The term antimicrobial resistance describes an infection that can no longer be treated because the microorganism(s) involved can survive and proliferate in the presence of the drug. Here, Dr Carolyne Horner offers a personal view of the future.
These untreatable antimicrobial-resistant (AMR) infections are occurring now, in the 21st century, despite all the advances made in medicine and technology.
Owing to the COVID-19 pandemic, we are living in an age when awareness of infectious disease has never been higher. Many people can have a conversation about COVID-19 but the same may not be said about AMR. How many people know about and fully understand the implications of a pandemic of impossible-to-treat infections? Here I debate why more meaningful and candid conversations are needed to drive urgent action in order to mitigate the threat of AMR.
First, I would argue that more conversation is required to address why certain regions of the world still lack access to clean water and sanitary living conditions. Infrastructure improvements would go a long way to reduce the burden of infectious disease worldwide, subsequently reducing the need for antimicrobials. The stark reality is that until everyone on the planet has access to basic amenities, the AMR problem is far from being solved.
Second, I would argue that our conversations are confusing. The language used to communicate about AMR often creates a barrier and as a result many people remain unaware of the seriousness of the issue. Messages may be better received if they were simplified and made more relevant to everyday life. Behavioural scientists tell us that emotions and feelings are more likely to change behaviour rather than emphasis on data analysis and knowledge. Indeed, a graph showing rates of resistant Gram-negative bacteria causing bloodstream infections does not have the same emotive response as a tiny premature baby with neonatal sepsis fighting for their life on a neonatal intensive care unit (ICU) ward.
Third, not all conversations about AMR and associated themes are constructive. An overwhelming amount of information is available 24/7 via the internet and social media, including information that is unclear, misleading and sometimes false, making it difficult to find reliable sources of information to stay informed. In certain situations, such as the promotion of vaccination, this ‘infodemic’ may hinder progress in raising awareness of the long-term impact of AMR.
Traditionally, actions against AMR have focused on drug development; however, the current market for newly developed antimicrobials is unsustainable. As an example, Achaogen invested a billion dollars and 15 years developing plazomicin, a new aminoglycoside antimicrobial to treat multidrug-resistant bacteria, yet the company was unable to secure a return on its investment and declared bankruptcy in 2019. Clearly, a different approach is needed. NHS England and NHS Improvement are pioneering an innovative antibiotic delinkage model that uses a subscription-type payment scheme for new antimicrobial drugs. If successful, this model will set an example for others to follow.
Another area requiring significant international input and collaboration is the worldwide introduction of regulation to reduce unnecessary and inappropriate antimicrobial use in humans, animals and the environment. For those who think this is an insurmountable task, reflect on how, in 1987, chlorofluorocarbons (CFCs) were banned worldwide, an accomplishment that has had a sizeable impact on the speed of global warming. Global regulation of antimicrobials would be a huge multilateral undertaking requiring stringent governance, but would surely have an immense and lasting impact on AMR.
Similarly, international collaboration is required to collect and share AMR data in a robust way. While AMR surveillance has improved, there are still some regions with limited coverage. Advances associated with the COVID-19 pandemic in areas such as vaccine development and deployment, genome sequencing, data sharing, and result reporting need to be translated into the AMR arena. Data tools and platforms now seen as standard for COVID-19 should be made available for drug-resistant pathogens, including negative test data and deaths attributable to AMR.
COVID-19 aside, AMR is without doubt the most serious long-term global health threat of our time. Unless we have the right conversations, using messaging appropriate for each audience, sustainable actions and long-lasting outcomes are unlikely. On a local level, conversations are needed to engage and empower individuals and communities to change their attitudes and behaviours towards the use of antimicrobials. On an international level, political will is needed to support far-reaching societal changes that will improve the quality of life for so many, while at the same time reducing the global burden of infectious diseases. Ultimately, we all need to work together, steadily and with urgency, in order to mitigate the threat of AMR before it is too late.
About Carolyne Horner
Dr Carolyne Horner is the Scientific Lead at Una Health. She has a BSc (Hons) in Biological Sciences from the University of Leicester, and a PhD from the University of Leeds. Carolyne trained as a Clinical Scientist (Microbiology) at Leeds Teaching Hospitals NHS Trust, where she worked for over 15 years before moving to the British Society for Antimicrobial Chemotherapy to work as a Clinical Affairs Officer. She is an Associate Editor for the journal BMC Microbiology.
