The 79th session of the United Nations General Assembly (UNGA) to host second high-level meeting on the rise of antimicrobial resistance (AMR), a problem that the World Health Organization (WHO) calls a “major threat to public health and global development.”
In 2019, bacterial AMR was directly responsible for 1.27 million deaths worldwide and contributed to 4.95 million deaths. And this resistance continues to spread.
The main cause of the increase in pathogen resistance to antimicrobials is the overconsumption and inappropriate use of these drugs in humans, animals and plants. This problem concerns not only their use, but also production standards, which also represent a risk factor.
In India, more than half of the antibiotics prescribed are used to prevent infections rather than treat cases.
This month the WHO published a guide on the management of wastewater and solid waste in the production of antibiotics. The aim is to provide “a neutral scientific basis” for regulators, buyers, inspectors and industry to integrate strict control of antibiotic pollution into their standards.
India, often called the “pharmacy of the world” for its massive production of medicines, is one of the main markets targeted by this document. Indeed, the country is not only the world’s largest consumer of antibiotics for human health in absolute value, but also the epicenter of antimicrobial resistance.
Antimicrobial resistance in India
The Indian Council of Medical Research (ICMR) AMR Surveillance Network Annual Report 2023 analyzed antibiotics used for respiratory infections, fever, diarrhea, pneumonia, sepsis and other blood infections. He revealed thatEscherichia coliresponsible for gastrointestinal infections, is the most frequently resistant pathogen, followed by Klebsiella pneumoniaewhich notably causes pneumonia and urinary infections, as well asAcinetobacter baumannii, Pseudomonas aeruginosa et Staphylococcus aureus. E. coli and K. pneumoniae show increasing resistance to the majority of treatments.
However, the use of antibiotics in India remains largely unwise. According to a ICMR National Center for Disease Control (NCDC) survey 2021-22more than half of the antibiotics prescribed are used to prevent infections rather than to treat proven cases. Nearly 57% of prescriptions fall under the WHO “surveillance group,” which includes drugs that are particularly vulnerable to the development of resistance.
In July, a study led by Tavpritesh Sethi and published in The Lancet Regional Health confirmed the worrying rise in resistance to crucial antibiotics, such as imipenem, used against Acinetobacter, Klebsiella et E. coli. This study, carried out between 2017 and 2022, used statistical and artificial intelligence tools to analyze trends in resistance and blood infections.
Vaccines could significantly reduce the use of antibiotics in low- and middle-income countries (LMICs), offering hope of reducing both healthcare costs and poverty, according to Indian antimicrobial resistance experts.
In addition to their role in preventing infections directly caused by certain pathogens, vaccines play a key role in the fight against antimicrobial resistance (AMR) by limiting the appearance of viral infections likely to predispose to bacterial colonization.
Researchers observed that resistance trends vary across regions of India. Resistant isolates of E. coli were more common in the south, while resistant Staphylococcus predominated in the north.
The resistance ofAcinetobacter was more present in the center and northeast of the country, while Klebsiella, P. aeruginosa et Enterococcus had a more uniform distribution. Strong multi-resistance was noted for Klebsiella, Acinetobacter et Staphylococcus.
Can vaccines play a role?
Vaccines could significantly reduce the use of antibiotics in low- and middle-income countries (LMICs), offering hope of reducing both healthcare costs and poverty, according to Indian antimicrobial resistance experts.
However, a strategy based on vaccination poses challenges, as some infectious agents do not yet have vaccines. Some scientists say AMR should become a global priority, mobilizing emergency efforts as was the case for the rapid development of COVID-19 vaccines.
Studies show that after the introduction of vaccination programs, antibiotic prescriptions fell significantly: by 64% in Ontario, Canada, and up to 88% among children in Italy, Japan and Japan. Pakistan.
In addition to their role in preventing infections directly caused by certain pathogens, vaccines play a key role in the fight against AMR by limiting the appearance of viral infections likely to predispose to bacterial colonization.
For example, the flu weakens the immune system, increasing the risk of bacterial co-infections. Vaccination helps reduce the viral load and the duration of infection, thus limiting the period during which bacterial colonization can occur. The same mechanism is observed with measles, a virus that directly attacks immune cells. Most measles-related deaths are due to bacterial co-infections.
Studies show that after the introduction of vaccination programs, antibiotic prescriptions fell significantly: from 64% in Ontarioin Canada, and up to 88% in children in Italy, Japan and Pakistan.
Additionally, vaccination against minor infections like chickenpox could drastically reduce antibiotic costs. In countries like Senegal and South Africa, flu vaccines could prevent up to 390 antibiotic prescriptions per 100,000 people per year, illustrating their potential to reduce the misuse of antibiotics and curb resistance.
Although new antibiotics are urgently needed to treat bacterial infections, increased vaccine use could prolong the effectiveness of current and future antimicrobial treatments.
Promising projects
The World Health Organization (WHO) has classified high priority pathogens into three groups, based on the potential for vaccine development:
i. Group A (very high) : for pathogens already covered by approved vaccines. The objective is to increase existing vaccination coverage.
ii. Group B (high) : for pathogens whose vaccine candidates are in the advanced phase of development. The objective is to accelerate their launch to the market.
iii. Group C (moderate) : for pathogens with vaccine candidates in early phase trials or still under study. The objective is to better understand their potential and their impact.
Currently, it is clear that vaccines are underutilized as a crucial element in the AMR strategy, complementing other interventions such as antibiotic stewardship and new drug development – which are desperately needed for pathogens such as tuberculosis, Staphylococcus aureus, Klebsiella pneumoniae and gonococci.
To further strengthen innovation in the fight against AMR, particularly in low- and middle-income countries, there are several promising areas, such as the development of rapid diagnostics and point-of-care testing; antimicrobial peptides (small protein fragments that inhibit certain bacteria, viruses, fungi and pathogens); phage therapy, which uses viruses to target and kill certain bacteria; artificial intelligence-assisted drug discovery; nanotechnology-based drug delivery systems; or the management of the intestinal microbiome, among others.
These innovative approaches can help tackle AMR from different angles – from diagnosis to treatment, prevention and environmental management – to address what is truly an existential global health challenge.
