Tackle the ‘silent pandemic’ of antibiotic resistance like the Covid-19 pandemic — but do better, say global health experts

Those working in health, government and civil society to tackle antibiotic resistance should “strike while the iron’s hot” to apply and improve upon the lessons learnt during the Covid-19 pandemic, argued a panel of health experts during a webinar on 4 March 2021 organised by the Global Antibiotic Resistance and Development Partnership. 

They were discussing what can be learnt from the Covid-19 pandemic and applied to tackling the “silent pandemic” of antibiotic resistance. All agreed that it is as urgent an existential threat as the Covid-19 pandemic.

About 700,000 people die of a drug-resistant infection each year. Bacteria can become resistant to antibiotics, which are designed to kill or slow their growth. These are microscopic, single-celled organisms. 

After repeated exposure to antibiotics, weaker bacteria will die and leave the drug-resistant bacteria behind to multiply. Using antibiotics when they are not needed gives them a gap. New medicines need to be developed to tackle them. Gonorrhoea is such a case. 

It’s clear that Covid-19 has shone a light on the pandemic of antibiotic resistance, said Dr Marc Mendelson. 

He is a professor of Infectious Diseases and the Head of the Division of Infectious Diseases & HIV Medicine at Groote Schuur Hospital in Cape Town. He is also the Chair of the Ministerial Advisory Committee on Antimicrobial Resistance.

From his experience as a clinician, he has seen how antibiotics have been inappropriately prescribed to people with Covid-19. Recent data shows that only 7% of patients with Covid-19 also had a bacterial infection, however about 80% were receiving antibiotics in hospitals across the world. 

As a result, this viral pandemic will likely drive an increase in antibiotic resistance, Mendelson warned. 

Covid-19 has many lessons for those tackling the “silent pandemic” of antibiotic resistance. For one thing, it has shown that tests can be developed and made accessible globally — this has not been the case in the field of antimicrobial resistance, he said. 

The pandemic had brought home the fact that often there was little treatment to offer those with a resistant infection, just as in the early days of the Covid-19 pandemic.

As with Covid-19, old “workhorse” drugs are still the staples used in the field of antibiotics despite new options being available, Mendelson said. “It’s the old drugs we need to look to and maybe Covid-19 is tipping a hat to that.”

Another lesson for the field of antimicrobial resistance is the power of a single purpose approach driven by a single team.

“At Groote Schuur hospital, at the height of the pandemic we had over 500 doctors from different specialities all working on Covid wards… in antimicrobial resistance, we’re still talking to very few people who really understand it and are invested. We need to take this team approach forward,” he said.

Infection prevention control is usually “appalling” for bacteria. However, infection prevention control for Covid-19 was improved quickly. “I think this was largely driven by fear for the self. We were worried and fearful for our own safety,” he said. He said this was crucial to understand when trying to keep up this standard of infection prevention control.

Unlike Covid-19, the threat of antimicrobial resistance has been cast as a problem for the future. “People dissociate from futuristic predictions,” he added. The daily statistics on Covid-19 show the threat in real time. He argues this kind of surveillance and communication can be done for the antimicrobial resistance pandemic.

The public does not know what the deathly consequences of antimicrobial resistance look like. This is the opposite for Covid-19. “The threat and drivers which move people towards actually doing something about a problem is missing. If we don’t change this to something we can see, we will have problems,” he said.

Covid-19 has shown that there must be a mindset shift from a “one health” approach to a “one world” approach, said Dr Joanne Liu. She is a paediatric emergency physician at the University of Montreal and a former International President of Médecins Sans Frontières.

“We will not think of the correct tools to respond to a global biothreat if there are only a few people invited to the table,” she explains. This needs to happen to create a new platform to address antibiotic resistance.

She questioned if Covid-19 will really be the “reality check” the world needs to address its paltry pandemic preparedness. 

She’s unsure. 

“I think it’s important that a global health threat like Covid-19 and antibiotic resistance should be raised to the level of an existential threat, like nuclear accidents. It needs to be our Chernobyl moment to make sure we’re prepared for the next pandemic,” she said.

Covid-19 has shown that this type of urgent attention and action is possible and it must be applied to antibiotic resistance, argued Dr Manica Balasegaram. He is the Executive Director of the Global Antibiotic Research and Development Partnership. It works to accelerate the development of accessible treatments for drug-resistant infections.

He urged governments to invest in things that will counter antibiotic resistance and make sure access to new tools are equal and just. It is critical to make sure old antibiotics are available worldwide. He urged countries to take the threat seriously. 

Panellists agreed that time is of the essence. It is unthinkable to wait for the Covid-19 pandemic to pass before talking about the pandemic of antibiotic resistance. 

Liu warned that as soon as the world was “out of the woods” of Covid-19, they would want to move on and not talk about other pandemics. “We need to strike while the iron is hot — this is an existential threat,” she urged.

Mendelson urged governments to get serious about the underlying issues of how to mitigate the pandemic of antibiotic resistance. 

“The global powers need to take seriously the fact that this is a one world issue. Most of the world is still being asked to use antibiotics in place of methods of control of infection that have been enjoyed by high-income countries for decades now that low and middle-income countries still don’t enjoy, such as clean water, sanitation and vaccination — prevention, prevention, prevention. Meanwhile, we are losing lives.” MC/DM