November 18, 2024
World AMR Awareness Week – 2024
To commemorate World AMR Awareness Week (WAAW), we have brought together One Health Trust research, podcasts, events, and more that cover the growing threat of antimicrobial resistance (AMR) and delve into the complexities of this global phenomenon.
Articles
Learn about some of the research we have contributed to since last year’s World AMR Awareness Week. Our work covers diverse dimensions of AMR, including surveillance, social and economic disparities, control strategies, public policy, collaborative and intersectoral approaches, and more.
November 2024
Routine immunization against Streptococcus pneumoniae and Haemophilus influenzae type B can greatly reduce antibiotic consumption.
Childhood vaccinations against Streptococcus pneumoniae and Haemophilus influenzae type B (Hib) can significantly reduce antibiotic use, thereby mitigating the risk of antimicrobial resistance (AMR). One Health Trust researchers used IndiaSim, a dynamic microsimulation model, to analyze the impact of these vaccines on antibiotic consumption in India from their inclusion in the national immunization program from 2004 through 2016. Pneumococcal and Hib vaccination with coverage similar to the DPT3 vaccine could decrease antibiotic use by 61.4 percent. Increased vaccination coverage since 2004 has likely reduced antibiotic demand by up to 93.4 percent among the poorest quintile of the country. Further enhancing vaccination rates may diminish health inequities and reduce outbreak-related antibiotic use. [Lancet Regional Health – Southeast Asia]
October 2024
New WHO guidance to mitigate gender disparities in the prevention and treatment of drug-resistant infections
Women and girls are at a greater risk of complications from drug-resistant infections due to gender-related barriers to healthcare and exposure to drug-resistant pathogens, including through unpaid labor. Women are also 27 percent more likely than men to receive antibiotics in their lifetime. The World Health Organization’s new guidance to address gender disparities in the prevention, diagnosis, and treatment of antimicrobial-resistant infections outlines 20 recommendations for United Nations Member States that aim to promote equitable antibiotic access and mitigate gender-specific vulnerabilities linked to AMR. [WHO]
Immunization in AMR mitigation strategies in South Africa
The Global Antibiotic Resistance Partnership (GARP) members in South Africa summarized barriers, facilitators, and solutions to the integration of vaccination as a critical prevention strategy for AMR. Despite their value, vaccines are underutilized in the context of AMR mitigation. Similarly, AMR is not included as a metric for vaccine value assessments. Recommendations included conducting awareness campaigns adapted to varying health literacy levels, leveraging the pharmacy workforce to promote immunization and antibiotic stewardship, and integrating AMR and vaccine research. [South African Medical Journal]
Global amoxicillin shortages indicate a huge access gap.
Global disparities in antibiotic access are exemplified by long-lasting shortages of amoxicillin, a first-line WHO Access antibiotic recommended for treatment of 10 out of 12 of the most common primary care infections in adults and children. The low cost of amoxicillin leads to slim profit margins along the supply chain, disincentivizing all actors – from manufacturers to prescribing physicians – to prefer the higher-priced Watch antibiotics. While solving the access gap is complex, public investment in the supply chain is already underway in the European Union, with plans to expand to other regions. Universal Health Coverage plans should incorporate access to antibiotics and prioritize strengthening regional manufacturing capacity to achieve equitable, universal access to these essential medicines. [CMI Communications]
September 2024
Launch of WHO’s first guidance on managing antibiotic pollution from manufacturing
The World Health Organization released its first-ever guidance on managing antibiotic pollution from manufacturing. Reducing pollution from pharmaceutical waste is important in tackling antimicrobial resistance (AMR). With contributions from global experts, the guidance aims to help regulators, manufacturers, and consumers take action. It promotes progressive implementation and stepwise improvement, recognizing the need to protect and strengthen the global supply of antibiotics and to ensure appropriate, affordable, and equitable access to quality-assured medicines. [World Health Organization]
August 2024
Universal rotavirus vaccination is crucial for improving child health outcomes in India.
India’s rotavirus vaccination program was initiated in 2016. OHT researchers utilized a dynamic agent-based model calibrated with national-level data to assess the program’s impact on disease burden and antibiotic misuse among children under five. Despite widely heterogeneous subnational vaccination coverage, estimates suggest that the program led to a reduction in 33.7 percent of cases, 38.3 percent of deaths, and 21.8 percent of antibiotic misuse attributed to rotavirus infections. Furthermore, increasing vaccination coverage to 68 percent could decrease rotaviral prevalence among children to less than 1 case per 100,000, significantly reducing inappropriate antibiotic use. [Vaccine]
Proposed study protocol to explore the social dimensions of AMR
OHT researchers co-authored a study protocol, the Power Relations in Optimisation of Therapies and Equity in Access to Antibiotics (PROTEA) study, which will explore the intersection of power dynamics resulting from social constructs (such as race, gender, and class) with infection prevention and control (IPC) and antimicrobial resistance (AMR) in India and South Africa. These results will be used to optimize healthcare practices related to IPC and AMR and expand equitable access to antibiotics and IPC practices. [Wellcome Open Research]
July 2024
The potential of vaccines for food-producing animals in low- and middle-income countries
Vaccinating food-producing animals in low- and middle-income countries is critical to prevent the spread of zoonotic diseases and antimicrobial resistance, fight poverty, and promote food security. Animal vaccines can maximize economic gains among farmers, reduce spillover risk, lower greenhouse gas emissions, and minimize antibiotic use and resistance in food-producing animals. Funding for animal vaccine research and development is urgently needed to transform their potential to mitigate the health, economic, and environmental risks of zoonotic diseases. [Science]
June 2024
Drug-resistant infections disproportionately affect women.
Women, particularly those residing in low-resource settings, may have a greater risk of contracting drug-resistant infections than men. Inadequate access to clean water contributes to women’s increased risk of drug-resistant urinary tract infections due in part to their menstrual hygiene needs. In some regions, women’s household responsibilities include fetching water and preparing food, which increases their exposure to resistant food- and water-borne pathogens. The review also found that more than 70 percent of national action plans against antimicrobial resistance (AMR) do not recognize gender inequalities, suggesting a critical data and policy gap in the global fight against AMR. [WHO]
Barriers and pathways for environmental surveillance of antibiotic resistance
What are some of the infrastructural, institutional, and sociocultural barriers to implementing environmental surveillance of antibiotic resistance in low- and middle-income countries? In an exploratory qualitative interview study, key informants reported various pathways to mitigate these barriers, some of which raised concerns about research and knowledge gaps due to the perceived inevitability of conflict, disagreement, or unavailability of resources in certain countries or regions. International agencies and the research community are equally important in helping to mitigate some of the barriers to actionable surveillance in lower-resource settings. [Global Health Action]
May 2024
The Lancet Series on Antimicrobial Resistance
The 2024 The Lancet Series on Antimicrobial Resistance, written by experts brought together by OHT, shows how better access to clean water, sanitation, infection control, and vaccination could prevent 750,000 deaths per year linked to drug-resistant pathogens in low- and middle-income countries. AMR kills more people than HIV, malaria, and tuberculosis combined, with LMICs most affected. The four–paper series advocates for a multifaceted approach to tackle the growing global health problem, prioritizing infection prevention, ensuring access to effective antibiotics, and investing in innovation. The authors propose global targets, titled “10-20-30 by 2030”, with the goals of a 10 percent reduction in deaths from AMR relative to 2019, a 20 percent reduction in inappropriate human antibiotic use, and a 30 percent reduction in inappropriate animal antibiotic use. [The Lancet]
April 2024
Vaccine value profile for Klebsiella pneumoniae in pregnant women
Globally, a maternal K. pneumoniae vaccine with 70 percent efficacy could avert almost 400,000 neonatal sepsis cases and 80,000 neonatal deaths annually. These were the findings from a study outlining the Vaccine Value Profile (VVP) for a maternal vaccine against Klebsiella pneumoniae – the second leading pathogen in deaths attributable to antimicrobial resistance (AMR) in 2019. The effects of a licensed vaccine on healthcare costs, productivity, and economic growth are largely unknown and represent an important research gap. [Vaccine]
A multifaceted approach to global health
There is a need for a multifaceted approach to global health issues, including antimicrobial resistance (AMR). To reduce the number of lives lost to AMR infections each year, stakeholders must prioritize 1) ensuring equal access to antibiotics; 2) changing the narrative about AMR; 3) investing in better tools (new vaccines, drugs, and diagnostics); and 4) setting global targets and measuring progress. [Med]
March 2024
Adapting antibiotic stewardship in low- and middle-income countries
A lack of access to novel antibiotics, gaps in bacterial resistance surveillance and antibiotic use data, and insufficient resources to implement antimicrobial stewardship – usually designed according to the availability of resources in high-income countries – limit the ability of LMICs to mount effective measures to prevent and reduce the burden of antibiotic resistance. Experts call for a new model for antibiotic availability and use in LMICs. First, evidence-based guidance should direct clinical decision-making regarding antibiotic use, particularly in the context of severe bacterial infections, with an emphasis on accessing Reserve antibiotics and novel antibiotic combinations. The implementation of such a model will require adaptation to local contexts, such as national political will, governance, and resources. Interdisciplinary advisory and implementation teams should be organized at the national level to ensure stewardship is informed by local perspectives and investment. [The Lancet Infectious Diseases]
February 2024
Inequities in global priorities and agendas threaten AMR mitigation.
The global fight against antimicrobial resistance (AMR) must prioritize equity in global agendas. Global funding today focuses on research and development of new therapeutics for hard-to-treat infections, a priority for high-income countries with well-established health infrastructure. In the Global South, research consistently shows that mitigation efforts that reduce infections (vaccines and improved water, sanitation, and infection prevention control) have the highest impact on AMR reduction. An Independent Panel on AMR must be created urgently to bring visibility to the evidence on AMR. At the same time, there is a need for the inclusion of and commitment from leaders from the Global South to ensure the sustainability of the interventions. [The Lancet Global Health]
January 2024
Mapping global hotspots of resistance in food animals
China, India, Brazil, Chile, central Asia, and southeastern Africa are antimicrobial resistance (AMR) hotspots in food animals. Tetracycline had the highest average resistance prevalence in Escherichia coli (59 percent) and non-typhoidal Salmonella species (54 percent) among food animals in low- and middle-income countries. Projections revealed that tetracycline and ampicillin could exceed critical levels in Africa and South America, while ampicillin and sulfonamides could pose the greatest risk in Asia. Action at the policy level should be taken to reduce antimicrobial consumption, particularly of the seven medically important antimicrobials highlighted in this study. Further AMR interventions and surveillance measures must be implemented to realize the third Global High-Level Ministerial Conference on AMR’s global target of reducing antimicrobials used in agrifood systems by 30-50 percent by 2030. [Nature Communications]
Predictive maps reveal hotspots for AMR in food-producing animals within European countries.
Prevalence estimates of antimicrobial resistance (AMR) from 31 European countries were used to derive predictive geospatial models for Escherichia coli, nontyphoidal Salmonella, and Campylobacter spp. in food-producing animals across Europe. The proportion of antimicrobials with over 50 percent resistance (P50s) was lower for Salmonella than for E. coli and Campylobacter, possibly due to the European Union’s previous efforts to lower the prevalence of Salmonella. In 9 out of 31 countries, more than half of cattle, pigs, and poultry are estimated to be raised in areas predicted to be AMR hotspots by the model. [Emerging Infectious Diseases]
December 2023
Contextualizing the fight to control the spread of antimicrobial resistance in India
Challenges related to the control of AMR in India are partly caused by the overuse of broad-spectrum antibiotics. Despite government initiatives like antimicrobial stewardship programs and regulations, issues persist, especially in rural areas with low resources. Additionally, while regulatory efforts are increasing, quality concerns in drug manufacturing persist. However, despite these challenges, experts are optimistic that increased awareness, local engagement, and lessons from COVID-19 will drive collective efforts to combat AMR. In this context, community awareness initiatives are growing, offering hope for change. [Nature]
November 2023
Accelerating progress on AMR
Ahead of the 2024 United Nations General Assembly (UNGA) High-level Meeting on AMR, OHT’s president, Dr. Ramanan Laxminarayan, emphasized the need to prioritize the growing AMR problem in low- and middle-income countries. He stated, “This is the second time that AMR has been featured at a high-level UN meeting. The first one, in 2016, highlighted the importance of the problem, which is associated with nearly five million deaths each year worldwide. Although there has been some progress in the past eight years, such as the development of national action plans by many countries, the pace of change has been slow.” [Nature Communications]
Assessing taxation strategies on antibiotics for veterinary use
How does taxation of veterinary antibiotics compare to bans in reducing AMR? Three taxation strategies were assessed under a baseline rate of a 50 percent price increase after 3,000 days when the prevalence of resistance reaches equilibrium: 1) taxation applied across all antibiotics, or flat tax (FT); 2) taxation to antibiotic classes with the highest, medium, and lowest levels of resistance, or single taxation (ST); and 3) a differential taxation scheme, in which taxation is scaled every three years according to the prevalence of resistance among the taxed antibiotic class (DT). While bans on antibiotics with high and medium resistance performed best on the metrics assessed in the study, the performance across all three taxation schemes matched that of the bans at a 60 percent taxation rate. The DT and FT strategies generated the largest median revenues, US$1.3 billion and US$1.29 billion, respectively. In addition to generating yearly revenue, veterinary antibiotic taxation offers more flexibility than bans through tradable permit schemes and caps on taxation rates. [One Health]
Combating drug resistance in the WHO South-East Asia Region
Although all South-East Asia Region Member States, with support from the WHO, have developed and endorsed national action plans (NAPs) on AMR, progress has been fragmented and complicated by a lack of technical capacity, limited resources, and the COVID-19 pandemic. Available data from the region show persistent levels of bloodstream infections due to resistant Escherichia coli and Staphylococcus aureus between 2017 and 2020 and an increasing level of hospital-associated bloodstream infections. Prioritization of One Health-centered policies will help countries address AMR from a holistic standpoint and accelerate the implementation of their NAPs against AMR. [The Lancet Regional Health – Southeast Asia]
One World, One Health – Podcasts on AMR
Listen to our podcasts with host Maggie Fox as she discusses the many facets and effects of AMR with experts, activists, and those who live with the devastating repercussions of this global crisis.
When Superbugs Get Personal – From Professional Preoccupation to a Family’s Nightmare
Dr. Nour Shamas shares a personal story – how her mother contracted a drug-resistant urinary tract infection and the ensuing antibiotic access challenges.
“My life is never going to be normal again.” – The toll of antibiotic resistance
Rosie Bartel describes her unending fight with an AMR infection and what she is doing to stop it from happening to others.
A Life Cut Short When Antibiotics Stopped Working
Diane Shader Smith tells us about her daughter, who died due to a drug-resistant infection and the importance of her story.
Can Vaccines Help Slow the Spread of Superbugs?
OHT’s Dr. Erta Kalanxhi talks about how vaccines can prevent the rise of drug-resistant bacteria and viruses.
A Prize for Superbug Solutions
Professor Marc Mendelson of the University of Cape Town, South Africa tells us how the 2024 Trinity Challenge will support researchers’ ideas to fight AMR in innovative ways.
The Smallest Victims of Drug Resistance
Dr. Mike Sharland of St. George’s University of London discusses neonatal sepsis and the need for better antibiotics for vulnerable babies.
When Good Bacteria are Killed, C. Difficile Strikes
Christian Lillis of the Peggy Lillis Foundation tells us about C. diff infections, and Peggy Lillis, his mother, who succumbed to this dangerous disease.
A Problem of Access and Excess – Antibiotic Resistance
Dr. Otto Cars of ReAct outlines the history of the fight against antibiotic resistance and what he hopes its future might be.
The Stubborn Germs That are Getting the Upper Hand
Dr. Iruka Okeke of the University of Ibadan, Nigeria, discusses how drug-resistant infections can happen to anyone and how we need to do more to keep track of them.
Targeting Drug Resistance – Achievable Goals to Keep Antibiotics Working
Dr. Aislinn Cook of the Centre for Neonatal and Paediatric Infection at St. George’s University of London tells us about some concrete ways the world can work together to control the spread of drug-resistant germs.
What if Drug-Resistant Infections Never Happened in the First Place?
Dr. Joseph Lewnard of the One Health Trust and the University of California, Berkeley, tells us the main ways to prevent antibiotic-resistant infections from happening in the first place.
Wanted: A New Approach to Funding Treatments for Drug-Defying Germs
Dr. Ursula Theuretzbacher of the Center for Anti-Infective Agents talks about new approaches that may work to bring badly needed new antibiotics to the world.
Innovation to Save Antibiotics – Prize-Winning Diagnostics for UTIs
Jasmin Major of Challenge Works discusses the importance of diagnostic innovation in the fight to control AMR.
It has been a busy year – OHT Events on AMR
Learn about some of the events the One Health Trust has hosted and co-hosted over the last year to stimulate conversations, bring awareness, and catalyze action to tackle AMR.
On March 5, 2024, in Washington, D.C., the One Health Trust, in partnership with the Infectious Diseases Society of America, the Sepsis Alliance, the AMR Action Fund, and the Cystic Fibrosis Foundation, held a nonpartisan, in-person policy briefing on tackling antimicrobial resistance (AMR). The event featured important talks on advances that have been made in addressing drug resistance and its remaining and increasing burden.
Workshop on AMR, gender inequity, caste, and climate change – Bangalore, India 2024
On March 18 and 19, 2024, the One Health Trust hosted a workshop funded by the World Health Organization and the British Academy in Bangalore, India. The workshop highlighted the urgent need to address antimicrobial resistance (AMR) in an intersectional way. The workshop participants provided diverse perspectives on and potential solutions to control the spread of these difficult-to-treat infections. The experts showed the need for work across disciplines and sectors to solve major health problems. Among recommendations made, participants discussed to need to ensure women are included in clinical trials, establish inclusive prescribing guidelines for new antibiotic treatments, improve access to drinking water and menstruation products, and promote education to reduce stigma around gynecological issues and sexually transmitted diseases.
The Launch of The Lancet Series on Antimicrobial Resistance: Sustainable Access to Effective Antibiotics was hosted on the sidelines of the World Health Assembly in Geneva, Switzerland, on May 28, 2024, at the Jardin de Penthes. The event, organized by the One Health Trust, was co-hosted by IFPMA, the Global AMR R&D Hub, ICARS, IDSA, Africa CDC, AMR Action Fund, and FIND. The event was also supported by the United States Centers for Disease Control and Prevention. The launch amplified the policy recommendations from the Series, which aimed to inform the 2024 United Nations political declaration on AMR.
Ensuring Sustainable Access to Antibiotics: From UNGA to Impact – New York, USA 2024
After more than a year of planning, the One Health Trust team was thrilled to co-host an event that kicked off a week of discussions on global AMR control before the second UNGA High-level Meeting on AMR on September 22, 2024, in New York City. The One Health Trust, alongside partners in the fight against AMR – Africa CDC, AMR Action Fund, U.S. CDC, ICARS, IFPMA, Global AMR R&D Hub, IDSA, FIND, and Bill & Melinda Gates Foundation – convened experts, policymakers, government, and civil society organizations at the Harvard Club in an evening full of discussions of the journey so far and the challenges and commitments that lie ahead.
Visualizing AMR
Take a look at the infographics we have published over the last year, summarizing and highlighting important findings and messaging related to AMR.
Preventing Infections From Happening in the First Place
Targets for Global Action to Address AMR
The Need for Sustainable Access to Effective Antibiotics
Antibiotic-resistant infections kill 5 people every 2 minutes
Who is Affected by Antimicrobial Resistance?
Three Ways Kids Can Help Slow the Spread of AMR
Image designed by Samantha Serrano
