Antimicrobial resistance (AMR), where the ability of a drug to treat an infection is compromised, reached the highest political level last week with the convening of a UN General Assembly meeting dedicated to the threat. With estimates of 700,000 deaths occurring each year due to drug-resistant infections and the World Bank projecting that if left unchecked, the problem could cause annual global GDP to fall between 1.1% and 3.8% before 2050, all member states adopted a political declaration that outlined commitment to a broad range of interventions. The first of its kind, the declaration rightfully recognized that combating AMR demands a multi-pronged approach, including raising awareness of the threat and its solutions; more prudent use of current drugs; replenishing the pipeline of antibiotics; developing new types of drugs, rapid diagnostic tests and vaccines; closer collaboration between the agricultural and human health sectors, and sustained funding for implementing national plans.
Vaccine development is an often underrated part of addressing AMR. Among the proposed solutions for tackling AMR, vaccines are a major tool that eliminates the need for antimicrobials, and therefore the need for other interventions related to conserving the utility of such drugs. While it is unrealistic to expect that it would be possible, or even cost-effective, to develop vaccines for every infectious disease, the potential of vaccines to address AMR can be exploited much further, to reduce the consumption of antimicrobials.
Human consumption of antibiotics increased by a rate of approximately 40% between 2000 and 2010 and in the United States, over 70% of antibiotics that are medically important for humans are used to treat animals. In order to effectively tackle AMR, creating an environment where antimicrobial use is minimized is urgently required.
Despite these commonly accepted challenges and the well-known advantages of using vaccines to prevent infection and therefore eliminate the need to prescribe antimicrobials, vaccine development continues to hold a low profile in the basket of solutions for AMR.
Part of the reason for this may be the view that new vaccines are technically difficult to develop, and are an extremely expensive and time-consuming investment. This is true, but the development of new drugs is similarly based on high financial bets and long routes to market with no guarantee that they will achieve regulatory approval. Years of research to develop vaccines for HIV and malaria have resulted in little hope that they will become a reality soon, which may have weakened the case for prioritizing other vaccines in the fight against AMR.
However, at least three new vaccines against bacteria have been developed since the 1980s and as a consequence, these interventions have prevented infection, illness and death and contributed significantly to reducing the need to prescribe antibiotics. The World Health Organization underlines the importance of the pneumococcal conjugate vaccine for its ability to prevent 1.6 million deaths caused by pneumococcal diseases and its benefit at curbing growing resistance of Streptococcus pneumoniae against commonly used antibiotics; as such it is included on the agency’s list of essential medicines. Other recently produced bacterial vaccines including those against meningitis and haemophilus influenzae (Hib) are also known for their dual benefits of preventing infection and illness but are valued too for the triple benefit of avoiding AMR by eliminating the need for antibiotic use. Although targeting efforts toward new antibiotics is undoubtedly sensible, they will not tackle the ability of pathogens to naturally develop resistance against them. Vaccines however, ensure that resistance does not pose a threat to public health to begin with.
More efforts should be dedicated to a cost-benefit analysis of vaccines for AMR control and their relative value compared with investments in stewardship of antimicrobials and better pipelines of new antibiotics. This may strengthen understanding of the unique and dynamic role that conferring immunity to disease can play in tackling AMR.
Last week’s high-level meeting underlined the significance of AMR as a global threat. Much has been written about the decision of the UN secretary general to elevate AMR to such political heights but it remains to be seen how far this initiative will go beyond raising awareness. However, the universally accepted declaration will likely encourage commitments to intensify efforts and mobilize sustainable funding. In planning how the resources are allocated in the fight against AMR, the enormous of potential of vaccines must not be relegated to the sidelines.
Professor David Heymann CBE, Head and Senior Fellow, Centre on Global Health Security and Abbas Omaar, Research Assistant, Centre on Global Health Security.