AMR & Infectious Diseases
“The lastest research estimates that almost 40 million lives are at risk over the next 25 years if we fail to
James Anderson, AMR Industry Alliance Page 04
“To reduce the burden of AMR and its risks, environmental interventions must be at the core of the solutions.”
Sheila Aggarwal-Khan, United Nations Environment Programme (UNEP) Page 10
The 'Zero Malaria Experience': how modern science can end one of the world’s oldest diseases.
(Read more on page 14)
Photo credit: Malaria No More UK
How generative AI is transforming antibiotic discovery
Scientists are employing the latest advances in artificial intelligence — along with innovative funding approaches — to accelerate the pace of antibiotic discovery.
In drug discovery, AI is becoming a pioneering force for good. For example, Phare Bio, a social venture founded in 2020, uses generative AI to develop novel antibiotics in partnership with Jim Collins’ lab at MIT.
Generative AI is rapidly accelerating antibiotic discovery
“Antibiotics are the backbone of modern medicine, but escalating antimicrobial resistance threatens these critical tools unless novel antibiotics are rapidly discovered and brought to market,” says Dr Akhila Kosaraju, Phare Bio CEO.
“By using generative AI to design antibiotics against pathogens on the World Health Organization’s high-priority list, we’re bringing unprecedented speed and novelty to antibiotic discovery and rebuilding the global pipeline.”
Many pharma companies use predictive AI to streamline drug discovery. This allows them to quickly screen across millions of existing compounds to identify those with properties of interest. Generative AI marks a sea change, however, in designing new compound structures not currently found in nature, enabling more novelty and a new level of disease-targeting.
“We’re currently adding toxicology and formulation filters into our AI platform. With this customisation, we can design antibiotics with reduced toxicities and target product profiles aligned to real patient needs. This would be a gold standard not just for antibiotics but for AI-based drug discovery more broadly,” says Dr Kosaraju.
Hybrid funding model that incentivises drug discovery
It’s not just the discovery process that benefits from innovation. To overcome challenges plaguing antibiotic development, funding approaches need rethinking too. Phare Bio leverages a unique business model to advance candidates through the ‘valley of death,’ the early stage in development when most drugs fail.
“Developing a drug is high-risk and expensive, costing on average $1.3 billion,” says Dr Kosaraju. “That’s why pharma companies tend to focus on products with potential outsized returns, whereas antibiotics, on average, have low profit margins and limited sales. To address this, we employ a hybrid business model using philanthropic and grant funding for the riskiest early-stage preclinical studies, plus commercial partnerships and spinoffs for costly later-stage R&D. In doing so, we aim to rebalance the risk-reward ratio more favourably for antibiotic development.”
WRITTEN BY Dr Jean Pierre Nyemazi Acting Director, Global Coordination and Partnership Department and Quadripartite Joint Secretariat on AMR, WHO
TThe 2024 UNGA HLM political declaration: a milestone for antimicrobial resistance response
In a historic step forward, the United Nations General Assembly (UNGA) adopted the High-Level Meeting (HLM) Political Declaration on AMR in October 2024.
his unprecedented international commitment reflects the global community’s recognition of AMR as one of the most urgent global threats. The UNGA HLM political declaration on AMR provides hope for an effective, coordinated and transformative response. Part of this is aiming for a 10% reduction in human deaths due to AMR by 2030, taking 2019 as the baseline.1
Actions in human and animal health
In human health, the declaration urges all countries to address AMR through prevention of drug-resistant infections; vaccination and routine immunisation; effective diagnostic and laboratory infrastructure; and provision of safe water, sanitation and hygiene.
In agriculture and animal health, the declaration recognises the critical importance of reducing non-veterinary use of antimicrobials, disease prevention and animal welfare measures. This includes vaccination and good animal husbandry practices.
Actions in the environmental sector
For the first time, the declaration recognises that environmental factors contribute to the development and spread of AMR. It also highlights the need for priority actions to prevent and address the discharge of antimicrobials and their metabolites into the environment.
Coordinated and multisectoral AMR response
The declaration emphasises sustained and accountable political leadership and ownership of the response
to AMR at the national level, as well as the need for international cooperation. It recognises the central coordinating role of the Quadripartite organisations. It requests them to establish an independent panel on evidence for action on AMR by 2025 and update the Global Action Plan on AMR by 2026 to ensure a robust multisectoral response
The declaration calls for strengthening sustainable AMR financing, particularly for low and middle-income countries. It sets the target of achieving a modest USD 100 million. This will catalyse the achievement of 60% of countries having funded national AMR action plans by 2030.2 Recognising that additional resources will be essential; it will help sustain and accelerate a long-term response to AMR at both global and national levels.
Turning words into action
The UNGA HLM was a significant milestone. However, it will only be considered a landmark event if the words of the political declaration are followed up with global solidarity, broad multisectoral collaboration, increased investment and the determined actions needed to respond to AMR at scale and with the urgency required. The stakes are clear — without concerted effort, AMR could undo a century of progress in modern medicine.
References 1. Murray, Christopher J. L. et. al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, Volume 399, Issue 10325, 629 – 655. 2. Political Declaration of the High-Level Meeting on Antimicrobial Resistance, United Nations, 2024.
WRITTEN BY Tony
@Mediaplanet UK & IE
Senior Project Manager: Amy Shah amy.shah@mediaplanet.com Project Manager: Grace Ukandu grace.ukandu@mediaplanet.com Business Development Manager: Caroline Klingen
Henry
INTERVIEW WITH Akhila Kosaraju MD, CEO/President, Phare Bio
Greenway
How unreliable UTI testing methods put women at risk — and drive AMR
The blind spots of current diagnostics for urinary tract infections leave much room to improve antimicrobial stewardship and women’s health. It’s time for innovation and change.
Urinary tract infections (UTIs) are extremely common, and most women will experience at least one in their life. If left untreated, they can progress to serious kidney infections and sepsis and, in rare cases, can even be fatal.
Accurate UTI diagnosis slows AMR UTIs are frequently treated with antibiotics, but if the wrong one is used, symptoms persist and patients are overexposed to ineffective antibiotics. Swift and accurate diagnosis, followed by the correct antibiotic choice, provides a line of defence against the growing threat of antimicrobial resistance (AMR).
Unfortunately, available diagnostics for UTIs are often inadequate, notes Giles Sanders, Head of In Vitro Diagnostics at TTP, a technology and product development services company with a strong focus on women’s health and AMR. “This can lead to patients being incorrectly denied treatment, prescribed the wrong antibiotics or prescribed several different antibiotics — all of which encourages AMR,” he says.
Why current methods of diagnosis are unreliable
The current diagnostic pathway often involves a urine sample being tested with a dipstick first, then sent for microbiological culture and antibiotic susceptibility testing. These methods have poor sensitivity and miss some genuine UTIs. Additionally, the culture test does not reliably detect all organisms and can take days to report a result. This means that GPs prescribe a ‘go-to’ antibiotic rather than one that will always properly target the infection. This can mean that patients suffer for days on the wrong antibiotic.
Keiko Yata from the Women’s Health Initiative at TTP, believes that the current ‘one-size-fits-all’ approach is failing patients and endangering antimicrobial stewardship. UTIs can be complex, she warns — and patients may be the best judge of whether they have one or not.
“Patients can present to their GP saying: ‘I think I have a UTI’,” says Yata. “So, they’re given a dipstick or culture test which — because they are unreliable — come back negative, and they are told that no treatment is
necessary. Yet, the patient knows they have a UTI — and the GP probably does, too. It’s not a helpful situation. Also, blind antibiotic prescribing could be driving AMR.” Yata also believes that the burden of UTIs should be more recognised. “Because the subject of UTIs is still taboo, women don’t always feel they can talk openly about them. That has to change.”
Diagnostics that can address women’s health and AMR
While current diagnostics can be useful, they don’t catch all cases, and they take too long. Therefore, we should embrace more sophisticated and trustworthy techniques. For example, antimicrobial susceptibility testing (AST) at the point of care could be hugely valuable. One such test launched in 2023, which monitors bacterial growth in real time and can provide antibiotic susceptibility profiles for five commonly used antibiotics in 45 minutes, won the Longitude AMR Prize in 2024.
“Another alternative would be molecular techniques, such as PCR or DNA sequencing, which could be used in cases where standard diagnostics don’t bring a resolution,” says Kate Rouse, TTP Consultant. While not commonly used, these tools could boost women’s healthcare and help prevent AMR spread.
Investing in more sophisticated techniques Across the board, a more thoughtful and research-led approach could widen the range of diagnostic options available. For the good of patients and antimicrobial stewardship, there is no time to waste. “Diagnostic development takes time,” says Elena Boland, TTP Consultant. “Investment in this area is needed now. Otherwise, we risk moving ever closer to the catastrophic stage of being unable to use available antibiotics because of AMR.”
Giles Sanders agrees. “If the right test can deliver the right treatment rapidly, the economic costs will pay for themselves many times over,” he says. “Unfortunately, like many women’s health issues, it is an underfunded and under-researched area. Governments need to better appreciate the burden of UTIs and be willing to invest in modern diagnostic approaches.”
Giles Sanders Head of In Vitro Diagnostics, TTP
Why rapid diagnostics are key to fight climate-driven health threats
Rising temperatures and changing weather patterns are having a devastating impact on global health, making the accessibility of precise diagnostics even more important.
Arguably, one of the biggest impacts of climate change isn’t talked about enough: the devastating effect rising temperatures and changing weather patterns have on human health.
Increasing vector-borne diseases
“In particular, vector-borne diseases are on the increase,” explains Dr Douglas McAllister, Scientific Fellow at Medix Biochemica, an in vitro diagnostics raw material supplier. “Take dengue fever, which is transmitted by the aedes mosquito. This is on the rise in tropic and subtropic areas.” Worryingly, only a slight temperature increase is necessary for such vectors to survive and thrive.
The need for rapid and accurate in vitro diagnostics (IVD) has become more important.
“Healthcare practitioners have to quickly understand the nature of an infection to prescribe the most appropriate treatment,” says Dr Amy Moore, Global Infectious Disease Portfolio Product Manager at Medix Biochemica. “Because if it’s viral rather than bacterial, antibiotics won’t work — but they can contribute to antimicrobial resistance (AMR).” AMR-resistant infections can then lead to failed treatments and the development of sepsis.
Collaboration is essential for better public health Diagnostic tests should be universally accessible — but, sadly, are not. “The reason for that is economics,” says Dr McAllister. “Countries with the resources are subsidising, purchasing and distributing rapid tests. Resource-poor countries don’t have that luxury.”
Medix Biochemica has become a big player in the field of infectious disease, providing essential raw materials for IVD assays, quality control materials and molecular diagnostic reagents supporting improved diagnostic accuracy and capabilities. Yet, no one company can square this particular circle. Collaboration among stakeholders — including governments, healthcare providers, philanthropic organisations and individuals — is key to better diagnostics, improved public health and curbing AMR and sepsis.
Going forward, Dr McAllister expects patients to demand improved diagnostics for all kinds of ailments. “With Covid, people could selfdiagnose at home. They now have a taste for it and, presumably, will start asking: ‘Why can’t I do the same for strep throat?’ So, the diagnostic genie is out of the bottle, and that’s a good thing.”
Talent loss and market issues are a major threat to addressing global AMR crisis
Growing resistance to antibiotics has rapidly become one of the world’s most important global health threats.
The latest research estimates that almost 40 million lives are at risk over the next 25 years if we fail to act.1 In response, the United Nations convened a pivotal High-Level Meeting in September – its first on antimicrobial resistance (AMR) since 2016 – dedicated to addressing AMR’s growing threat.
Shrinking antimicrobial R&D workforce
Following the first high-level meeting, the AMR Industry Alliance was formed. Since then, there has been much progress to celebrate across key areas such as stewardship, research and development (R&D), as well as working towards standards that support the responsible manufacture of antibiotics. However, a lingering concern remains: the shrinking pool of antimicrobial research and development professionals. This loss of talent threatens our already very fragile pipeline for new antibiotics. While significant strides have been made in other aspects of AMR, this important vulnerability has gone overlooked for too long.
Antimicrobial market investment challenges
compared to more than 46,000 for cancer, for example. Fortunately, many of the researchers remaining in AMR are committed and engaged, and countries are beginning to address the market problem.
A new way forward
A broken market requires novel solutions. For example, the UK launched an innovative subscription-based model that delinks revenue from sales volume, which helps to support companies to continue their antimicrobial research and development efforts. Progress, albeit piecemeal, was made at the High-level Meeting as world leaders committed to advancing solutions to address the shortage of AMR researchers in their political declaration.
Both public and private sectors must invest to support researchers and stay ahead of resistant bacteria.
Both public and private sectors must invest to support researchers and stay ahead of resistant bacteria by meeting the demand for new antimicrobials. Attracting and retaining top scientific talent is essential for long-term progress.
The market for antimicrobials faces unique challenges. To mitigate AMR, new antimicrobials are needed. Moreover, they should only be used when older ones don’t work: that tends to limit sales volume. Consequently, new antimicrobials often don’t attract investment. This makes it difficult for companies, large and small, to create the new drugs we desperately need to combat rising AMR. Even when they succeed with R&D, many antibiotic biotech companies don’t offer long-term careers as they still go bankrupt or get bought out. It’s no surprise, then, that the top talent in the field are leaving for other disease areas: our research2 estimates there are only 3,000 AMR researchers
WRITTEN
INTERVIEW WITH Dr Douglas McAllister Ph.D, Scientific Fellow, Medix Biochemica
WRITTEN BY Tony Greenway
INTERVIEW WITH Dr Amy Moore
Why antifungal resistance is a global health concern — and how we can fight it
Rapid fungal diagnostics save lives and have a positive impact on antifungal resistance, says Dr Tom Chiller from the Centers for Disease Control and Prevention (CDC) in the US.
INTERVIEW WITH Dr Tom Chiller
MPHTM, Chief, Mycotic Diseases Branch; Associate Director for Global Health, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, USAO
BY
WRITTEN
Tony Greenway
Are fungal disease cases on the rise globally?
Dr Tom Chiller: As the climate and environment are changing, fungi are adapting. They’re ubiquitous opportunists that cause many different syndromes and diseases, which I’d put into three categories. The first and most superficial are skin diseases — although we’re seeing new emerging species that are highly resistant to treatment. Then, there’s subcutaneous disease and, lastly, deep, invasive internal diseases which can be life-threatening, particularly to patients with weakened immune systems.
Is antifungal resistance a growing issue?
We’re seeing more fungal infections that are resistant to drugs than a
decade ago. For example, Candida auris can cause severe illness, is often resistant to medications and has ripped across the world in a short time. Then there are heavily resistant, very nasty skin infections originating from South Asia that are present in the UK and the US. Right now, we really only have three classes of antifungals to treat invasive infections
Why are rapid fungal diagnostics important? What part do they play in fighting antifungal resistance?
The longer it takes to get a patient on to the right therapy, the harder it is to treat them and — in serious cases — the higher their risk of mortality. Also, because many fungal syndromes resemble bacterial infections, many
patients who are waiting a long time for a diagnosis may mistakenly be prescribed antibacterial medication when they really need antifungal medication. That’s not just bad for the patient — it also contributes to the problem of bacterial resistance. So, quicker diagnosis helps us curb resistance, lowers hospitalisation costs and saves lives.
How important is antifungal stewardship — and how can clinicians and diagnostic companies help?
It’s vital. I’m a big believer that accurate diagnostics help healthcare professionals be the best stewards of any medicine they’re using. Once we know what we’re dealing with, it’s a matter of using the right drug for the right bug at the right time.
I can’t emphasise enough the importance of employing diagnostics in our stewardship routines. We do need more rapid diagnostics, however, but I’m a ‘glass is half full’ guy and some promising small companies are now engaged in that field. Plus, the World Health Organization is finally getting more involved in the fungal space, which helps create awareness of the dangers of fungal infections
How to stop the cycle of environmental contamination that begins in hospitals
An on-site treatment solution decontaminates hospital wastewater — a key channel for antimicrobial resistance (AMR) — before antibiotics and harmful pathogens find their way into the natural environment.
If it wasn’t for the antibiotics administered in hospitals, patients could die from routine surgeries and common illnesses. Yet, ironically, the ubiquity of antibiotic treatment in hospitals is precisely why they have become hotspots for microbial contamination, explains Peter Kelly, CEO of Pharmafilter.
“The pharmaceuticals and antimicrobials administered in hospitals are so powerful that patients can only metabolise 20% of them,” says Kelly. “The rest is unmetabolised and therefore present in the urine and faeces in hospital wastewater. If this contaminated wastewater is allowed to travel downstream to a treatment plant, it becomes a key channel for AMR.”
Revolutionising management of hospital waste and wastewater
of intelligent shredders in a hospital’s sluice room. These machines shred waste — including risk waste, sharps, food waste, disposable bedpans and urinals and PPE — which is transported via the existing sewer network or a dedicated pipeline to a waste and wastewater treatment plant in the hospital grounds.
Arresting the cycle of contamination poisoning the natural environment
The way hospital waste and wastewater are managed must change urgently.
Wastewater treatment plants are not equipped to remove local pharmaceuticals from hospital effluent and can be ideal breeding grounds for AMR. There is an upstream automated treatment solution, devised by Pharmafilter, which Kelly believes will revolutionise how hospital waste and wastewater are managed. “A hospital can mitigate the impact of antimicrobial resistant bacteria if it installs an on-site solution to decontaminate waste and purify wastewater at its source, and so remove any toxic elements making their way into the wastewater stream,” he says. The solution is easy to set up and involves deployment
“Solids and liquids are then separated,” says Kelly. Wastewater, meanwhile, is treated to remove the last trace of pharmaceuticals, contaminants, antibiotics, cytotoxins and harmful pathogens before they find their way into our water, soil and air.” Pharmafilter wants to understand if captured contaminated wastewater could be of value to researchers and lead to development of new medicines and treatments.
The way hospital waste and wastewater are managed must change urgently, insists Kelly, revealing that his company’s solution is being rolled out across Ireland, the UK and other European countries. “The relentless cycle of contamination coming from hospitals is poisoning the natural environment and leading to serious health problems such as respiratory illnesses, heart disease, cancer and AMR,” he says. “To arrest it, we need proven technology that is clinically, operationally and financially viable for hospitals.”
INTERVIEW WITH Peter Kelly CEO, Pharmafilter
WRITTEN BY Tony Greenway
Leveraging diagnostics and multisectoral partnerships in the global fight against AMR
While new data suggest that annual deaths attributable to antimicrobial resistance (AMR) will rise from 1.14 million in 2021 to 1.91 million in 2050,1 collective action is urgently needed including access to essential diagnostic tools.
The economic implications of AMR are astounding too — with potential GDP losses of up to $3.4 trillion annually by 2030,2 disproportionately impacting lowresourced countries.
The critical role of diagnostics in AMR Diagnostics are crucial for effective healthcare. In the context of AMR, they help healthcare professionals differentiate between viral and bacterial infections, guide antibiotic use, prevent misuse and monitor resistance patterns. While tests in hospitals or even the home testing we saw during COVID-19 are commonplace in high-income countries, many hospitals and communities worldwide far too often underutilise or lack access to these essential tools.
is already a reality many patients face daily across the globe due to antimicrobial resistance (AMR).
For instance, Tori Kinamon, a former collegiate gymnast, nearly lost her leg to a latediagnosed MRSA infection that required eight surgeries and extensive rehabilitation.
In 2019, a four-year-old boy struggled with severe respiratory issues and a drugresistant infection requiring difficult-to-obtain antibiotics, which ultimately contributed to his tragic death from a bloodstream infection complicated by congenital short bowel syndrome. Such experiences underscore that AMR does not discriminate — it affects people from all walks of life.
Showcasing successful partnerships
We are committed to promoting the responsible use of antibiotics by supporting healthcare providers.
The fight against AMR is severely hampered by these glaring inequalities and blind spots in AMR surveillance data and access to diagnostics. In many low- and middle-income countries (LMICs), the absence of robust data systems means the true extent of AMR is obscured. For instance, as recently as 2017, nearly half (43%) of the countries in Africa lacked available AMR data. 3 Without accurate data, we are fighting an invisible enemy, unable to allocate resources effectively or measure the impact of interventions. Strengthening health systems and improving laboratory capacity are vital. As the pharmaceutical sector develops new antibiotics, we need systems in place to ensure they are used appropriately and only when necessary.
AMR affects people of all backgrounds
We live in a world where a simple infection can turn deadly, routine surgeries are risky and minor cuts can lead to life-threatening situations. This
Since 2019, bioMérieux has partnered with the Fleming Fund, a UK aid programme, to equip clinical and veterinarian reference laboratories in 15 countries across Africa and Asia, with advanced diagnostic technology, digital surveillance solutions and training for healthcare professionals. This partnership aims to enhance patient care, understand resistance burdens better and strengthen AMR surveillance systems while supporting the implementation of national AMR plans. New laboratory equipment delivered to Bhutan is identifying resistant pathogens in just 60 minutes, compared to older methods which took 24 hours.
In May 2024, bioMérieux, the Malawi Ministry of Health and Pfizer initiated an innovative partnership to improve infection prevention, diagnostics, surveillance and treatment in five central hospitals across the nation. By working together, we are committed to promoting the responsible use of antibiotics by supporting healthcare providers.
Advancing together
AMR is a complex challenge that demands a united front. There is no silver bullet, so we must leverage the collective efforts of governments, healthcare providers, academia, the private sector, the patient community and civil society.
On September 26, the United Nations General Assembly held a High-Level Meeting on AMR, where world leaders have committed to urgent and meaningful action, particularly for the most vulnerable communities in the world. We have seen desperately needed commitments to
WRITTEN BY Professor Dame
Sally Davies UK Special Envoy on Antimicrobial Resistance
WRITTEN BY Dr Charles Cooper Executive Vice President, Chief Medical Officer, bioMérieux
leverage funding and implement National Action Plans on AMR. It was a landmark opportunity for stakeholders to come together and work towards a common goal of global access to antibiotics, vaccines, diagnostics, finance, data and leadership from policymakers, the public, NGOs and the private sector.
Global AMR collaboration framework
The UN Declaration from the HighLevel Meeting is crucial in fostering an environment that supports multisectoral partnerships and sets a global vision for collaboration, backed by the necessary resources — financial and otherwise. To support these changes in clinical care and government policy, leaders require access to data to inform action, which is generated in large part through the use of diagnostics and surveillance. So, now begins the hard work of implementing these commitments.
Crucially, the High-Level Meeting has committed to establishing an independent science panel on AMR. Similar to the Intergovernmental Panel on Climate Change (IPCC), it will assess the latest data and inform future global targets and interventions. The panel must be globally representative and inclusive of all countries and sectors — and ideally hosted in Africa — where AMR is most felt. We urge global leaders to contribute to the upcoming consultation and make their voices heard so that the panel delivers for everyone across the world.
Urgent action for AMR
Now is the time for action and investment. We need resources and political will. We call on global and national government bodies to facilitate partnerships across sectors to develop policies, improve surveillance, enhance diagnostic utilisation and implement effective actions. Everyone can make a difference. We don’t want to reach the next high-level meeting in 2029 with nothing to show for our efforts. Advancing together isn’t just a theme; it’s a necessity.
References
1. GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024 Sep 28;404(10459):1199-1226.
2. General Assembly of the United Nations, Multi-stakeholder hearing on antimicrobial resistance, 2024.
3. Tadesse, B. T., Ashley, E. A., Ongarello, S., Havumaki, J., Wijegoonewardena, M., González, I. J., & Dittrich, S. (2017). Antimicrobial resistance in Africa: a systematic review. BMC infectious diseases, 17(1), 616. https://doi.org/10.1186/ s12879-017-2713-1
Photo provided by bioMérieux
On September 2024, bioMérieux organised an event in New York, with The Wellcome Trust, The American Society of Microbiology, The Republics of Malawi and France, to discuss how to secure the global AMR agenda by harnessing the collective strength of multi-sector partnerships.
Spread paid for by bioMérieux
UK’s subscription model is
a
small step in the long fight against AMR
The UK has launched the first-ever market incentive to support the development of new antimicrobials. Without further commitments by other countries, there will be no impact on the AMR innovation ecosystem.
Even though political declarations in support of AMR innovation are accumulating (UN General Assembly, G7 Communiqué), it is still as difficult as ever to find enough money to develop new antimicrobials.
Subscription model boosts innovation
The subscription-based payment model for antimicrobials launched in the UK is however generating optimism among innovation stakeholders. Started in 2022 as a pilot and now turned permanent, the UK model guarantees pharmaceutical companies a fixed annual payment for new antibiotics, regardless of usage, breaking the traditional reliance on sales volume for revenue. The UK can pride itself on being the first to act, with this instrument covering most innovators’ needs. However, will that be enough?
Global adoption needed for impact
With the current lack of sustainable business models, many small biotech firms struggle to survive the lengthy, costly process of bringing new antimicrobials to market. The recent difficulties encountered by companies such as Destiny Pharma (UK) and Nosopharm (France) illustrate the problem perfectly and underscore the fragile state of the antimicrobial innovation sector.
Don’t set the wrong targets
The UK model guarantees pharmaceutical companies a fixed annual payment for new antibiotics.
While this initiative is a step forward, it won’t solve the broader market failure issue unless other countries adopt similar incentives. Make no mistake; any mechanism that would not offer sufficient or sufficiently predictable financial incentives will have no impact.
AMany countries want to do something. However, as many of them are affected by problems of access to antimicrobials, or even shortages, they tend to focus on these issues and develop dedicated incentives. Even if solving these availability problems is critical, looking at the problem solely from this angle is dangerous and short-sighted. The fight against AMR is a long-term race, and we need the means to go the distance. That’s something that only innovation can provide. Indeed, our intimate relationship with the microbial environment means that we must constantly develop new solutions to keep ourselves safe. We cannot only settle for what already exists. Without sufficient resources, these new solutions will never see the light of day. That’s why every country needs to do its bit and commit to supporting innovation — just like the UK did.
From farm to fork: curbing antimicrobial resistance in agrifood systems
Antimicrobial resistance (AMR) is a global health crisis, and sustainable farming practices are essential to reduce its spread. Farms and agrifood systems are pivotal in shaping how we address this challenge.
griculture, particularly the prudent and responsible use of antimicrobials in livestock, plays a significant role in addressing AMR. Farms are often the first point of contact where antibiotics are used to prevent and treat diseases in animals. However, overuse and misuse of these drugs contribute to the growing resistance and lead to failure of treatments, which has direct implications for human, animal, plant and environmental health. According to the Food and Agriculture Organization of the United Nations (FAO), addressing AMR at the farm level requires immediate and coordinated action.
Sustainable farming practices to combat AMR
To reduce the risk of AMR, farms need to adopt sustainable agricultural practices. This includes improving animal health through better hygiene, biosecurity and vaccinations, therefore reducing the need for antibiotics. Additionally, it involves adopting alternatives to antibiotics, such as alternative feeds and integrated pest management (IPM). FAO’s initiatives, such as Reduce the Need for Antimicrobials on Farms for Sustainable Agrifood Systems Transformation (RENOFARM), highlight the importance of educating farmers, veterinarians and animal health workers on responsible antimicrobial use and promoting
stricter regulations to curb misuse. These will ultimately lead to a minimised and controlled AMR emergence and spread in food and agriculture.
Systems approach: connecting agrifood systems and policy
AMR is not just a farming issue; it is deeply embedded in the wider agrifood systems. A One Health approach, which integrates human, animal plant and environmental health, is vital in managing AMR. Effective policies are required at the national and international levels to ensure proper oversight of antimicrobial use in agriculture. Collaborative efforts from policymakers, farmers consumers, among other key stakeholders, are crucial to safeguard the efficacy of antimicrobials for future generations.
Food security for the future
As the global population grows, the demand for animal-based products increases, raising the stakes in the fight against AMR. By supporting sustainable agrifood systems and enforcing stricter regulations on antimicrobial use, we can protect the health of humans, animals, plants, and the environment. The responsibility lies with all of us — farmers, consumers and governments — to take proactive steps toward reducing the threat of AMR and ensuring food security for the future.
WRITTEN BY Thanawat Tiensin Assistant DirectorGeneral, Director, Animal Production and Health Division and Chief Veterinarian, Food and Agriculture Organization of the United Nations (FAO)
WRITTEN BY Frederic Peyrane Managing Director, BEAM Alliance
If practices generate AMR, it will reduce the effectiveness of our antibiotics.
Call for industry-wide action and standards to fight AMR
Innovative pharmaceutical companies that make antibiotics are taking steps to reduce the negative potential consequences of AMR pollution in their manufacturing processes.
Antimicrobial resistance (AMR) is often referred to in the future tense as if it’s a brewing healthcare crisis. We have to get real, insists Rex Clements, CEO of antibiotic manufacturer, Centrient Pharmaceuticals. AMR — which makes infections harder or even impossible to treat with antibiotics — is an urgent crisis of the here and now.
Ongoing AMR global health threat
The Global Research on Antimicrobial Resistance (GRAM) Project predicts that antimicrobial resistance will cause 39 million deaths — that’s three deaths per minute — between 2025 and 2050. “Effective antibiotics are the foundational medicines of any healthcare system,” says Clements. “Yet, we increasingly see bacteria and other microbes develop resistance to the available medicines. So, according to the World Health Organization (WHO), AMR is considered a top global health threat right now.”
How antibiotics manufacturing can contribute to AMR
There are various reasons why AMR has become a clear and present danger. It’s well-reported that its main drivers are the overuse or misuse of antibiotics and the lack of new antibiotics coming onto the market. “Yet, there’s a third driver which is of huge concern to us as antibiotics manufacturers,” says Clements. “This happens when antibiotics are released into the environment from waste products in the manufacturing process.” Essentially, if
a high burden of active antimicrobials is present in pharma factory wastewater — and that wastewater is then released into waterways — it can contribute to AMR pollution.
Making pharmaceutical manufacturing responsible and sustainable Pharma companies therefore need to adopt a rigidly controlled and sustainable manufacturing process, of the type practised by Centrient Pharmaceuticals. Clements admits that this responsible approach is personal. “I have three children,” he says. “Frankly, I want them to grow up in a world where antibiotics work. So, I have absolutely no interest in running a company that contributes to AMR. We’re one of the first companies globally to focus on pharma manufacturing in a sustainable way.”
In 2000, the company developed its enzymatic manufacturing process. It requires less energy and water, and it avoids the use of harmful solvents and other chemicals. “It effectively replaced a 13-step solvent-based process used in the production of antibiotics, with a one-step enzyme that is clean, efficient and natural,” says Clements. “We’ve continued to evolve this process, which is now on its fifth generation.”
Finding forward-looking solutions to curb AMR
The company is also a founding member of the AMR Industry Alliance, a private-sector coalition that provides sustainable solutions to curb antimicrobial resistance. As such, Centrient is committed to complying with Predicted No-Effect
Concentration (PNEC) discharge targets set by the Alliance. “PNEC is an industry standard,” says Clements. “We prioritise wastewater treatment at our manufacturing sites and ensure that we’re using the newest technology to manage AMR. Any water that leaves our facilities is fully compliant with these targets.”
In addition, the pharmaceutical company has worked with the British Standards Institute to develop an international industry standard for sustainable antibiotic manufacturing and, in 2023, piloted an independent AMR certification scheme. Earlier this year, they announced that they had been awarded the certification for their own site in Santa Perpetua, Spain. Plus, the company has invested in facilities in Europe and the Americas, ensuring it has diversified sourcing of key earlystage intermediate materials to protect antibiotic supply against stock shocks.
Collective compliance with manufacturing standards
Going forward, Clements stresses the importance of collaboration between all stakeholders in the antibiotic space. “We need our competitors to comply with the same standards,” he says. “Otherwise, if practices generate AMR, it will reduce the effectiveness of our antibiotics. It’s important the industry works together to establish best practices and learn from each other. Centrient is one of the largest and among the last European manufacturers of antibiotics in Europe, ensuring we uphold the highest standards and set the industry benchmark.”
INTERVIEW WITH Rex Clements CEO, Centrient Pharmaceuticals
WRITTEN BY Tony Greenway
Photo provided by Centrient
Rapid UTI diagnostics platform helps flight global misuse of antibiotics
Medical device company showcases groundbreaking multipurpose diagnostic platform, which enables the rapid detection of both urinary tract infection (UTI) and antibiotic sensitivity, helping to combat catastrophic levels of antimicrobial resistance.
The rise of antimicrobial-resistant superbugs is a quiet but mounting threat fuelled by antibiotic misuse, resulting in bacteria that withstand current treatments. Timely diagnostic innovations are essential in preventing the misuse of antibiotics and preventing antimicrobial resistance (AMR) from reaching catastrophic levels.
Mustafa Al-Adhami, CEO of Astek Diagnostics, explains: “At the moment, doctors are making guesses on how to treat patients due to long diagnostic waiting times, leading to the misuse of antibiotics and the development of antimicrobial resistance.”
Rapid UTI diagnostics innovation
Named after his grandfather who was mistreated with antibiotics following a urinary tract infection, Al-Adhami started working on a solution named Jiddu, meaning ‘grandfather’ in Arabic. Working alongside him is a dedicated team of scientists, engineers and entrepreneurs, all driven by a commitment to innovate against major health threats.
“Most antibiotic resistance emerges due to UTIs, with 8 million doctor visits1 in the US alone,” says Al-Adhami. “At Astek Diagnostics, we are creating the JidduTM Platform, an innovative clinical diagnostics platform that offers infection confirmation for urinary tract infections and antibiotic sensitivity indication within one hour. This is by no means a replacement for the use of cultures, but we are providing rapid and timely diagnostic results which can guide appropriate treatment.”
Expanding global efforts
Currently running five pilots across various urology practices, clinics and hospitals, Astek Diagnostics is offering free devices and cartridges to enable practices to assess their technology independently. Instead of using the best guess antibiotic, clinicians can have realtime information to guide them, dropping the current rate of antibiotic misuse dramatically.
“Physicians are traditionally looking at symptoms to prescribe antibiotics due to delays in traditional testing. We want to empower clinicians to incorporate AMR testing into firstline clinical practice,” Al-Adhami continues. “We want to put patients at the centre of treatment. The less guessing being made when it comes to treating patients with antibiotics, the slower the emergence of superbugs.” Reference 1.
Combatting AMR: the need for environmental action and global collaboration
A global response to antimicrobial resistance requires cross-sector collaboration, focusing on environmental interventions. This is essential to preserve our ability to treat diseases in humans, animals and plants; ensure food safety and security; and protect the environment.
Antimicrobial resistance (AMR) is one of the top 10 threats to global health and development, projected to cause over 39 million deaths by 20501 — that’s three deaths every minute. Economically, if unchecked, AMR would have devastating consequences escalating healthcare expenditures, productivity losses and negative impacts on livestock production.
AMR linked to environmental crises
AMR is intricately linked to the triple planetary crisis of climate change, biodiversity loss and pollution. It hits developing countries hardest due to pollution, lack of sanitation and weak health systems.
The environment plays a significant role in its emergence, transmission and spread. Key economic sectors contributing to environmental AMR include pharmaceutical manufacturing, agriculture, food production, healthcare and municipal wastewater.
Focus on environmental interventions
INTERVIEW WITH
WRITTEN BY Bethany Cooper
To reduce the burden of AMR and its risks, environmental interventions must be at the core of the solutions. These include limiting the discharge of effluents and waste from pharmaceutical industries and hospitals, regulating the use and disposal of antimicrobials in farms — including aquaculture and crop production — and improving integrated water and waste management practices.
Addressing the environmental dimensions of AMR requires enhancing environmental governance, planning and regulation; strengthening reporting,
surveillance and research informing policies; raising awareness; and scaling up preventative actions, with further private sector engagement addressing key economic sectors.
Multi-sectoral approach needed
It’s clear, therefore, that AMR is a multi-faceted problem requiring a multi-sectoral approach that combines human health, agricultural, animal and environmental sector-specific interventions. This is the approach of the UN General Assembly Political Declaration adopted in September 2024; countries pledged to reduce AMR-associated global deaths by 10% by 2030 compared to a baseline of 4.95 million deaths in 2019 and committed to USD 100 million in sustainable catalytic funding for national action plans. Only by joining forces can we leverage action to prevent and combat AMR.
References 1. Naghavi, Mohsen et al. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts
Urology Care Foundation. Understanding UTIs Across the Lifespan. 2016.
Mustafa Al-Adhami, CEO, Astek Diagnostics
Specialist pharmaceutical consultancy paves the way for smarter antibiotic development
Antibiotic development has become unattractive to many large pharmaceutical companies, leaving academics and smaller entrepreneurial companies to drive research and development.
Antimicrobial resistance (AMR) represents a significant and global threat to public health, making infections harder to treat, increasing disease spread and resulting in poor patient outcomes. Rienk Pypstra, Chief Medical Officer and Head of Infectious Diseases at tranScrip, explains: “More infections are becoming resistant to existing treatments. Hospitals and communities are seeing increased resistance in difficult-to-treat infections caused by gram-negative pathogens, creating significant burden on healthcare systems globally.”
The changing face of antibiotic development
Antibiotic development has become less attractive to large pharmaceutical companies due to high research and development costs, limited returns and complex regulatory and post-approval hurdles. “Working with antibiotics is different to other therapeutic areas because they target bacteria rather than human cells or receptors, meaning learning and progress from other disciplines cannot be transferred,” Pypstra continues. “We are now seeing more research being undertaken by academics and smaller entrepreneurial organisations, which are less experienced in drug development and may need guidance to navigate challenges in clinical development, secure funding and support commercial activity.”
The need for expertise
tranScrip is a specialist pharmaceutical consultancy that partners with a range of clients, from dynamic startups and innovative biotechs to the top 50 pharmaceutical giants, providing strategic expertise, therapeutic experience and operational excellence across the entire product lifecycle.
“We have teams of highly experienced physicians and scientists together with regulatory, clinical and commercial experts supporting the earliest developmental stages in translational medicine, all the way to successful market launch and prescription,” says Pypstra. “Our mission is to enable clients to maximise the value of their products for the benefit of patients worldwide.”
AMR needs to be on the political agenda
While reports such as the O’Neill report underscore the urgent need for political and financial commitment, and various initiatives such as CARB-X, BARDA, HERA and AMRAF aim to address the funding gap, Pypstra stresses that efforts are still insufficient if we are to address the potentially catastrophic effects of AMR.
“Long-term investment is essential. It’s time for policymakers to address this on a global scale,” he says.
Why multifaceted action is needed to combat antimicrobial resistance
Antimicrobial resistance (AMR) is one of the greatest public health challenges today, claiming over 35,000 lives annually in Europe1 and threatening modern medicine’s effectiveness.
The economic toll is staggering, costing the EU approximately 1.5 billion Euros annually in healthcare expenses and productivity losses, according to estimates from the European Centre for Disease Prevention and Control (ECDC) and the Organisation for Economic Co-operation and Development (OECD). Without urgent action, the situation could lead to 10 million deaths annually by 2050,2 making AMR a looming crisis we can no longer ignore.
Urgent need for new antibiotics
While we need to prevent unnecessary use of antibiotics, we must also work on getting new antibiotics on the market. The European Parliament already completed its work on the pharmaceutical legislation and now awaits the Member States to finalise their stance. Time is running out to implement effective incentives for developing new antimicrobials.
reduce misuse and preserve their effectiveness. This approach could also help improve healthcare outcomes in rural areas and smaller hospitals, where resources may be limited. Moreover, continuous training for healthcare professionals in both hospital and community settings is vital.
Multidisciplinary teams and equitable access Strengthening infection prevention protocols and improving antimicrobial stewardship (AMS) programmes are essential. Involving multidisciplinary teams (doctors, pharmacists, nurses and microbiologists) alongside patient advocates can optimise antibiotic use and prevent drug-resistant infections. Support for equitable access to advanced diagnostic tools and AMS education is necessary to provide the infrastructure for effectively preventing, diagnosing and managing infections.
Without urgent action, antimicrobial resistance could lead to 10 million deaths annually by 2050.2
New antibiotics are essential to fight resistant infections, yet these drugs must be used sparingly, creating an economic paradox that stifles investment. Current incentive structures like the ‘subscription-style’ payment model or milestone payments, which decouple profit from use, could provide a viable solution but need immediate implementation.
Bacteriophages and rapid diagnostics
Additionally, we must focus on public awareness and preventive measures. Bacteriophages, which remain an untapped resource, offer promising alternatives in the fight against resistant infections. Coupled with this, rapid diagnostic testing is crucial. Ensuring patients undergo quick, point-ofcare testing before antibiotics are prescribed would
Governments must act swiftly to deliver on AMR incentives while ensuring that both innovative treatments and preventive measures are accessible, with national action plans kept up to date and effectively implemented. Lives depend on our prompt action.
References
1.
Wölken
Pypstra
Cooper
Why antimicrobial resistance and the changing climate are interconnected
To effectively combat antimicrobial resistance (AMR) and climate threats, we must adopt a holistic approach that recognises the intricate links between human, animal and environmental health.
As AMR and the changing climate converge, their interconnectedness becomes clear. The climate crisis accelerates global warming, facilitating the spread of infectious diseases in new areas.
Rising temperatures, rising infection risks
Rising temperatures and shifting weather patterns facilitate the spread of infectious diseases like dengue, chikungunya, West Nile virus and malaria into new regions, complicating global health objectives such as the fight against malaria, already hindered by AMR.
Warming may hasten the emergence of new pathogens and revive dormant ones, some potentially resistant to current antibiotics.1 Studies also show a direct link between rising temperatures and the spread of AMR across humans, animals and the environment.
Extreme weather events such as floods and droughts disrupt sanitation, decrease food production and heighten food insecurity, further straining healthcare systems, weakening immune systems and increasing infection risk. This leads to greater antibiotic use driving AMR development.
United against a perfect storm
Addressing AMR in the context of climate requires global
coordination. This means stronger global governance, implementing the One Health approach, integrating crosssectoral AMR surveillance, promoting sustainable agriculture to reduce antibiotic use and fostering public awareness.
We need to accelerate research and innovation in antibiotics, vaccines and sanitation systems. Moreover, investment in a Global AMR Fund and climate adaptation programmes is essential to support vulnerable regions. The recent Political Declaration of the High-level Meeting on Antimicrobial Resistance is a step in the right direction but leaves much to be desired.
A united front
The European Public Health Alliance (EPHA) is driving a unified response to the intertwined threats of AMR and climate change, advancing a holistic approach linking human, animal and environmental health. Through the AMR Stakeholder Network, MEP Interest Group on AMR and the One Health in Action partnership, EPHA fosters cross-sector alliances, building resilience against the health impacts of AMR and the climate crisis.
References
1. Paul J Edelson et. al., Climate Change and the Epidemiology of Infectious Diseases in the United States, Clinical Infectious Diseases, Volume 76, Issue 5, 1 March 2023, Pages 950–956, https:// doi.org/10.1093/cid/ciac697
Rising temperatures and shifting weather patterns facilitate the spread of infectious diseases, complicating global health objectives already hindered by AMR.
~The European Public Health Alliance (EPHA)
WRITTEN BY
Sara Bertucci Policy Manager, EPHA
WRITTEN BY
Milka Sokolović Director General, EPHA
Get to know the carbapenem-resistant brewing in hospital wastewater
Bacterial resistance to antibiotics is rising, and carbapenemresistant superbugs are becoming more lethal than (MRSA), despite
Wantibiotics in humans and animals over the last few decades has created a Darwinian pressure on bacteria, selecting only the most resistant bacteria to survive. This process is known as antimicrobial resistance (AMR).
Rising carbapenem-resistant infections
In hospitals, the most vulnerable patients are treated with broadspectrum antibiotics because, due to AMR, narrow-spectrum agents like Penicillin can no longer be relied upon for treating serious infections. When patients require longer hospital stays, they risk developing hospitalacquired infections, which are treated with last-resort carbapenem antibiotics.
These drugs are increasingly less susceptible to resistant bacteria. As a result, carbapenem-resistant bacteria, known as carbapenemase-producing organisms (CPO), have emerged and stand to become a problem more deadly than MRSA.
The perfect breeding place
Patients receiving antibiotics will excrete between 10–90% of it in their faeces or urine, depending on the antibiotic type.1 These go down the drains of our homes and hospitals. In hospitals, excreted last-resort antibiotics enter drainage systems along with the trillions of bacteria that inhabit this same space. Hospital drains provide an ideal environment for drug-resistant bacteria like CPO to thrive due to warmth, moisture and frequent exposure to bacteria and antibiotics.
CPO spreads drug resistance CPO share genetic material with different species of bacteria. This results in the spread of drug resistance in multiple types of bacteria. Laboratory experiments backed by outbreak investigations in hospitals have established that bacteria in drains can travel upwards and for long distances in waste pipes due to changes in pressure in plumbing systems. This results in plumes of resistant bacteria emerging from toilets, sinks and shower drains into hospitals, even when they are not in use.
Water-safe hospitals
The Healthcare Infection Society supports building hospitals which prevent AMR spread. To prevent CPO and bacterial transmission from drains, European hospitals have adopted water-safe patient care by redesigning and reducing hand-wash basins and shower drains. This minimises patient exposure to wastewater. Frimley Health NHS Foundation Trust is one of the first hospitals in the UK to begin to adopt this approach.
References 1. Frade V.M.F. et al. Environmental contamination by fluoroquinolones, Brazilian. J. Pharm. Sci. 2014 doi: 10.1590/s1984-82502011000100004.
WRITTEN BY Dr Manjula Meda Chair, Healthcare Infection Society
The market for antimicrobials faces unique challenges. To mitigate AMR, new antimicrobials are needed.
~James Anderson, Board Chair, AMR Industry Alliance
Making ‘Zero Malaria’ possible with science and innovation
We can end malaria in our lifetimes. This ancient disease still kills hundreds of thousands of children yearly, despite being preventable.
It’s worth repeating this as it’s easy to forget amidst the perfect storm of threats we face from climate change to insecticide resistance and funding shortfalls. But thanks to great leaps in scientific understanding, we are better equipped to tackle this disease.
Malaria-fighting advancements launched
Groundbreaking vaccines have been rolled out across malaria-endemic countries just this year, next-generation bed nets are fighting back against resistance and new tools in the pipeline, like ‘gene drive’ technologies, offer future solutions too. Scientific innovation powered by global collaboration gives us hope.
It is precisely this spirit of optimism and possibility we aimed to communicate through the Zero Malaria Experience; an immersive, interactive installation which launched in London earlier in November to highlight the life-saving potential of malaria science (see supplement cover).
Partnership and leadership crucial for research
alliance of campaigners and experts, and fronted by Malaria No More UK Ambassador, David Beckham. David’s unerring passion for the cause of ending malaria paired with his near unrivalled reach to audiences across the globe, helped project our message of hope to those with the power to change the future.
Groundbreaking vaccines have been rolled out across malaria-endemic countries just this year.
With 2025 being a crucial year for malaria funding, it’s vital that policymakers hear loud and clear the importance of funding organisations like Gavi, the Vaccine Alliance and The Global Fund to Fight AIDS, Tuberculosis and Malaria to ensure the tools we have reach those who need them. Alongside this, governments, including ours here in the UK, must provide the financial backing our scientists need to secure a pipeline of malaria innovations for the future, too.
With this leadership, we can get the malaria fight back on track to help end the disease within our lifetimes. Doing so would save millions of children’s lives, stimulate billions in global economic growth and free up capacity in health systems to conquer other diseases. A ‘Zero Malaria’ world is possible.
The awareness-raising effort was made possible by a global
Building policy and science partnerships to combat AMR
The rise of antibiotic resistance threatens life-saving medical procedures. Coordinated global action based on scientific evidence is crucial to combat this growing health crisis.
Many lifesaving procedures in modern medicine are only possible because of the availability of highly effective antibiotics. The increasing global spread of multiresistant pathogens is fundamentally challenging these achievements.
Strategic approaches to control AMR
Five key strategies are envisaged to successfully control AMR:
1. Optimised use of antibiotics through the implementation of global and national policy and stewardship intervention
2. Reducing the need for antibiotics by preventing infections through vaccination, water, sanitation and hygiene (WASH) systems, plus
infection prevention and control standards
3. Ongoing national and global surveillance of antibiotic use and resistance to support targeted health policy interventions
4. Research into the optimal use of currently available and new antimicrobial agents and diagnostics for the management of multi-resistant infections
5. Development of new antimicrobial agents for treating multi-resistant pathogens and new financing mechanisms for antibiotic therapies that decouple industry revenues from antibiotic use
Policy-science alliance against AMR
In September 2024, the UN General
Assembly (UNGA) agreed to set a target to reduce the number of infections caused by AMR pathogens by 10% and that 70% of the total human use should be narrowspectrum Access antibiotics. Further binding objectives, across the One Health sectors, will be needed to effectively tackle the problem.
Scientific societies should actively engage in setting evidence-based targets, continuously monitoring and evaluating the effectiveness of policy interventions and facilitating shared learning between countries. The agreement at the UN General Assembly to establish an independent scientific panel on antimicrobial resistance, similar to the panel on climate change, is therefore a major step forward.
Key role in the fight against AMR for scientific societies
Scientists and experts in AMR must protect public health. The European Society for Microbiology and Infectious Diseases (ESCMID) and other global societies in microbiology, infectious diseases and other areas are committed to this responsibility. Active participation in the AMR Scientific Panel is crucial for leveraging scientific expertise and collaborating with policymakers, which can influence AMR policy decisions. We can still prevent future generations from entering a postantibiotic era.
WRITTEN BY Professor Michael Sharland Professor of Paediatric Infectious Diseases, City St George’s, University of London
WRITTEN BY Professor Holger Rohde Professor of Molecular Microbiology, University Medical Center Hamburg-Eppendorf
WRITTEN BY
Dr Astrid Bonfield
CEO of Malaria No
More UK
There are some exciting new diagnostics, including rapid molecular tests and AI-enabled portable X-rays
Paying the price to rid the world of tuberculosis
More than a million people die each year from tuberculosis (TB), a disease that many think belongs in the past. The key to fighting it is better funding, say experts.
Tuberculosis remains the deadliest infectious disease, according to the World Health Organization (WHO). It is known as the ‘orphan’ disease because it has less visibility than malaria or HIV — and less funding, too.
Tuberculosis as the ‘orphan’ disease
tuberculosis and malaria while TB gets just 18%. This so-called ‘disease split’ is unfair, says Dr Suvanand Sahu, Stop TB’s deputy executive director.
It’s a view that Dr Lucica Ditiu, executive director of the Stop TB Partnership, is passionate about changing. The partnership works to advocate for TB sufferers, provide treatment for all, stop transmission, reduce TB’s social and economic toll and develop tools to fight it.
“High-income countries consider TB a disease of the past,” she says. “They don’t realise they have TB in their own countries. London has, in parts, rates that are higher than some high-burden countries.” The death toll is despite TB being treatable, curable and, crucially, preventable.
Ending the TB stigma
One of the difficulties is the stigma surrounding TB — “more than with HIV,” says Dr Ditiu. “People who have HIV and TB prefer to speak about HIV, not tuberculosis.” This leads to a lack of funding, preventing large-scale awareness campaigns in low and middle-income countries which have the highest burden.
Ignorance is also a danger, Dr Ditiu adds. “People are very scared. The fear is coming from a lack of knowledge.” As many as a quarter of the world’s population — 2 billion people — are infected with the TB bacteria.2 Perhaps only 20% will develop full TB, but that’s 400 million people. Some 10 million develop the illness every year.3 Anybody can get it, despite its association with poverty and poor living conditions. “We had a lawyer from London, and she had TB,” says Dr Ditiu. “Nobody tested her because they couldn’t imagine that such a brilliant, sparkling girl could have it.”
The battle for funding
Funding is crucial to the fight. HIV/AIDS and
“If the Global Fund has to fulfil its mandate and reduce deaths due to all three diseases, it cannot achieve it by underfunding TB,” he says. The Global Fund and Stop TB have recently signed a new accord to help move towards ending TB in high-burden countries by 2030.4 “If we have the money, it’s achievable,” Dr Ditiu insists. “You need to diagnose and treat people at scale.” She believes individual countries must step up: “We see huge ambition from countries like Indonesia, the Philippines, Bangladesh, Pakistan and Nigeria with huge increases in diagnosing and treating people.”
Covid-19 response should show us the way Dr Ditiu says the Covid response shows that political will and funding can be there: “Look how much the world mobilised when people were threatened by Covid. Even the country with the lowest health budget was able to provide live data, vaccinate and diagnose people at incredible rates; why is similar engagement not happening for TB — also an airborne pandemic?”
There was some good news in the WHO’s annual report on tuberculosis, says Dr Sahu, with 8.2 million people diagnosed and treated in 2023, more than any other year. Yet, he adds, there is more work to do on drug-resistant TB, one of the biggest AMR issues. The WHO estimates about 400,000 people develop drugresistant TB each year. Although deaths have fallen, the incidence of TB has not, jeopardising one of the UN’s Sustainable Development Goals for 2030. However, says Dr Sahu, there are some exciting new diagnostics, including rapid molecular tests and AI-enabled portable X-rays for screening. “The tools are there,” he adds. “What is lacking is the ability to scale up and provide access to everybody. To realise the potential, we need funding.”
For 25 years, Medicines for Malaria Venture and partners have forged a path towards the global goal of a malaria-free future, delivering an antimalarial toolbox with 17 rigorously tested malaria therapies, which have helped save 15.4 million lives. MMV will continue to innovate until the goal of a malaria-free world is achieved.
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