In a white paper shared in November, Vaccines Europe explores how vaccination can be a “valuable tool” to address the considerable and growing threat of antimicrobial resistance (AMR). The release of this paper comes just before European Antibiotic Awareness Day (EAAD) on 18th November, a European health initiative that “provides a platform and support” for campaigns on the “prudent use of antibiotics” in the region. It also precedes World AMR Awareness Week, a WHO campaign from 18th to 24th November.
WHO states that World AMR Awareness Week (WAAW) is celebrated to “improve awareness and understanding” of AMR, and “encourage best practices among the public, One Health stakeholders, and policymakers”. Each of these groups is responsible limiting the emergence and extent of AMR. The theme is “preventing antimicrobial resistance together”, and the focus for 2023 is on recommendations for combatting AMR including:
- National action plans
- Surveillance and monitoring of antimicrobial resistance and antimicrobial consumption
- Infection prevention and control
- Antimicrobial stewardship and prudent use of antimicrobials
- Recommended targets for antimicrobial consumption and antimicrobial resistance
- Awareness, education, and training
- Research and development and incentives for innovation and access to antimicrobials and other antimicrobial resistance countermeasures
How bad is AMR?
Antimicrobial resistance (AMR) is described by Vaccines Europe as a “major challenge of our times”. It is a “global public health issue” and a “societal issue” according to the United Nations’ Sustainable Development Goals (SDGs). The report states that 4.91 million deaths were associated with bacterial AMR in 2019, a figure that could increase to 10 million deaths a year by 2050. The human cost would be associated with a financial burden too; by 2050 AMR is estimated to generate costs of between $300 billion and $1 trillion a year.
“AMR is an inherent natural process occurring in microorganisms, which can be enhanced by multiple drivers, the most significant being the overuse and misuse of antibiotics both in humans and animals.”
As the quotation above acknowledges, AMR may be natural but the rate at which it is causing problems is not. There are many initiatives in place that try to tackle AMR through a One Health approach, but these do not adequately address the effects of AMR, which is “exacerbated by inadequate infection control” and “limited treatment alternatives”.
What good is vaccination?
“Vaccination is now recognised to be a cost-effective tool in the fight against AMR. It has the capacity to address AMR-related health consequences by preventing deaths and complications, decreasing the prevalence and transmission of resistant pathogens, and reducing the misuse and overuse of antimicrobials.”
Despite the benefits associated with vaccination, vaccine development “remains a challenging task”, according to the paper. Obstacles include “scientific hurdles”, “high costs”, and “prolonged licensure review” processes. Even where effective vaccines have been developed, their global coverage remains “low”. However, Vaccines Europe predicts that more vaccines will become available in the future.
“To fully harness the benefits of vaccines in addressing the unmet medical needs associated with infectious diseases and AMR, comprehensive efforts are required across the entire value chain.”
To this end, the paper offers recommendations to ensure that the development, availability, and use of vaccines is applied “in synergy” with other tools against AMR.
“The solution resides in the complementarity of prevention and other tools.”
Strategies and suggestions
What does the paper suggest? The figures below illustrate strategies for both existing and upcoming vaccines.
The conclusion calls for “additional efforts” to “facilitate the development and introduction” of these upcoming vaccines alongside promotion of the “appropriate use” of existing vaccines. “Appropriate support” from the private and public sector, such as “innovative financing mechanisms” and partnerships would encourage “more efficient” vaccine development.
Another recommendation is the development of regulatory guidance and frameworks to “support the value of vaccines” in addressing AMR.
“It is crucial to integrate the impact of vaccines on AMR control into decision-making strategies of regulatory agencies, health technology assessment (HTA), and national policies.”
Within this, healthcare professionals “play a pivotal role” and should be supported through understanding the benefits of vaccines and their role against AMR. This can be accompanied by public awareness programmes and the integration of life-course immunisation into vaccination strategies.
“To accomplish these goals, there is a need for policies and systems that facilitate the generation of robust real-world data for measuring the impact of vaccines in Europe. By investing in the development and widespread adoption of existing and future vaccines, we can better protect public health, reduce the risk of antibiotic resistance, and ultimately address the unmet medical needs associated with infectious diseases and AMR.”