Thread by @bopinion

We’re already fighting the next global health emergency: Growing antimicrobial resistance (AMR).

Common ailments such as UTIs and sepsis are increasingly able to tough out the drugs developed against them. Some develop into superbugs that defy treatment trib.al/Z4TUOmz

Antimicrobials is the catch-all term for the many antibiotics, antivirals, antifungals and other drugs that prevent infections in:

🙆🏽Humans
🦓Animals
🌱Plants
trib.al/Z4TUOmz

Pathogens naturally develop resistance to antimicrobials as they evolve, but thanks to an overuse of antibiotics and other conditions, the speed of such resistance has become a major global health issue trib.al/Z4TUOmz

It’s hard to overstate the urgency of the challenge:

Covid-19 has resulted in some 5.6 million deaths, but previous estimates have said AMR will claim 10 million lives annually by 2050 — and that figure already looks low trib.al/Z4TUOmz

Drug-resistant infections are already killing more people globally than malaria and HIV combined.

In the U.S. alone, there are some 2.8 million antibiotic-resistant infections annually and over 35,000 people die as a result trib.al/Z4TUOmz

Global estimates of the burden of antimicrobial resistance confirm the worst fears:

In 2019, nearly 1.3 million deaths were directly attributed to infections that were drug-resistant and more than 4.9 million deaths were related to drug resistance trib.al/Z4TUOmz

Nearly 79% of the deaths were attributed to three syndromes:

⚕️Lower respiratory and thorax infections
⚕️Bloodstream infections
⚕️Intra-abdominal infections
trib.al/Z4TUOmz

Better education, sanitation, surveillance and diagnostics are all urgent — and our experience with Covid should help us.

If fewer people get infections in the first place, fewer antibiotics are needed and there’s a lower prospect for drug-resistance trib.al/Z4TUOmz

New drugs also need to be part of the solution.

While there are science challenges here, warped incentives when it comes to developing commercializing new drugs explain why there have been no truly new antibiotics in the past 30 years trib.al/Z4TUOmz

Drugs are commercially successful if pharma companies can make enough money on them to recoup their development.

The cost of developing an antibiotic is an estimated $1.5 billion, while average revenue is estimated at around $46 million a year trib.al/Z4TUOmz

An ironic twist is that doctors are discouraged from prescribing new antibiotics unless absolutely necessary.

This drives down sales and discourages investment. The price of new antibiotics also looks uncompetitive when compared to existing generics trib.al/Z4TUOmz

Of 15 new FDA-approved antibiotics in the past decade to 2020, 5 were shelved.

18 were approved and launched in the G7 and other European countries in that time, but the majority were accessible in only three nations — Britain, the U.S. and Sweden trib.al/Z4TUOmz

The challenge is ensuring access to medicines without encouraging overprescription.

A number of countries are trying to address the issue. In the U.K., a pilot program uses a Netflix model, paying for antimicrobials via a subscription trib.al/Z4TUOmz

There may be glimmers of hope on the scientific front.

Earlier this week, a group of Australian scientists said they found a way to defeat superbugs using treatments combining nanoparticles (ultrafine particles) with antibiotics trib.al/Z4TUOmz

The pandemic has taught us about the high cost of delayed action to global health crises — and the enormous gains to be made when scientific innovation is incentivized.

Our next test is to see whether we can remember those lessons trib.al/Z4TUOmz