. The UK has encouraged new drug development through innovation prizes and simplified regulatory frameworks. Similarly, the US took steps in 2012 to incentivise research by extending the patent period of new drugs by five years. Sweden, the Netherlands and Denmark have also banned the use of antimicrobial growth promoters in food production. Canada and the US have recently joined this trend, placing new restrictions on antibiotic use in animals during the last few months.
International discussion of AMR was initiated by the WHO's 2001 Global Strategy for Containment of Antimicrobial Resistance report. However, when a 2014 WHO surveillance report revealed the ascension of AMR 'to alarming levels', it became clear that stronger international steps were necessary. Soon after, the 2015 World Health Assembly endorsed a Global Action Plan (GAP): a framework designed to improve education, surveillance and judicious antibiotic distribution, while reducing infection and incentivising investment in new drugs and vaccines.
Despite these advances, there could be more robust international efforts to address the aforementioned market failure currently inhibiting antibiotic development. A recent British report proposed making antibiotics more commercially viable through the establishment of a global organisation authorised to allocate lump-sum payments to successful drug developers. This would decouple financial incentives from the volumes of antibiotics sold. The GAP explicitly emphasises the 'economic case' for combatting AMR, and by this logic, an international investment in drug innovation would be well justified.
Moreover, lower-income countries are at greater risk of spreading resistance as 'their legislation, surveillance, prevention and monitoring of AMR are weak or inadequate'. Universal availability of these life-saving drugs should remain an essential goal for global health initiatives. However, international efforts to implement the GAP's objective to 'support developing countries build capacity', institute effective drug management and improve infection control, is a vital part of mitigating the global spread of AMR.
It's promising that the global community has demonstrated such strong policy development efforts. However, implementation speaks louder than strategy. It's essential that all countries continue to cooperate and deliver on their national strategic objectives over the next few years. Because, in the words of FAO Deputy Director General Helena Semedo, 'we need to save our life-saving drugs'.
Photo courtesy of Flickr user mario.