● Introduction [ver].
● The WHO estimates the impact of vaccines in reducing microbial resistance [ver] | Vaccines in use or with a high probability of being approved and used | Vaccines with a medium probability of being approved and used | Vaccines with low probability of being approved and used.
● Mechanisms by which vaccines reduce microbial resistance [ver].
● Results of WHO estimates [ver].
● Conclusions and recommendations [ver] | Recommendations.
● Bibliographic references and recommended links [ver] | Other references.
● Microbial resistance to antibiotics (AMR) is associated with a high number of deaths, as well as very high social and economic costs.
● A WHO document discusses the role that vaccines can play in reducing AMR. 44 vaccines (in use or under investigation) targeting 24 pathogens (19 bacteria, four viruses and one parasite) are evaluated.
● The mechanisms by which vaccines reduce AMR are not well known, although the reduction in the incidence of infections and protection against infectious complications are probably the main ones.
● The discussed study presents the impacts (deaths, DALYs, antibiotic consumption, hospitalizations and loss of productivity) for each vaccine and theoretical use scenarios, individual pathogens and associated clinical syndromes, and according to WHO regions.
● Regarding vaccines and deaths due to AMR avoided: vaccination against tuberculosis would be the ones that would prevent the most deaths, followed by those aimed at Klebsiella pneumoniae, E. coli extraintestinal, pneumococci and S. aureus.
● The African continent would be, according to estimates, the one that would receive the greatest impact, with almost 200,000 deaths avoided each year.
● For its part, vaccination against RSV during pregnancy would be associated with a significant reduction in antibiotic consumption at a global level.
● Microbial resistance to antibiotics constitutes a major public health problem. Vaccines can play an important role in its reduction in healthcare practice.
● Plans to combat microbial resistance must recognize the role of vaccinations, integrating those related to immunizations into their objectives.
● The WHO also recommends including in cost-effectiveness evaluations of research and eventual introduction of new vaccines, data related to the expected benefits of vaccines in the field of microbial resistance.
Introduction
In 2019, the impact of the microbial resistance to antibiotics (AMR): Of the 7.7 million deaths associated with 33 different types of bacterial infections, about 5 million could be attributed to AMR. In addition to death and disability, antimicrobial resistance has very high economic costs (OMS, 2023; Antimicrobial Resistance Collaborators, Lancet 2022; Kim C, BMJ Global Health 2023).
Priorities to address AMR and reduce their impact on human health include: prevention of all infections that can lead to antimicrobial use; guaranteeing universal access to quality diagnosis and adequate treatment of infections; surveillance and monitoring of AMR and consumption/use of antimicrobials; and the research and development of new vaccines, diagnostics and therapeutic medicines.
The WHO recently published a study focused on role that vaccines can play in reducing AMRdocument discussed below.
The WHO estimates the impact of vaccines in reducing microbial resistance
The document published by the WHO consists of 168 pages in PDF format (presentation y document).
The document evaluates 44 vaccines (in use or under investigation) targeting 24 different pathogens (19 bacteria, four viruses – influenza, norovirus, rotavirus and RSV – and one parasite –Plasmodium falciparum-), from the following approaches and study variables:
- Health impact: deaths and loss of disability-adjusted life years (DALYs).
- Antimicrobial consumption.
- Economic impact: hospitalization costs and loss of productivity.
The vaccines evaluated are classified into three groups: vaccines in use or under investigation but with a high probability of being approved and used; and investigational vaccines with a medium or low probability of being approved.
Vaccines in use or with a high probability of being approved and used
In this group are vaccines against S. pneumoniae (pneumococcus), M. tuberculosis, S. typhi, Haemophilus influenzae type b (Hib) N. gonorrhoeae, P. falciparumrotavirus and RSV. Of these, and depending on the coverage levels and the target population, the first three (pneumococcus, M. tuberculosis, S. typhi) are those associated with a greater impact on health, economic and consumption of antibiotics.
Vaccines with a medium probability of being approved and used
In this group are those aimed at: E. coli extraintestinal, K. pneumoniaegroup A streptococcus, Shigella, E. coli enteropathogen, P. aeruginosa, Salmonella no-typhi, C. jejuni, H. pylorus and norovirus. Among these vaccines, only some have estimated a moderate or high impact on the studied variables associated with AMR.
Vaccines with low probability of being approved and used
This group includes a large and heterogeneous group of vaccines with limited expectations of achieving complete development and being approved and used. Three of them (improved vaccines against E. coli extraintestinal, pneumococci and S. aureus), used in the child population, elderly people and risk groups, would be associated with theoretically relevant impacts.
Mechanisms by which vaccines reduce microbial resistance
There are several mechanisms by which vaccines reduce AMR (see image above):
- Directly, reducing infections by sensitive or resistant microorganisms. This is the case, for example, of pneumococcal vaccines.
- Indirectly, protecting against complications that could require hospitalization and use of antibiotics. This is the case, for example, of influenza vaccines and complications due to pneumococcal infection.
- The effect of vaccinations, in some cases, also reaches unvaccinated individuals. This effect would also have its impact on the RMA.
- By reducing the incidence of viral infections, vaccines contribute to reducing the consumption of antibiotics associated with the care practice of patients with viral disease.
- Vaccines, by reducing the circulation of pathogens, would contribute to reducing the opportunities for interaction between them and the transmission of resistance factors and evolutionary pressure.
Results of WHO estimates
The discussed study presents the impacts (deaths, DALYs, antibiotic consumption, hospitalizations and loss of productivity) for each vaccine and theoretical scenarios of use, individual pathogens and associated clinical syndromes, and according to WHO regions.
For example, regarding the vaccines and AMR deaths avertedsee the attached image. Vaccination against tuberculosis would be the ones that would prevent the most deaths, followed by those aimed at Klebsiella pneumoniae, E. coli extraintestinal, pneumococci and S. aureus.
Another example, the impacts of vaccines according to WHO regionscan be seen in the attached image. The African continent would be, according to estimates, the one that would receive the most impact, with almost 200,000 deaths avoided each year.
A new example: Impact of preventing RSV infections in infants through maternal vaccinationshown in the attached image. Vaccination against RSV during pregnancy would be associated with a significant reduction in antibiotic consumption globally.
Las vaccines in use today They could prevent up to 106,000 deaths each year, 9.1 million DALYs, 861 million US dollars ($) in hospitalization costs and another 5.9 billion in productivity losses, all associated with AMR. These vaccines could also reduce antibiotic use by 142 million DDD annually. Furthermore, by achieving the objectives of the Immunization Agenda 2030 (IA2030) regarding pneumococcal vaccination of children and the elderly, approximately 27 100 additional deaths per year and the corresponding savings in DALYs and hospital costs would be avoided. and productivity losses.
The estimated figures for vaccines in their final phases of development, as well as for vaccines in early phases of research and with a lower probability of being approved and used, are, likewise, very important, although subject to a high level of uncertainty.
Conclusions and recommendations
Las Microbial resistance to antibiotics constitutes a major public health problem.a major global health challenge that threatens the ability to treat infectious diseases. Resistance to first-line drugs also represents a considerable economic burden, since it prolongs the duration of the disease (more days of hospitalization) and treatment, and motivates the prescription of higher-cost therapies (ISGlobal).
Vaccines can play an important role in reducing AMR in healthcare practice. This role has been little recognized until now. The recommendations shown below emerge from the WHO estimates, aimed especially at decision-making entities in research and distribution of health and social resources.
Recommendations
- National and supranational plans to combat microbial resistance must recognize the role of vaccinations, integrating those related to immunizations into their objectives.
- Promote the introduction of essential vaccines and the improvement of vaccine coverage to optimize their varied impacts.
- Include in the cost-effectiveness evaluations of the introduction of new vaccines and research plans for new vaccines, data related to the expected benefits of vaccines in the field of microbial resistance.
- Incorporate surveillance plans for AMR and the impact of vaccinations on them.
-oOo-
Bibliographic references and recommended links
Other references
- Dall C. Vaccine makers seek a role in the fight against antibiotic resistance. CIDRAP, February 7, 2024.
- Frost I, et al. The role of bacterial vaccines in the fight against antimicrobial resistance: an analysis of the preclinical and clinical development pipeline. Lancet Microbe. 2023;4(2):e113-e125.
- Laxminarayan R, et al. Expanding antibiotic, vaccine, and diagnostics development and access to tackle antimicrobial resistance. Lancet. 2024;403(10442):2534-50.
- Lancet, editorial. Antimicrobial resistance: an agenda for all. Lancet. 2024;403(10442):2349.
- Lewnard JA, et al. Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis. Lancet. 2024;403(10442):2439-54.
- Okele IN, et al. The scope of the antimicrobial resistance challenge. Lancet. 2024;403(10442):2426-38.
- One Health trust, October 16, 2023. The Value of Vaccines to Mitigate Antimicrobial Resistance – Evidence from Low- and Middle-Income Countries. ►Commented on: IFPMA, October 16, 2023. The value of vaccines to mitigate antimicrobial resistance.
- Van Heuvel L, et al. The impact of influenza and pneumococcal vaccination on antibiotic use: an updated systematic review and meta-analysis. Antimicrobial Resist Infect Control. 2023;12:70.
[volver al principio]
The Vaccine Tango with Antibiotic Resistance
Ah, microbial resistance to antibiotics (AMR)—the ultimate party crasher at the global health gala! According to the World Health Organization (WHO), about 5 million of the 7.7 million deaths tied to bacterial infections in 2019 were attributed to AMR. It’s like having a five-star, all-you-can-eat buffet of infections, and guess what? The main dish of the day is resistant bacteria! So what’s the plan? Vaccines, of course! Let’s dig into this robust WHO report like a bad comedian proding at an awkward silence!
What’s Cooking Inside the Report?
This document spans 168 pages—with more facts and figures than a calculator at a math convention. It evaluates 44 vaccines aimed at 24 pathogens (that’s right, 19 bacteria, four viruses, and one little parasite cousin). The report examines:
- Health impact: deaths and disability-adjusted life years (DALYs).
- Antimicrobial consumption.
- Economic impact: hospital costs and productivity loss.
A Look at the Vaccines
The WHO divides these vaccines into three groups: the “already here” bunch, the “maybe next time” group, and the “are we even asking for this?” category.
Vaccines in use or with a high probability of being approved: Get ready for the heavy hitters like Streptococcus pneumoniae, Mycobacterium tuberculosis, and Salmonella typhi. They’re the Al Pacino of the vaccine world—big names with a huge impact on health.
Vaccines with a medium probability of being approved: This crew includes wannabe stars like E. coli and Klebsiella pneumoniae, hoping to make it big someday in the health circus.
Vaccines with a low probability of being approved: Honestly, these guys are the extras in the movie. You might see them, but don’t hold your breath waiting for them to take center stage.
How Do They Beat AMR?
The mechanisms by which vaccines work their magic to reduce AMR are quite fascinating! Let’s break this down like Lee Evans onstage when he’s trying to find an exit in a crowded room:
- Direct reduction of infections by targeting microorganisms.
- Ghosting complications that lead to unnecessary antibiotic use.
- Helping not just the vaccinated ones, but also their unvaccinated buddies!
- Cutting down on viral infections, which means fewer antibiotics given out like candy.
- Creating a barricade that limits the chance of bacteria mingling and sharing their resistance secrets!
What’s the Bottom Line, Then?
The WHO estimates that booster shots could prevent a whopping up to 106,000 deaths annually from AMR. That’s like giving life a ‘do-over’ button for many. Imagine the productivity saved; we’re talking about billions of dollars! And if you’re wondering where these lives will be saved the most, it’s looking like the African continent—a hero in this saga—with nearly 200,000 deaths avoided yearly. Here’s a whole continent doing the right thing!
Conclusions and Recommendations
The WHO suggests that national strategies need to embrace the role of vaccines against AMR. So here’s the game plan:
- Start recognizing vaccines in overarching AMR combat strategies.
- Boost the introduction and coverage of essential vaccines.
- Include data about expected benefits related to AMR in cost-effectiveness evaluations.
- Implement surveillance plans to keep track of AMR and the efficacy of vaccines quickly.
Final Thoughts
The push against AMR isn’t just a health issue—it’s a call to arms for healthcare providers, researchers, and policymakers alike. The road ahead is filled with enough twists and turns to make a soap opera jealous, but with vaccines joining the fray, we might just end up with a happy ending after all! Let’s roll up our sleeves—metaphorically speaking—and show AMR who’s boss!
Reduce the overall burden of disease, which in turn lowers the need for antibiotic treatments.
Time for Action!
As we wrestle with the rising tide of AMR, the call to action is resounding: we must recognize and leverage the power of vaccines. The recommendations from WHO highlight the necessity of integrating vaccines into national and international strategies against AMR:
- Develop comprehensive plans to combat microbial resistance that explicitly include vaccination strategies.
- Encourage the adoption and coverage of essential vaccines to amplify their benefits.
- Factor the economic and health benefits of vaccines into cost-effectiveness analyses for new vaccine development.
- Establish robust surveillance mechanisms for AMR and monitor the impact of vaccinations on resistance trends.
Let’s Get Informed!
For those looking to deepen their understanding of antibiotics, vaccines, and the ongoing battle against AMR, check out the following resources and studies:
- Dall C. – Vaccine makers seek a role in the fight against antibiotic resistance.
- Frost I, et al. – The role of bacterial vaccines in the fight against antimicrobial resistance.
- Laxminarayan R, et al. – Expanding antibiotic, vaccine, and diagnostics development.
- One Health Trust - The Value of Vaccines to Mitigate Antimicrobial Resistance.
- Van Heuvel L, et al. - Impact of influenza and pneumococcal vaccination on antibiotic use.
With vaccines stepping into the spotlight, it’s time to acknowledge their critical role as not just preventative measures but as vital allies in the global effort against antimicrobial resistance. Let’s band together, innovate, and take action before AMR becomes the headliner we never wanted to see!
