One World, One Health – Take on the Superbugs Challenge

Bacterial culture prepared to test new antibiotic candidates.

Humans, animals, plants and the environment we all share face increasing risks of antimicrobial resistance (AMR), with the potential for irreversible damage increasingly likely. Our health and that of the planet are at stake, declares a great champion for more action.

We know what to do. Think one health has been with us for as long as Gastein European Health Forum, which celebrated its 25th anniversary at last week’s annual meeting. But the COVID-19 pandemic has loudly proclaimed this to be an even greater imperative, emphasizing the interplay between human behavior, public health and economic development like never before. What is needed now is for the global community to put health – human, animal and environmental – at the heart of policy-making.

The G7 summit in Elmau a few months ago recognized this imperative with a commitment “to work in partnership to strengthen health systems around the world and to intensify our pandemic prevention, preparedness and response efforts as part of the One Health approach”. G7 leaders included RAM in their final communiqué, pledging to “spare no effort to continue to fight this silent pandemic”.

A threat with more deadly potential than COVID-19

As the UK’s Special Envoy on Antimicrobial Resistance, I consider it my duty to educate the world about this threat we all face due to the growing prevalence of drug resistant microbes – including bacteria, viruses and parasites.

This is a pandemic that has the potential to be deadlier than COVID-19. It is already associated with five million deaths per year, making AMR the third leading underlying cause of death worldwide. According to a groundbreaking study in The Lancetpublished in January, drug-resistant bacteria alone were responsible for some 1.27 million deaths in 2019.

Meanwhile, an O’Neill Review landmark study predicted that the number of deaths from antimicrobial resistance could reach 10 million each year by 2050 – if we don’t change the trajectory of drug resistance now.

Disproportionately affects the most vulnerable

Tragically, antimicrobial resistance disproportionately affects our world’s most vulnerable, with much of the burden of antimicrobial resistance-related deaths occurring in sub-Saharan Africa where access to antibiotics and medicines is generally more limited, while such as the ability of laboratories to detect drug-resistant microbes.

Lives and livelihoods are at stake, with the world Bank estimating that up to 24 million more people could be pushed into extreme poverty if we do not act collectively.

Without antibiotics, I have said (to put it mildly), “we’d be in for a truly dreadful mess” or, more bluntly, “a post-antibiotic apocalypse”. Animals would die, plants would die, and more of us humans would die as our ability to produce food for the world’s growing population stagnates.

This is not a sci-fi scenario filmed by Ridley Scott, but a clear and present danger for all of us. It is therefore time to act. Because, as a colleague said Put the“Superbugs are beating us in a competition we can’t afford to lose.”

Correct market failures

Antibiotics dispensed in a pharmacy in India.

There are hurdles to overcome, but they are not insurmountable with sufficient public health leadership and political will.

Above all, we need to address a deep and prolonged market failure. No new class of antibiotics has been discovered for four decades. Frighteningly, the World Health Organization (WHO) has identified that the the clinical pipeline of antibiotics is insufficient to combat resistance because so few drugs in development are truly innovative or tackle the most dangerous classes of pathogens.

A lack of incentives means that, unfortunately, the small start-ups that drive innovation can easily fall at the last hurdle or simply go bankrupt – so that new antibiotic discoveries never reach the patients who need them. most need.

We need to redouble our efforts to find solutions that bring companies back to developing antibiotics. The RAM Equity Fund, which emerged from conversations between the WHO, Wellcome Trust and the pharmaceutical industry, is now backed by $1 billion in investment capital from some of the world’s largest pharmaceutical companies. Aimed at small and medium-sized biotechnology companies with promising innovations, the Fund aims to stimulate the development of two to four new antibiotics by 2030. This is a good start. Now we need more than this promising initiative.

More “attractive” incentives

The G7 also pledged to explore “pull” incentives to allow new antibiotics to come to market and ensure they are accessible to those who need them most, while ensuring responsible use. and appropriate.

I am proud that England has led the way with its pilot project involving a subscription payment model for new antibiotics, with stringent management requirements. Under this model, the UK government will start paying pharmaceutical companies a fixed fee for the supply of antibiotics. This will help tackle the growing global drug resistance crisis and ensure that treatments are accessible to patients registered with the National Health Service. A similar model could be adopted in the United States in the form of the Pasteur Law before Congress, which is also offering initial funding of up to $3 billion.

One Health and RAM

Inspecting the health of a pig in Busia, Western Kenya.

Of course, the scope of addressing antimicrobial resistance in the context of one health involves many interventions across a range of sectors.

It involves measures to promote more rational and appropriate use of existing medicines for human and animal health. It also implies the need to prevent zoonotic diseases from crossing the human-animal barrier due to ecosystem degradation and poor food safety practices. Similarly, more careful use of antibiotics and other medicines is essential in the plant health and animal health sector, alongside that of human health.

And at the same time, One Health thinking goes well beyond AMR to include ways in which we promote healthier, more sustainable development that prevents disease from occurring. Although the term has been with us for two decades or Moreover, One Health concepts have yet to be fully integrated into public health policy-making, as the experience of the COVID pandemic and previous outbreaks such as Ebola has underscored.

Last year I called The Trinity Challengebringing together the private sector and academia, united by the common goal of developing ideas and actions to contribute to a world better protected against global health emergencies.

More than 340 contestants from over 60 countries shared their creative ideas, and I’m proud that the winning solution, the Participatory One Health Disease Detection (PODD) from OpenDream in Thailand, allows farmers to identify and report zoonotic diseases that could potentially jump from animals to humans, triggering another pandemic. Hopefully we’ll see more approaches like this in the future.

To close the gaps in prevention, preparedness and response, we need a sustained exit from siled thinking and collaboration across countries and sectors. One Health thinking must be accompanied by One World policymaking that addresses issues such as global food security, animal welfare and environmental sustainability as a top priority. We are, really, all in the same boat.

Lady Sally Davies
Lady Sally Davies

Dame Sally Davies was appointed UK Government Special Envoy on RAM in 2019. She is also the 40th Master of Trinity College, University of Cambridge. She was Chief Medical Officer for England and Senior Medical Advisor to the UK Government from 2011 to 2019. She was a member of the World Health Organization (WHO) Board of Trustees from 2014 to 2016 and co- Convenor of the UN Inter-Agency Coordination Group (IACG) on Antimicrobial Resistance (AMR), which reported in 2019. In 2020, Dame Sally was announced as a member of the new UN Global Leaders Group on AMR , serving alongside prominent figures around the world to advocate for action against AMR. In 2020, Dame Sally became the second woman (and the first outside the Royal Family) to be appointed Dame Grand Cross of the Order of the Bath (GCB) for her services to public health and research, after having received his DBE in 2009.

Image credits: WHO, AMR Industry Alliance, ILRI / Charlie Pye-Smith.

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