‘Pandemic’ is a word that the world really does not want to – understandably – hear right now. But it needs to.
That continues to be true for Covid-19, with the officially recorded global death toll nearing seven million. The impending northern winter presents major risks to which nations are increasingly, deliberately, blind. Yes, #CovidIsNotOver.
But it is also true more broadly. For there’s another pandemic continuing to rage – among animals rather than humans – that of highly pathogenic avian influenza (HPAI). This usually has emerged from Asia, but we are currently seeing new, intense outbreaks centred in Africa and Europe. It is spreading to mammals – factory-farmed mink being a particular risk, as well as, of course, the hideous torture centres that are factory-farmed poultry.
It is a reminder that we have created a world that could have been designed to promote the development and spread of deadly viruses and bacteria – as Covid-19 emerged from human-bat interaction. We’ve invaded and destroyed huge swathes of the natural world, opening new spaces for new and old threats to humans. As French philosopher Bruno Latour noted, like Macbeth, none of us now can avoid Birnam Wood.
A threat, exacerbated by Covid-19
And there’s another threat looming: known diseases, for which there have been treatments, which have become increasingly ineffective as a result of human action. A result of the world we have created: the world of war, of pollution, of profligate use of pharmaceuticals. The Covid-19 pandemic catalysed a rise in antimicrobial resistance (AMR). Future pandemics must not be allowed to do this, or we raise even further the risk of AMR, allowing the revival of a historic danger we thought we had conquered – mortality and morbidity from common infections.
As the Covid-19 inquiry is revealing more clearly by the day, our current systems are utterly inadequate for the dangerous world we face. Innovative technologies and practices will not be enough to save us from the next pandemic: we must improve communication and coordination between science and policymaking. The UK must create government positions capable of bridging this gap and lead the way in aligning policies for the highly interconnected issues of pandemic preparedness and AMR.
The UK can lead the way on AMR
As inadequate as our governmental provisions are, the UK is a rightfully acknowledged leader in AMR research, and there is an opportunity for genuine, constructive leadership to improve global readiness for inevitable future pandemics. This has to include viral outbreaks, but also the wide range of imminent threats from other pathogens like bacteria and fungi.
AMR means fewer effective drugs are available for treating infections, compounded by a lack of new drugs being developed to replace them. Bacterial AMR was associated with an estimated five million deaths in 2019, and is one of the World Health Organization’s (WHO’s) top ten global health threats.
AMR is globally recognised as vital to pandemic preparedness
A complex interaction of factors drove increases in AMR during Covid-19, including changes in patterns of antimicrobial prescribing and infection prevention strategies, and consequences of intense pressures on health services. As policies and strategies are developed for future pandemics, we have a chance to capitalise on the interconnectedness of pandemics and AMR, taking a One Health perspective that recognises the role of sectors such as agriculture and industry in zoonosis, spread of infection, and proliferation of AMR due to environmental exposure to antimicrobials.
At a global level, WHO began a negotiation in the wake of Covid-19 for a new global health treaty or ‘pandemic instrument’ on pandemic prevention, preparedness, and response. Arguments to include AMR and the benefits to broadening the view of pandemic preparedness have been highlighted in the academic literature with a collection of publications spanning many disciplines including law, anthropology, history, public health, public policy, economics, and veterinary medicine. There is already significant overlap in the actions needed to address AMR and pandemics more widely. Both rely on strategies for infection prevention, investment in research, and disease surveillance.
The causes and consequences of AMR are far-reaching
Not only has AMR risen since 2019, but it has widened the gap in global health inequality, as highlighted by a systematic review and meta-analysis of AMR in patients with Covid-19. The report found a higher incidence of antimicrobial resistant infections in low- and middle-income countries than high-income countries. Lack of clean water, sanitation and hygiene in less developed countries is driving the spread of resistant infections. As highlighted in the ‘Prevention first’ report from the all-party parliamentary group (APPG) on
antibiotics, and APPG on water, sanitation and hygiene: “We can’t win the battle against antibiotic resistance without acting on the water, sanitation and hygiene crisis in healthcare facilities now.”
I, alongside other concerned parliamentarians, have previously raised to government through the APPG on Antibiotics, that the policy approach for viral pandemics should be combined with ongoing efforts to contain and control drug-resistant infection. This could be accomplished through establishing a named Cabinet Office minister, capable of coordinating objectives across a myriad of departments, breaking down silos and streamlining efforts.
An opportunity not to be missed
This week is World AMR Awareness Week. To fail to recognise the need to integrate pandemic preparedness and AMR would be to miss an opportunity to streamline efforts and take great strides in tackling two of the most critical global health challenges facing us today. The government must make every effort to support international organisations to integrate AMR into preparedness strategies, and, at a national level, appoint a government minister with a role to address drug-resistant infection and pandemic prevention and preparedness.
This article was written with Katy Stokes, working with me as a senior intern supported by the British Society for Antimicrobial Chemotherapy
