Stop AMR from becoming the next pandemic

Another pandemic looms: The anti-microbial resistance (AMR) wave has been forming for decades. Bacteria acquire strengths that render antibiotic treatments useless, thus a societal and economic burden on countries.

The Global South accounts for more than 80 per cent of AMR deaths, set to exceed four million each in Asia and Africa in three decades. A 2019 study puts the Global North numbers at 141,000. It will be 10 million globally by 2050, from 1.27 million today.

The AMR issue is as alarming as it’s infuriating. The weakening of treatments through the evolution of the pathogens, accelerated by human behaviour, propels the transmission by both diagnosed patients and healthy individuals.

This is blamed on, one, poor stewardship and monitoring: About half of antibiotic treatments are initiated with the wrong drug and without a proper diagnosis—a conundrum exacerbated by, among others, prescription, sale and consumption of drugs audit limitations. Then there’s underdevelopment and underutilisation of diagnostic tools.

Hydrological pathways

Antibiotics also find their way into the environment through veterinary and agricultural practices or poorly regulated hydrological pathways, especially at the wastewater treatment sites. These undercut the useful lifespan of drugs, mostly launched in the 1970s-2000s: The average time to resistance for the 1930s-50s antibiotics was 11 years; it’s up to three years for the 1970s-2000s ones.

Another bottleneck is the absence of pharmacological innovation to respond to novel bacterial evolution. A 2016 report says 15 new antibiotics would be needed over a decade, at least four of them novel.

These are drugs with new chemical scaffolds or differentiated mechanisms of action. But the pipeline has dwindled and clinical development lagged. In Africa, new life-saving antibiotics are rare or unavailable. Globally, only seven (16 per cent) of 43 antibiotics in the pipeline are as novel.

Biggest culprit

The biggest culprit in this lack of innovation quagmire is the absence of a global market keen on financing research, commercialisation and massive production. Related to that is fragmented and unreliable antibiotics supply chains as many countries depend heavily on a few producers.

There’s a need to refocus AMR policy and progress on novel treatments via a sustainable innovation ecosystem that leverages private sector research and development (R&D) and public-private collaboration. Given the required investments and probabilities of success, only the private sector can muster the necessary volume and variety of innovation.

That will only become handy with a sustainable ecosystem that insures society against resistance breakouts, offers healthcare systems access to novel antibiotics and provides sustainable return on investment to manufacturers and investors to incentivise innovation. Let the starting point be a shared vision that addresses the root of the crisis and long-term innovation, broad access and stewardship.

Mr Onyango, a life scientist, is a Global Fellow at Moving Worlds Institute. [email protected].