Sonita Chada-Grathwol Ph.D
Sr. Program Manager,
Antimicrobial Resistance (AMR), Novartis
Dr Dominic De Souza
Global Head, Anti-Infectives
Sustainability and AMR Program, Sandoz
COVID-19 has highlighted how vulnerable we still are to infectious diseases. Antimicrobial resistance, often dubbed the “silent pandemic”, threatens to undermine the efficacy of common antibiotics, the foundation of modern healthcare.
The history of medicine, says Dr Dominic De Souza, Global Head Anti-Infectives Sustainability and AMR Program at Sandoz, can be divided effectively into two stages: before and since antibiotics. Before the discovery of penicillin in 1928, even a minor infection could prove deadly.
De Souza says: “Penicillin, and antibiotics generally, transformed healthcare; think of tuberculosis, where the effective first-line treatment used to be a combination of fresh air and sunlight!
“Antibiotics today save and protect millions of lives: by treating infectious diseases and by enabling countless routine surgeries or treatments where you temporarily suppress the immune system, including chemotherapy.”
The weakest bear the brunt
AMR, which occurs when microorganisms evolve to resist antimicrobial medicines, represents a unique and growing threat to the sustainable use of antibiotics. A natural phenomenon, it has been progressively accelerated by antibiotic (mis)use over the decades.
The result, as called out by the 2016 UK O’Neill report, is that an estimated 700,000 people now die every year due to AMR.
What’s more, as Sonita Chada-Grathwol, Program Lead for the cross-divisional Novartis AMR Program, says: “Children, the elderly, women and the poorest of the poor bear the brunt.”
She adds: “According to leading NGO GARDP, 214,000 babies die every year from drug-resistant infections – that’s nearly a third of the total annual death toll. Of five million-plus annual under-five deaths, they estimate that three million are due to infectious diseases such as pneumonia and sepsis, with up to 40% now resistant to standard treatments.”
While AMR is more common in developing nations, drug-resistant bacteria can infect anyone, anywhere. As COVID-19 has shown, treatment-resistant pathogens can spread rapidly and uncontrollably worldwide.
We have to get away from the simplistic belief that R&D will produce a ‘silver bullet’ to magically end AMR, because every new drug will in time also be subject to resistance.
A balanced global approach
De Souza warns that AMR cannot be simply eliminated, but he is hopeful that its impact can be minimised by a “truly holistic approach” – if we act now.
“We have to get away from the simplistic belief that R&D will produce a ‘silver bullet’ to magically end AMR, because every new drug will in time also be subject to resistance.
“We need to focus equally on all four pillars of the AMR response strategy – as well as innovation, that means responsible manufacturing, responsible use and appropriate access.”
Responsible manufacturing means minimising antibiotic residues in all production-related waste streams, proper use of resources, optimal hygiene and safe waste disposal throughout the value chain.
De Souza notes that Sandoz, a leading global supplier of generic antibiotics and the only remaining company with a vertically integrated antibiotics supply chain based in Europe, is now celebrating 75 years of penicillin production at Kundl in Austria. Indeed, it is investing more than EUR 150 million into its Kundl-based production network.
Responsible use means appropriate education to prevent overuse, underuse or misuse of existing antibiotics. Diagnostics and surveillance also help to radically improve point-of-care decisions. It means working with partners to drive stewardship, both on internally-led programs such as Novartis Healthy Family and on external programs, for instance with the Commonwealth Pharmacists Association (CPA) and the Ecumenical Pharmaceutical Network (EPN).
Appropriate access is about getting the right drug to the right patient at the right time. This means both preventing millions of avoidable deaths due to lack of antibiotics and preventing the spread of AMR due to lack of appropriate treatments.
Healthcare is not a cost
Chada-Grathwol believes that lasting success will need a wide-ranging public-private collaboration effort. The global initiative to develop a COVID-19 vaccine in record time shows how success might look, while the patchy progress towards equitable global distribution shows what could go wrong.
She concludes: “We need to change the political discourse so that spending to ensure global public health is seen as an investment, not a cost. Think of this as a ‘Manhattan Project’ for the public good.”