Conference Presentation, Panel
Outsmarting Superbugs: What Are the Alternatives?
Milken InstituteMargaret Hamburg, Matthew Hepburn, Peter Jackson, Nancy Knight, Jeanette Mucha, Peter Piot, Peggy Hamburg, David Wallace, Lance Price
- Global annual deaths from antimicrobial resistance (AMR) are projected to rise from 700,000 to 10 million by 2050 if current stewardship and development trends persist unchanged.
- Unchecked AMR is estimated to impose economic costs measured in tens of trillions of dollars by 2050, causing global healthcare costs to exceed one trillion, reducing global exports by up to 3.8 percent annually, and potentially increasing extreme poverty by 28 million people in low-income nations where AMR could erode approximately 5 percent of GDP.
- Current AMR impacts are viewed as non-cyclical and persistent, contrasting with the 2008 financial crisis, with existing untreatable malaria cases reported in Cambodia, Thailand, and Burma, and drug-resistant tuberculosis survival rates on third-line therapy remaining between 30 and 40 percent.
- A yearlong AMR challenge is underway with over 100 global organizations committed, aiming to increase visibility and urgency, while the Global Health Security Agenda involves over 60 countries, with over 70 nations having their systems assessed yielding an average score of two out of five.
- The U.S. CDC is launching initiatives to support Haiti in rebuilding laboratory systems for drug-resistant tuberculosis diagnostics using GeneXpert technology and assisting India in establishing surveillance systems for resistant urinary tract infections.
- Corporate and public health entities are implementing specific stewardship plans, including CVS Minute Clinics prioritizing education across 3,000 sites, Doctors on Demand targeting a 20 percent reduction in unnecessary antibiotic prescribing for upper respiratory infections by year-end, and Petco and Walmart committing to restrict prophylactic antibiotic use and report on antibiotic practices within their respective supply chains.
- Funding and development efforts include Carb-X investing $80 million by year-end for over 40 projects, the Combating Antimicrobial-Resistant Bacteria Initiative elevating AMR to a national security priority to enable DARPA resource reallocation, and the Milken Institute and Faster Cures dedicating themselves as partners in the global challenge.
- DARPA is developing novel therapeutic approaches, such as modulating human host response to infection inspired by animal tolerance and engineering DNA to instruct muscle cells to produce antibodies at a fraction of traditional costs.
- Biotech innovation is focused on live biotherapeutics and hybrid yeast technologies, such as Cybac's products designed to neutralize 96 percent of C. diff toxins within hours and prevent pathogen binding or spore formation.
- The UK has launched a five-year AMR strategy to address R&D gaps, featuring an 18-month trial of "pull incentive" models intended to encourage private capital return to the antibiotic sector through market reforms.
- Regulatory progress includes the FDA limiting antibiotic use for growth promotion and requiring veterinary oversight in animal husbandry, alongside partnerships with industry to improve clinical trial strategies and efficacy demonstrations.
- Future clinical trials are predicted to increasingly occur in remote endemic regions like China due to insufficient patient numbers in Western markets, though some new product strategies face viability risks regarding cost and market access.
- Long-term solutions are predicted to require sustained international political focus comparable to HIV, with experts advocating for the inclusion of clean water and wastewater investments in sustainable development goals and the mobilization of private capital through necessary reforms.