WHO priority list of antibiotic resistant bacteria: Thoughts from an expert
Last month WHO published a list of priority bacteria based on their levels of antibiotic resistance. We asked Prof Rosanna Peeling for her thoughts on the list. Rosanna is Professor and Chair of Diagnostics Research and Director of the International Diagnostics Centre (IDC) at the London School of Hygiene & Tropical Medicine.
On 27 February 2017 WHO published it first ever list of antibiotic-resistant priority pathogens to promote and guide global research and development (R&D) to combat AMR. This list is long overdue as it highlights the urgent need to invest R&D efforts in a group of not so well recognised “superbugs” that are rapidly making hospitals and other care facilities a dangerous place with untreatable, life threatening infections. This list of global priority pathogens underscores the universal nature of public health threats posed by these resistant pathogens.
With global travel, this scare is not limited to the developing world, where the burden of AMR is largely unknown and control measures are often inadequate. The recent news of the woman in Nevada who died of a bacterial infection resistant to every available antibiotic in the United States is an early warning that no country can afford to be complacent.
What’s on the list?
At the top of the WHO list in the Critical Category are bacteria that have rapidly developed resistance to carbapenems, universally recognised as an antibiotic of last resort. The bacteria that are on the high and medium priority list cover a broad range of antibiotic resistance that has posed significant threats to human health. In 2013, the US Centres for Disease Control and Prevention published the top 18 pathogens that pose urgent, serious and concerning threats to the US. Although the levels of threat are different for resistant pathogens between the two lists, Carbapenem-resistant Enterobacteriaceae (CRE) made it in the top category on both lists.
What has been the industry response to AMR?
The pharmaceutical industry has initiatives such as Good Drugs for Bad Bugs and Innovative Medicines Initiative (IMI). There have been efforts not only to bring pharmaceutical companies back to developing new classes of antibiotics, but also to assess anti-infective properties of traditional medicines, small peptides, antibodies, probiotics, bacteriolysins as alternatives to reduce the use of antibiotics to treat systemic or invasive infections.
At the 2017 World Economic Forum in Davos, Switzerland, AdvaMedDx, the association representing major diagnostic companies, in collaboration with UNAIDS announced a global stakeholder initiative to optimise the use of diagnostic tests in the fight against AMR.
The global initiative committed to:
- Building a long-term economic case for diagnostics as a public good in the fight against drug-resistant infections
- Establishing public-private partnerships to develop health systems and create wide-scale access to diagnostics
- Working to ensure effective global utilization of diagnostics
- Advocating for research and development investments, funding, simplified regulatory processes and sustainable reimbursement policies to encourage development.
What about diagnostics manufacturers?
Dame Sally Davies, who gave an opening plenary at this AMR event in Davos, said:
“Antimicrobial resistance is the biggest threat to global health—it could halt the progress of over a century of modern medicine. Rapid point-of-care diagnostics are critical to the fight against drug resistant infections. Identifying the cause of an infection – bacterial, viral, fungal – will improve prescribing decisions and reduce unnecessary prescribing. The world needs to be committed to supporting the development and use of new diagnostics.”
The question is whether it is possible to develop a diagnostic test that covers all these resistant bacteria or should there be a series of different tests that are more targeted.
Apart from the availability of good diagnostic targets, a more complex question is which type of rapid detection technology can be deployed at different levels of the health care system and what resources are available to procure the best possible tests at each level.
When I was at WHO, I advocated for the ASSURED criteria for the ideal diagnostic test: affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free and deliverable to those who need them. With the exception of rapid HIV and malaria tests, we are still very far from achieving these goals.
The Longitude Prize, the commitment of the diagnostic industry in this global stakeholder diagnostics initiative, and the priority list from WHO will help focus our R&D efforts and gives us hope that we can reduce inappropriate use and conserve antibiotics for future generations.