Opinion: Antimicrobial Resistance – the ‘silent’ pandemic we need to take seriously

20 November 2023

Pandemic fatigue, blunting our willingness to take-on a public health emergency, is real. So for all that we’ve endured through the extreme trials and tribulations of COVID-19 over the last three years, the last thing anyone wants to contemplate is a new pandemic.

Yet one is already here: we just don’t seem to appreciate the urgency or scale of the threat.

It’s the ‘silent’ pandemic of antimicrobial resistance, AMR. It occurs when microbes such as bacteria change to become resistant to drugs that are designed to destroy them. They are evolving faster than we can bring new drugs to market, turning into untreatable ‘superbugs’.

AMR has been recognised by the World Health Organization as one of the top ten public health threats facing humanity. There are even warnings about a ‘post-antibiotic era’ where minor infections – currently easily treated with common antibiotics – may become deadly.

The numbers are bracing, with estimates of 10 million people globally dying each year by 2050 and an annual impact on the Australian economy of between $142 - $283 billion.

While there’s general recognition of the challenge – in Australia we have the National Antimicrobial Resistance Strategy: 2020 & Beyond – it is clear more needs to be done to help slow the development of AMR.

As we mark World AMR Awareness Week, it’s worth thinking about what those actions could be, which is exactly what a new report from the Australian Antimicrobial Resistance Network (AAMRNet) does. AAMRNet was established by MTPConnect in 2020 to bring together key industry, clinical and research stakeholders to step-up Australia’s efforts to combat AMR.

The report – Fighting superbugs: ensuring Australia is ready to combat the rise of drug resistant infections – examines the threat to human health posed by the rise of drug-resistant infections and presents a series of recommendations that will equip the Australian healthcare system to fight the superbug pandemic.

One of the key challenges is that the the innovation pipeline for new antibiotics is drying-up. The evolving nature of bacteria means it takes only 2-3 years for drug-resistance to develop, while bringing a new drug to market can take between 10 – 15 years. We’re just not keeping pace with public health needs.

The nature of responsible antibiotic use makes the economic case for new medicines challenging. We need access to them, but they also need to be kept in reserve, only used when absolutely needed. And when they are used, it’s only for short periods of time. With reimbursement currently linked to sales volumes, and with phase I to III clinical trials costing upwards of $130 million (and as much again for post-approval follow-on trials), commercial viability is not there.

It’s why today only a handful of pharmaceutical companies have antimicrobials in clinical development.

And there’s the question of access. Compared to the U.S. and European Union, Australia has limited access to existing antibiotics. Only three of the twenty antibiotics considered new and registered in the U.S. and/or the EU since 2011 are registered in Australia. As has been piloted in the U.K., a subscription model could be explored for Australia, one which de-links reimbursement from sales volume, providing more predictable revenue for the manufacturer and improving timely and equitable access to much needed new treatments for drug-resistant infections.

From incentives for more home-grown R&D and globally competitive data and market protections to more point-of-care testing for antimicrobial infections, the recommendations in the new report from AAMRNet, developed in collaboration with specialist health advisory firm Evohealth, capture expert advice and input from leading Australian and international experts in AMR and represent practical steps Australia can take to address the AMR challenge.

The threat of AMR to the health and welfare of Australians and the sustainability of our healthcare system cannot be underestimated.

Through Howard Florey and his Nobel prize-winning work developing penicillin into an antibiotic treatment, Australia has played a key role in the antibiotic revolution of human health, and our researchers, entrepreneurs and industry players can do it again.

The question is, can we break out of the inertia created by COVID-19 pandemic fatigue and commit to real and urgent steps to meet the new silent AMR pandemic.

Hon. Jaala Pulford is chair of MTPConnect and a former Victorian Minister for Innovation, Medical Research and the Digital Economy. 

This Editorial Opinion was first published by InnovationAus on 22 November following reporting of the Fighting Superbugs Report.