To fight an­timi­cro­bial re­sis­tance

The Myanmar Times - Weekend - - News - JÖRG REINHARDT news­room@mm­times.com

TWO weeks ago, G20 lead­ers com­mit­ted to work­ing to­gether to ad­dress one of the world’s most press­ing and per­plex­ing se­cu­rity threats: an­timi­cro­bial re­sis­tance (AMR) – a fierce and evolv­ing ad­ver­sary against which con­ven­tional ther­a­peu­tic weapons are of no use.

The threat is straight­for­ward: bac­te­ria and other mi­crobes are be­com­ing re­sis­tant to avail­able medicines faster than new medicines are be­ing de­vel­oped. Ev­ery year, drug-re­sis­tant mi­crobes kill about 700,000 peo­ple world­wide – more than three times the an­nual death toll from armed con­flicts.

In 2016, a spe­cial panel com­mis­sioned by the Bri­tish gov­ern­ment pre­dicted that, by 2050, as many as ten mil­lion more peo­ple will die from drug-re­sis­tant mi­crobes ev­ery year. AMR now poses a clear and present dan­ger to ev­ery per­son on the planet. Un­less we con­front it head-on, we could re­turn to a world in which it is com­mon for peo­ple to die from ba­sic in­fec­tions.

Be­yond the cost in hu­man lives, AMR could dev­as­tate the world’s economies. In Europe alone, the an­nual health-care costs and pro­duc­tiv­ity losses as­so­ci­ated with AMR al­ready to­tal an es­ti­mated €1.5 bil­lion (US$1.7 bil­lion).

The G20, for its part, has taken an im­por­tant step for­ward. Each G20 coun­try has promised to start im­ple­ment­ing na­tional plans to fight AMR in earnest, and to do more to pro­mote new treat­ments against re­sis­tant mi­crobes. To that end, G20 lead­ers are call­ing for an in­ter­na­tional “R&D Col­lab­o­ra­tion Hub” to “max­imisze the im­pact of ex­ist­ing and new an­timi­cro­bial ba­sic and clin­i­cal re­search ini­tia­tives.” And they have promised to ex­plore how mar­ket in­cen­tives can be used to en­cour­age new re­search.

Be­yond the G20, in­no­va­tive pub­licpri­vate part­ner­ships are emerg­ing to de­liver new treat­ments against dru­gre­sis­tant killers such as tu­ber­cu­lo­sis. And some gov­ern­ments have al­ready started fill­ing crit­i­cal roles in the global re­sponse to AMR, by col­lect­ing data on the spread of re­sis­tant strains of E. coli, sal­mo­nella, and other com­mon pathogens.

Now it is up to po­lit­i­cal lead­ers to fol­low through on their com­mit­ments. Be­cause new treat­ments for mul­tidrug-re­sis­tant mi­crobes aren’t ex­pected to gen­er­ate much re­turn on in­vest­ment, it is in­cum­bent upon gov­ern­ments to make re­search and devel­op­ment in this field more at­trac­tive to pri­vate com­pa­nies, and, in or­der to stem the devel­op­ment of re­sis­tance, to en­sure that new drugs are not overused.

When tra­di­tional mar­ket mech­a­nisms fail, in­stru­ments such as “trans­fer­able mar­ket ex­clu­siv­i­ties” can help, by al­low­ing drug mak­ers to trans­fer an an­timi­cro­bial medicine’s in­tel­lec­tual-prop­erty ben­e­fits to an­other drug.

In ad­di­tion to pol­icy in­no­va­tions, more well-funded col­lab­o­ra­tions be­tween gov­ern­ments and pri­vate in­sti­tu­tions are needed. When pri­vate in­sti­tu­tions en­ter into such col­lab­o­ra­tive ef­forts, they must be pre­pared to work out­side of tra­di­tional bound­aries, ac­cept the chal­lenges as­so­ci­ated with com­plex pub­lic projects, and be will­ing to bring their skills, ideas, and ex­pe­ri­ence to the ta­ble.

In re­spond­ing to AMR, we can learn some valu­able lessons from other global pub­lic-health ef­forts. Malaria, which is caused by a par­a­site trans­mit­ted by more than 100 species of Anophe­les mos­quito, is a lead­ing cause of death in many parts of the world. But now that many gov­ern­ments and pri­vate in­sti­tu­tions have made fight­ing the dis­ease a high pri­or­ity, its death toll has been halved over the last 15 years.

Still, the par­a­site that causes malaria is devel­op­ing re­sis­tance to artemisinin, which forms the ba­sis for the most ef­fec­tive treat­ment: artemisinin-based com­bi­na­tion ther­a­pies. Artemisinin re­sis­tance first emerged in Cam­bo­dia just over a decade ago, and has since spread through Thai­land, Laos, Viet­nam, Myan­mar, and China.

It is now ap­proach­ing In­dia, and ex­perts are sure that it will even­tu­ally reach Africa. Ac­cord­ing to one re­cent study, if artemisinin re­sis­tance is al­lowed to spread, malaria will kill at least 116,000 more peo­ple ev­ery year.

Un­less new treat­ments be­come avail­able, the tremen­dous progress that the world has made against malaria will have been trag­i­cally short-lived. For­tu­nately, those en­gaged in the global re­sponse to malaria recog­nise that just as par­a­sites are adapt­ing, so must we. New ef­forts are un­der­way to iden­tify and min­i­mize the spread of re­sis­tant malaria, while si­mul­ta­ne­ously devel­op­ing new artemisinin-free treat­ments.

For ex­am­ple, the Re­gional Artemisinin-re­sis­tance Ini­tia­tive is work­ing to halt the spread of re­sis­tant malaria in the Mekong Delta re­gion, by mon­i­tor­ing and shar­ing dru­gre­sis­tance data and pro­mot­ing proper use of an­ti­malar­ial treat­ments. So far, the ini­tia­tive has se­cured €110 mil­lion through the Global Fund to Fight AIDS, Tu­ber­cu­lo­sis, and Malaria, which is fi­nanced pri­mar­ily by gov­ern­ments.

More­over, No­var­tis and the Medicines for Malaria Ven­ture (with sup­port from the Bill & Melinda Gates Foun­da­tion) are start­ing a new clin­i­cal trial next month to test KAF156, a mol­e­cule that could form the ba­sis of a new treat­ment against artemisinin-re­sis­tant malaria strains. – Project Syndicate

A file photo of an In­dian labour pulling his cart past by an ad­vert show­ing a health check-up, on World Health Day in Mum­bai, In­dia. Photo: EPA

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