WHO's Desperate Cries for Antimicrobial R&D

The recent World Health Organization (WHO) novel list on antimicrobial resistance and priority pathogens underlines the severity of the threat of antimicrobial resistance.Many will note that the pipeline is running dry for new antibiotic development despite growing resistance. The publishing of this list highlights three categories of resistance organisms, pointing to the three critical organisms; Acinetobacter baumannii, carbapenem-resistant, Pseudomonas aeruginosa, carbapenem-resistant, and Enterobacteriaceae, carbapenem-resistant, ESBL-producing.

Aside from making a clear catalogue of the 12 families of bacteria that pose the greatest threat to health, WHO’s news release regarding the list is a call to arms for pharmaceutical companies to strengthen research and development (R&D) efforts that would work towards a solution.

WHO’s Assistant Director-General for Health Systems and Innovation, Dr. Marie-Paule Kieny, stated in the press release that “if we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.”

Many have pointed to the need for incentivizing antibiotic research, development, and surveillance, as well as the need to help break the incentives for volume of drug use. Attempts to repair the broken market for antibiotic development may require a political economy approach that stems from a federal level. The most recent reports and studies from the Centers for Disease Control and Prevention (CDC) have estimated that in the United States alone, antibiotic resistance “adds $20 billion in excess direct health care costs, with additional costs to society for lost productivity as high as $35 billion a year.” This begs the question, is it time for the government to create more incentives for R&D and penalties for poor antimicrobial stewardship?

The lack of pharmaceutical response to this crisis has forced researchers to look outside the box for solutions. One such effort is the utilization of the microbiome, or the naturally-occurring germs within our bodies. The CDC is working to study the microbiome and the disruptive impact antibiotics have on it. Efforts drawing from the One Health Initiative have also pointed to this strategy as a means of addressing the growing antimicrobial resistance in both humans and animals. Since the MCR-1 gene was detected in an American woman last year, surveillance efforts have doubled and additional cases have been found; however, the energizing efforts quickly fizzled.

Studying the microbiome is one strategy for addressing the growth of antimicrobial resistance, but how many more reports on the cost (dollars as well as lives) and immediate threat of resistance will it take to get things done? WHO’s list is the most recent attempt in a long line of efforts to draw attention to this growing issue. While it’s not uncommon for public health crises to be relatively ignored by the general public, this is a crisis that has been growing for decades. Even Alexander Fleming warned of antibiotic resistance 70 years ago, just after he developed the life-saving penicillin. It seems that few worry about the lack of a generalized global surveillance or differences among US states in their reporting of resistant organisms and outbreaks. Perhaps we need more films to show the realities and stress the threat of antimicrobial resistance.

Overall, as the new WHO list highlights, we are in a dire situation and the stakes are high. Now is the time to invest in antimicrobial development, incentivize a decrease in antibiotic usage, and shift our focus to countries that may have lax microbial stewardship programs and are hubs for medical tourism. It will take a unified effort, but the time for action is slowly passing us by.