NAIROBI — Drug-resistant infections are viewed by global health experts as one of the biggest threats to human health, with the United Nations estimating that antimicrobial resistance could lead to 10 million deaths each year by 2050 if no action is taken.
But despite predictions like this, a main stumbling block is the lack of data available to understand the global scale of the problem.
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A new partnership between Pfizer, Wellcome, and the governments of Ghana, Kenya, Malawi, and Uganda aims to increase the amount of country-specific data on this issue so that health officials in those countries and around the world can better understand what sort of interventions are needed to tackle antimicrobial resistance.
“Surveillance is incredibly important because without that information, we're just flying completely blind,” said Pol Vandenbroucke, chief medical officer of Pfizer's hospital business unit.
Many factors have led to a situation in which some infections are resistant to certain antibiotics. Antibiotics have been inappropriately used in humans, animals, and agriculture, and poor manufacturing and hospital discharge practices have polluted the environment with these drugs, among other reasons. There is also a gap in investment in research and development of new antibiotics, as well as effective diagnostic tools to ensure that people are treated for the right infections, according to members of the new partnership.
According to the World Health Organization, 138 countries have national action plans for tackling antimicrobial resistance, and a WHO spokesman said another 48 countries are in the process of making plans. But developing and implementing a nationwide response is difficult without access to robust data, said Gemma Buckland Merrett, science and research lead of the drug-resistant infections priority program at Wellcome.
“We need to be able to generate local data, actionable data that would inform policy and action.”— Otridah Kapona, antimicrobial resistance national focal point and coordinator, Zambia National Public Health Institute
Challenges to collecting that data include ill-equipped laboratories and improper diagnostic testing, as well as paper record-keeping systems that make it difficult to bring datasets together to conduct analyses, she said.
"The response to [antimicrobial resistance] is not equal to the level we are dealing with," said Otridah Kapona, antimicrobial resistance national focal point and coordinator at the Zambia National Public Health Institute, during a webinar Thursday. “We need to be able to generate local data, actionable data that would inform policy and action.”
To survey for antimicrobial resistance, a patient sample is used to determine whether the pathogen causing the infection is susceptible to certain antibiotics.This data then needs to be coupled with patient data — including information on whether the patient died — to better understand the impact of infections, Buckland Merrett said. Currently, many hospitals only document the pathogen rather than bringing this information together, she said.
That data can be used at the hospital level to ensure that the patient gets the right treatment and to inform infection prevention and control systems at that facility. At the national level, it helps build policy around treatment guidelines and understanding of a country’s burden of antimicrobial resistance.
At the global level, the data helps to identify the predominant pathogens that have drug-resistance, which can influence the research and development of new treatments, and also to identify which countries are struggling with tackling this issue, Buckland Merrett said.
“People need to understand that [antimicrobial resistance] is a slow-moving pandemic. It needs to be prioritized politically, and action needs to take place across numerous fronts,” she said.
Surveillance pilot program
A pilot program will be run in two hospitals in each participating country over the next three to five years and will seek to strengthen laboratories, to train those who run them on how to conduct this surveillance, and to analyze the data.
This is the first major public-private partnership on antimicrobial resistance surveillance in Africa.
Pfizer hosts the only industry-led, open-access database that tracks antimicrobial resistance globally. It has collected about 685,000 samples from more than 80 countries. It is also one of the few large multinational pharmaceutical companies left in the field of developing antibiotics.
“Imagine a world in which there are no functioning antibiotics. … A smallest scrape could turn into a life-threatening infection.”— Pol Vandenbroucke, chief medical officer, Pfizer hospital business unit
The pilot program will be coupled with a study that examines the clinical and economic impact of antimicrobial resistance on patients.
Examples of other surveillance systems include the World Health Organization’s Global Antimicrobial Resistance Surveillance System, as well as the Fleming Fund’s efforts to build up capacity in low- and middle-income countries to improve their surveillance.
“Actions required to address [antimicrobial resistance] involve governments, pharmaceutical companies, health workers, private sector, farmers, agribusiness, and financial institutions,” said Maria Helena Semedo, deputy director-general at the Food and Agriculture Organization of the United Nations, during Thursday’s webinar.
Overwhelmed hospitals and secondary infections
The COVID-19 pandemic stands as a challenge to the pilot program. There are worries that the hospitals will be stretched thin because of the pandemic response, and their surveillance activities for antimicrobial resistance might not take priority, according to the partners.
There are also concerns that the levels of antimicrobial resistance will deepen as a result of the pandemic. Some people with COVID-19 get secondary bacterial infections, which can be drug-resistant, Buckland Merrett said. Another concern is that health workers are dispensing antibiotics to people with mild cases of the coronavirus, thinking it is another type of infection.
But there is also hope among some of the partners that the general public might take the threat of antimicrobial resistance more seriously following the pandemic since the importance of surveillance of infectious diseases has become more widely discussed.
“Just imagine a world in which there are no functioning antibiotics: You wouldn't be able to use most cancer treatments, travel would be very, very difficult because of the risk of infection, and a smallest scrape could turn into a life-threatening infection,” Vandenbroucke said. “In a way, COVID-19 is kind of a reflection of that world.”
Update, June 24, 2020: This piece has been updated to reflect the number of samples collected by Pfizer’s database is about 685,000 samples from more than 80 countries.