What are antimicrobial drugs

Drug resistance: "No time to wait"

May 27, 2019 - They are not even trying to downplay the problem: The Interagency Coordination Group on Antimicrobial Resistance (IACG) finds clear language in its new report: Resistance to antimicrobial drugs such as antibiotics is a global crisis - a whole century of medical progress is in danger.

There is no need to translate this sentence: "No Time to Wait" - this is how the IACG report is headed. Unless urgent action is taken, resistance to antimicrobial drugs - such as antibiotics against bacteria or, for example, agents against viruses and fungi - will have devastating effects on human and animal health within a generation. That is the central message of the IACG - a coordination body in which the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE) work together. Because the drivers for antimicrobial resistance are diverse (see graphic) - to solve the problem, concerted action is required. And a global answer.

These figures show that antimicrobial resistance will not just be a problem tomorrow:

  • According to the report, around 700,000 people around the world are already dying from the consequences of an infection against which available drugs are no longer effective - that's roughly half a year in Munich.
  • Of these, 230,000 deaths can be traced back to multi-resistant tuberculosis germs. If they had all lived in Freiburg, the city would no longer be inhabited.
  • By 2050, instead of the 700,000 deaths, it could be ten million per year, assuming a worst-case scenario.
  • According to the IACG report, without sustained efforts, antimicrobial resistance could be responsible for 2.4 million deaths in high-income countries (such as Germany) between 2015 and 2050.

However, these figures, some of which have been circulating in public reporting since 2014, are not entirely undisputed. According to Spiegel Online, the underlying core data “on how common and how deadly resistant germs are is doubtful”. The fact is, however, that the consequences of drug resistance are a global challenge that goes far beyond health concerns.

The World Bank estimates that up to 24 million people may be driven into extreme poverty by the consequences of the resistance problem by 2030; the economic consequences of a global resistance crisis could be comparable to the shock waves of the economic crisis of 2008/2009.

Antimicrobial resistance: when bacteria, viruses and the like fight for bare survival

Drug resistance is when drugs no longer work against the pathogens for which they were designed. Because the iron law of nature also applies to bacteria, viruses and fungi: it is about bare survival. The development of resistance - as a result of mutations - is therefore a completely natural process: the bacterium or virus that best adapts to the external framework and to a "threat" prevails in evolution. The result: important drugs threaten to become ineffective. For example antibiotics (see Pharma Facts): Pneumonia, urinary tract infections or sexually transmitted diseases then become untreatable, routine operations riskier.

The IACG calls for a holistic, cross-sectoral “one health” approach, because after all - in order to get the problem under control - many levers have to be turned. She recommends the countries

  • put their national action plans high on the political agenda and fund them accordingly;
  • to strengthen regulatory and control systems and to support education programs for the prudent use of antimicrobials in humans, in animal husbandry and in plant health;
  • invest in research and development of new technologies;
  • urgently to phase out the use of antimicrobial drugs that are particularly important for humans in agriculture.

The authors of the IACG report call for greater investment in new drugs, vaccines and diagnostics in order to have a larger arsenal of therapeutic options against drug resistance. These could quickly pay off financially: The World Bank estimates the costs of the consequences of drug resistance at nine billion US dollars per year. For high- and middle-income countries, investments of as little as two US dollars per person could be enough to contain the problem.

For many countries with lower incomes, however, larger but still “relatively modest” investments would be necessary according to the IACG. There is not much time left, according to the experts: "If investments and measures are delayed, the world will have to spend a lot more in the future to get the catastrophic consequences of drug resistance under control."