The Role of Vaccines in the Fight Against Antibiotic Resistance

Following the recent United Nations (UN) General Assembly meeting to discuss the growing global threat of antimicrobial resistance (AMR), health experts are highlighting the role vaccines can play in preventing dangerous infections.

Signaling new levels of urgency in the fight against drug-resistant pathogens, at the September meeting, UN General Assembly members signed a declaration for worldwide cooperation in tackling superbugs, the first of its kind. It acknowledges that overconsumption of antibiotic drugs—30% of which are taken by humans and 70% of which are administered to livestock and other animals raised for global food production—is driving the development of new drug resistance in pathogenic bacteria. According to a study by the Center for Disease Dynamics, Economics and Policy, the total global antibiotic consumption in humans rose by more than 30% from 2000 to 2010. The Centers for Disease Control and Prevention says that 23,000 deaths a year in the United States are caused by antibiotic-resistant infections and these infections cause another 25,000 deaths each year in Europe.

A new commentary by chairman of Public Health England and head of the Centre on Global Health Security at Chatham House, David Heymann, MD, and research assistant Abbas Omaar, MSc, makes the case for the development of new vaccines to prevent superbug infections and reduce antibiotic use. “Vaccine development is an often underrated part of addressing AMR,” write the study authors. “Among the proposed solutions for tackling AMR, vaccines are a major tool that eliminates the need for antimicrobials, and therefore, the need for other interventions related to conserving the utility of such drugs. While it is unrealistic to expect that it would be possible, or even cost-effective, to develop vaccines for every infectious disease, the potential of vaccines to address AMR can be exploited much further, to reduce the consumption of antimicrobials.”

Vaccines have been responsible for preventing diseases since the the development of the first smallpox disease in the late 18th century. Since then, scientists have developed vaccines for dozens of bacterial and viral diseases, creating vast leaps in public health and preventing countless pathogenic outbreaks. Today, there are vaccines designed to combat bacterial infections such as tuberculosis, typhoid, anthrax, pneumococcal diseases, and more, but the development of new bacterial vaccinations along with new antibiotic drugs has stalled.

According to the Pew Trusts, we haven’t seen new classes of antibiotics since 1984 due to scientific barriers pertaining to drug discovery, regulatory challenges, and diminishing returns on investment that have been heightened by antibiotic-resistant bacteria. Recently, researchers discovered a new antibiotic called Teixobactin isolated from microbes in soil. Though it could be several years before this new discovery is available in a prescription medication, it may promise a few decades of effective treatment before bacteria can develop resistance to it. Still, that the lull in antibiotic development has occurred at the same time as vaccine development leaves few novel weapons against ever-adapting superbugs.

“Part of the reason for this may be the view that new vaccines are technically difficult to develop, and are an extremely expensive and time-consuming investment. This is true, but the development of new drugs is similarly based on high financial bets and long routes to market with no guarantee that they will achieve regulatory approval,” say authors Dr. Heymann and Omaar, noting that vaccines for bacterial infections such as pneumonia (Streptococcus pneumoniae), meningitis (Neisseria meningitides), and Haemophilus influenzae type b have been released in recent decades.

According to the World Health Organization, the pneumococcal conjugate vaccine has prevented 1.6 million deaths, putting it on the agency’s list of essential medications, yet the benefits of developing new vaccines are too often outweighed by the costs, write the authors. “Years of research to develop vaccines for HIV and malaria have resulted in little hope that they will become a reality soon, which may have weakened the case for prioritizing other vaccines in the fight against AMR.”

Although the development of new antibiotics will remain crucial to public health, there is every reason to believe that with new treatments bacteria will continue to develop new resistance abilities. However, vaccinations can offer not only infection prevention but a way to sidestep the problem of superbugs altogether. The authors write, “More efforts should be dedicated to a cost-benefit analysis of vaccines for AMR control and their relative value compared with investments in stewardship of antimicrobials and better pipelines of new antibiotics. This may strengthen understanding of the unique and dynamic role that conferring immunity to disease can play in tackling AMR.”