Antimicrobial Resistance Series : Intro to AMR

The term antibiotic was first coined in 1941 by Selman Waksman to describe any small molecule made by a microbe that antagonizes the growth of other microbes. The antibiotic age occurred with the development of other agents such as tetracycline, streptomycin and chloramphenicol from soil bacteria; amongst others.

Modern medicine received a lifeline when Sir Alexander Fleming discovered the first known antibiotic drug in 1928. Through the efforts of Howard Florey and Ernst Chain who developed the drug to mass production, Penicillin came onto the market in 1945, helping to save millions of lives by preventing sepsis and other infections; and winning the trio a Nobel Prize in Physiology or Medicine the same year.

The reach of antibiotics in medical treatment is almost immeasurable. Antibiotics and other antimicrobial agents soon became the mainstay of modern medicine; being used in the treatment of Tuberculosis, Epstein Barr virus, Chlamydia and countless other clinical interventions along the spectrum of disease and care, including cancer chemotherapy and surgeries, facilitating and enabling safe treatment in medical interventions. Infections such as syphilis, formerly treated with arsenic compounds, became more safely treated with penicillin.

The spread of resistance to antimicrobial agents can be managed to some extent by behavioural modification, such as improved prescribing practices and the reduction of unnecessary antimicrobial dispensing and use. Better adherence to treatment regimens, stronger controls of counterfeit and substandard medicines, the avoidance of over-commercialization (oops – inconvenient realities exist here in abundance) and broadening patient education and awareness are all vital factors.

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Nonetheless, these measures, on their own, are insufficient to tackle the challenge in its entirety. The development of resistance by microbes is a natural phenomenon, and the development of resistance by bacterium, protozoa, viruses, and other microbes was inevitable. Thus, it is vital to understand that the global health concern of antimicrobial resistance is both scientific and economic.

Antimicrobial resistance, is likened to a slow-motion tsunami, posing a fundamental threat to human health, development, and security. In the presence of rising antibiotic resistance, and global alarm concerning increased mortality and morbidity due to antibiotic resistance; as well as the threat of modern medicine returning to a ‘pre-antibiotic’ era. “We are running out of time,” said Dr Margaret Chan, Former Director-General of the World Health Organisation, urging United Nations, global leaders to commit and act on commitments related to antimicrobial resistance on September 26th 2016.

During my masters I developed an interest in the economic forces driving investment in the pharmaceutical industry on the whole. This lead me rather seamlessly (if seamlessly were to mean ambling) to thinking about antimicrobial resistance. I ultimately wrote my dissertation in this area – focussing on the Davos Declaration on Combatting Antimicrobial Resistance signed by pharmaceutical, biotechnology and generic drug company signatories, diagnostic firms as well as industry associations.

With the United Nations and global community calling for urgent action. Having drawn the conclusion that perhaps multi-sectoral partnerships are valuable and, indeed, necessary.

Part of my study considered and investigated gaps in both knowledge and financing. The ways in which these financing gaps, essentially a market failure; and the nuanced areas surrounding how to harmonize the balance of adequate returns within the pharmaceutical and biotechnology industries; as well as favourable global, public health outcomes.

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Finally, it is undeniable that we owe our current state of mortality, morbidity and relatively long-life expectancy to the allied efforts of the pharmaceutical industry, regulatory and disseminating bodies within the global health sphere. A partnership that is not new; but that is more than ever in need of strengthening and coordination – a mission put into writing at the World Economic Forum (WEF).

Make no mistake. AMR poses a potential threat to all of us. Learning from Professor Hans Rosling, I have come to understand that in the field of Public Health, there are certain factors (somewhat) beyond our control. The mutation of certain viruses (to a large extent – despite increasingly more refined prediction modes and methods), for example. However, what is in the sphere of our control requires appropriate attention in addressing needs and threats.

It is my humble opinion that it is the coordinated action of these intrinsically linked and allied industries is what will ultimately evade a regression into what may only resemble a ‘pre-antibiotic’ era.

Have a banging Friday!

– Christiana

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