An interview with Dr Haileyesus Getahun, Director, UN Interagency Coordination Group on Antimicrobial Resistance

The misuse and overuse of antimicrobial drugs in humans, animals and plants are fuelling antimicrobial resistance (AMR) that makes it difficult to treat common infections like tuberculosis and malaria, which could cause 10 million deaths annually by 2050, said United Nations Interagency Coordination Group (IACG) on Antimicrobial Resistance report released on Monday. Dr Haileyesus Getahun, director of the IACG at the World Health Organization, explains why multi-sectorial action must be taken now to stop “a return to the old days of people dying from common infections and injuries”.

How big is the AMR threat in highly populated countries, such as India?

Antimicrobial resistance is a threat to everyone, everywhere. The WHO Global Antimicrobial Resistance Surveillance System (GLASS) collects data from 71 countries, including India, in which more than a third of countries reported widespread resistance to common pathogens. In some member countries of the Organization for Economic Cooperation and Development (OECD), about 35% of common human infections are already resistant to currently available medicines, and in some low- and middle-income countries, resistance rates are as high as 80%-90% for some antibiotic-bacterium combinations.

Resistance to second- and third-line antibiotics – the last lines of defence against some common diseases – are projected to almost double between 2005 and 2030. Concurrently, millions of lives are lost every year due to lack of access to existing antimicrobial agents: inadequate access to antibiotics alone kills nearly 6 million people annually, including a million children who die of preventable sepsis and pneumonia.

How many people will be affected?

If there isn’t collective leadership and action between governments, pharmaceutical companies, international agencies and civil society, predictions suggest that there could be as many as 10 million deaths worldwide by 2050. This would mark a return to the old days of people dying from common infections and injuries.

What are the biggest causes of AMR deaths globally?

Globally, it is estimated that at least 700,000 people die each year due to drug-resistant diseases, including 230,000 people from multidrug-resistant tuberculosis. Based on the WHO GLASS data collected from 3,097 hospitals and 2,358 outpatients clinics in 2017, the most common drug-resistant pathogens reported include E. coli, K. pneumoniae, Salmonella spp., Acinetobacter spp., S aureus, S pneumoniae, N gonorrhoea, and Shigella spp causing a variety of blood stream infections, respiratory tract infections, sexually transmitted infections and urinary tract infections, which are increasingly become untreatable.

What financial and regulatory investments need to be made to avert the crisis?

The bankruptcy of small biotech company Achaogen, which had successfully developed a new antibiotic that was effective in treating drug-resistant urinary tract infections, highlights the challenge to developing new antibiotics and bringing them to market. Going forward, it’s important to find ways to incentivize investment in research and development to replenish the pipeline of antimicrobials.

The IACG report reiterates that all research and development efforts to address AMR should be needs-driven, evidence-based and guided by the principles of affordability, effectiveness, efficiency and equity, as well as delinking the cost of investments in AMR research and development from the price and volume of sales. Many countries require support to implement national action plans in key areas such as building and analysing the evidence base, setting targets, developing regulatory frameworks and professional capacities across the One Health spectrum.

Why will One Health approach work better?

One Health is an approach to dealing with antimicrobial resistance where strategic collaboration across sectors, disciplines and stakeholder groups maximises the impact of action and acts as a force multiplier for positive results and impact. This means breaking down the silos and sharing expertise, data and advocacy platforms, and integrating surveillance systems to reach common objectives across human, terrestrial and aquatic animal and plant health, as well as food and feed production and the environment.

How can misuse be stopped?

The recent report by the World Organisation for Animal Health (OIE) indicates that the use of antimicrobials for growth promotion has seen a decline from 60 countries to 45 countries in recent years. Political understanding and engagement are essential to ensure that antimicrobials are used safely and sourced responsibly. Collateral measures to address challenges that could arise from the phasing out of antimicrobials in growth promotion, including using alternatives to antimicrobials, infection control and hygiene, education and provision of economic incentives to farmers as they transition from using antimicrobials as growth promoters, as well as promoting research to identify effective interventions, can help stop misuse.

What are the two biggest hurdles to averting the AMR crisis?

There is a lack of a sustainable innovation ecosystem that overcomes the challenges of research and development of new antimicrobials and the inevitable prospect of losing our defences against infections. The second is the lack of recognition by political leaders at all levels about the urgency to recognise antimicrobial resistance as a global crisis that threatens a century of progress in health and achievement of the Sustainable Development Goals. Unless we act today, a disaster will unleash in a generation.