Addressing International Antimicrobial Resistance

Antimicrobial resistance (AMR) has been an ongoing global public health issue for some time; however, when the COVID-19 pandemic emerged in 2020, AMR took a back seat in terms of priorities. In fact, there have been many studies showing that antibiotic prescribing increased during the pandemic as providers scrambled to care for patients. Although the world is still grappling with COVID-19, antimicrobial resistance has again become an emerging discussion in public health circles. More of an emphasis is being placed on antibiotic prescribing practices, and trying to identify ways to bring more antimicrobials to market.

The scope of the problem can be illustrated in a study published earlier this year. A global analysis published in The Lancet back in January estimated that AMR was the leading cause of death worldwide in 2019. Investigators estimated that resistance itself caused 1.27 million deaths in 2019, and that antimicrobial-resistant infections played a role in 4.95 million deaths.

In comparison, mortality for HIV/AIDS and malaria have been estimated to be 860,000 and 640,000 deaths, respectively that same year.

What Happens There Can Happen Here
It can be surmised that because LMICs have not had the same COVID-19 vaccination coverage as other parts of the world, new virus strains came emerge and develop into the predominant strain there and spread quickly internationally. Virus spread to new countries is just one plane ride away. Certainly, the emergence of the Omicron variant first identified in South Africa last year may serve as an example. First identified there in November, it quickly spread around the world leading to another COVID-19 surge. Many months later, the country still has a low vaccination rate. As of March 27, 2022 South Africa was only 30% fully vaccinated according to Our World in Data.

This lack of vaccine coverage in LMICs may serve as an example that demonstrates what can happen if the developing world is not provided access to needed medical care. In fact, there have been reports of people missing their tuberculosis treatments in the Ukraine due to the war, which could lead to multidrug resistant tuberculosis strains and the possibility of transmission to other people, whether in the Ukraine or in the case of refugees, in other countries. Although viruses and bacterial infections are transmitted uniquely and in varying ways, the overarching theme should be if it happens in LMICs, it can happen in Europe and the US.  

The Center for Global Development, which is based in Washington DC and London, is launching a new working group addressing antimicrobial resistance and will explore how to improve incentives for pharmaceutical companies to develop new antimicrobials and sell their products in LMICs, expand access to these live-saving drugs, and how to reduce unnecessary use.

Contagion spoke with Anthony McDonnell, senior policy analyst, Center for Global Development and Javier Guzman, MD, director of Global Health Policy and a senior policy fellow at the Center for Global Development who offered their perspectives on the challenges of AMR in low-income and middle-income countries, discuss their organization’s new group dedicated to fighting AMR, push and pull incentives, stewardship, and why it is paramount to consider this as a health issue with potential global ramifications.