Last year, both the European Centre for Disease Control and Prevention (ECDC) and the British government warned about the dangers of antibiotic-resistant bacteria. This week, the World Health Organization (WHO) became the latest institution to join in this increasingly ominous chorus with the release of a list of antibiotic-resistant priority pathogens – the first in the organization's 69-year history.
Marie-Paule Kieny, WHO's assistant director-general for health systems and innovation, told reporters at a press conference that the list, which catalogs the 12 families of bacteria posing the greatest threat to human health, "is not meant to scare people about new superbugs, but to signal to researchers and pharmaceutical companies what their priorities should be."
Given that a superbug – immune to all 26 antibiotics available in the US – has already claimed a life, a wait-and-see attitude looks no longer adequate, given that it takes anywhere from between 10 and 15 years to develop a treatment. And the longer governments drag their feet, the costlier the potential repercussions. According to the Review on Antimicrobial Resistance that was commissioned by the British government, if left untreated, superbugs could inflict the global economy with a US$100 trillion deficit alongside a death toll of up to 10 million a year by 2050.
"Antibiotic resistance is growing, and we are fast running out of treatment options," said Kieny. "If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time."
The list, which was compiled by researchers at the University of Tübingen in Germany, shares similarities with a document published by the CDC back in 2013, which zeroed in on 18 antibiotic-resistant threats. Many of the bacteria that were highlighted then, including the three it deemed critical – Acinetobacter, Pseudomonas and various strains of Enterobacteriaceae – appear on the WHO list. Where the lists differ is that the WHO has chosen to focus exclusively on bacteria that can cause fatal infections.
The WHO list is divided into three categories – critical, high and medium – which are based on the bacteria's resistance to treatment, how commonplace they are, whether they can still be treated, and the toll they exact on the healthcare system.
While the presence of these pathogens might vary from country to country, air travel has made it easier for them to cross national borders and wreak havoc worldwide. Given this state of affairs, according to Hermann Gröhe, federal minister of health in Germany, it is time for governments to work together to put in place policies that spur the development of new antibiotics.
One of the problems contributing to the current dearth of solutions, as Kieny pointed out during the press conference, is the fact that developing antibiotics is not a lucrative venture for pharmaceutical companies since they are meant to be taken only for a short period of time, unlike drugs for chronic diseases. An idea being floated to address this is to change the way companies are compensated by awarding them a cash prize or paying them an upfront fee for each new antibiotic that is developed so that profits are not dependent on product sales.
On another note, boosting R&D in this sector is just one part of the solution. Stopping the superbug onslaught also requires better efforts at communicating the role and use of antibiotics. According to the WHO, there is a lot of misunderstanding about what antibiotic resistance actually is and what can be done to prevent it, which in turn exacerbates the problem. In a previous WHO survey conducted among 10,000 people across 12 countries, including China, India and Russia, 64 percent of respondents believed antibiotics could be used to treat colds and flu (they can't – antibiotics have no impact on viruses); 32 percent believed they should stop taking antibiotics when they feel better, rather than completing the prescribed course of treatment; and 76 percent said that antibiotic resistance is what happens when the body becomes resistant to antibiotics.
A US poll conducted among more than 2,000 adults earlier this month by HealthDay/Harris Poll revealed that not only do many Americans share similar misconceptions, 69 percent of those surveyed admitted they know little to nothing about the problem.
Clearly, there is a need to improve understanding about this subject otherwise the problem will continue to persist even if new antibiotics are developed in future.
WHO's list of priority pathogens
Priority 1: Critical
Not only are these gram-negative bacteria resistant to multiple antibiotics, including last-resort carbapenems, they also have the ability to develop new methods of drug resistance and pass this information along to other bacteria. Elderly patients as well as those with compromised immune systems are particularly vulnerable, making these pathogens a deadly threat in hospitals and nursing homes, where they can colonize devices such as ventilators and blood catheters.
Priority 2: High
These bacteria can cause infections that are hard to treat but they are not as deadly as the first group of pathogens - yet.
Priority 3: Medium
While these pathogens are immune to certain antibiotics, they can still be treated. However doctors caution that these strains could evolve into those that are drug-resistant.