In October 2022 the WHO published a report that highlights the “first-ever” list of fungal priority pathogens. This is a “catalogue” of 19 fungi that “represent the greatest threat to public health”. Known as the FPPL, this list is the first global effort to “systematically prioritise fungal pathogens. The report also acknowledges the “unmet research and development (R&D) needs and the perceived public health importance”.
“The Who FPPL aims to focus and drive further research and policy interventions to strengthen the global response to fungal infections and antifungal resistance.”
Threats and treatments
Although fungal pathogens are a “major threat to public health” there are only “four classes” of antifungal medicines available with limited future candidates. These threats are becoming “increasingly common” and resisting the treatments that are available. The WHO’s statement indicates that we are ill-prepared with sufficient diagnostics. Those that are of an adequate level are “not widely available or affordable globally”.
The most vulnerable to invasive fungal infections include patients with prior illnesses or “underlying immune system related conditions”. For example, patients with cancer, HIV/AIDS, or post-primary tuberculosis infection are at greater risk of invasive fungal infections.
The WHO identifies evidence to suggest that the “incidence and geographic range” of these diseases are expanding due to global warming and globalisation. Furthermore, the COVID-19 pandemic saw an increase in reported incidence of invasive fungal infections among patients in hospitals. Dr Hanan Balkhy, WHO Assistant Director-General, AMR, described the threatening increase:
“Emerging from the shadows of the bacterial antimicrobial resistance pandemic, fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide.”
Although this is clearly a worrying phenomenon, we have devoted “very little attention and resources” to fungal infections. Thus, data are scarce. If we cannot know the “exact burden” of this threat, an appropriate response is unlikely.
The FPPL is divided into three categories: critical, high, and medium priority. However, WHO “emphasises that the FPPL must be interpreted and contextualised”. This is because some pathogens are of more concern in “regional or local contexts”. Throughout the report the phrase “no vaccine is available” emphasises how important further research will be. If we are unable to prevent cases, then our reliance on appropriate treatment is greater.
Calls for evidence and action
The report emphasises the need to continue compiling evidence “to inform the response to this growing threat and to better understand the burden”. It also calls for “coordinated action”. Dr Haileyesus Getahun, WHO Director, AMR Global Coordination Department, hopes the “inform and improve” the response to these pathogens.
“Countries are encouraged to follow a stepwise approach, starting with strengthening their fungal disease laboratory and surveillance capacities, and ensuring equitable access to existing quality therapeutics and diagnostics, globally.”
There are three primary recommended points of focus within the strategies proposed. They are focused on:
- Strengthening laboratory capacity and surveillance
- Sustaining investments in research, development, and innovation
- Enhancing public health interventions for prevention and control
The statement from WHO links resistance to antifungal medicines to “inappropriate antifungal use across the One Health spectrum”. Further collaborative efforts are required across this spectrum to address the “impact of antifungal use on resistance”.
To hear more about preparing for priority pathogens at the World Vaccine Congress in Washington 2023, get your tickets now.