Less talk, more action needed to avoid silent superbug tsunami

RoverEngland replies: “Yes I get my antibiotics no problem without doctors note in Bangkok. Also they are ¼ price of what I would pay in UK.” 
“Whatever antibiotics you want ... any pharmacies will sell,” another poster confirms. 
This kind of advice and the reality it reflects is one reason why two people every hour die from multidrug-resistant bacterial infections in Thailand. Worldwide, at least 700,000 people a year die from drug-resistant infections. If we don’t act now, this number is projected to jump to 10 million a year by 2050. This will cost the global economy up to $100 trillion and push a further 28.3 million people into extreme poverty.
Unfortunately, many developing countries permit the sale of antibiotics without a prescription. As a result, antibiotics are not used in the way that they are intended, and this is contributing to the rise of resistance. Today microorganisms that cause tuberculosis, malaria, urinary tract infections, and pneumonia are becoming increasingly resistant to a wide range of antibiotics. This emergence and spread of antimicrobial resistance (AMR) could force us back to a time when common infections and minor surgery could prove fatal.
Antibiotic-resistant superbugs have been on the radar for decades, recognised as among the most serious public health threats worldwide. AMR has been discussed at G20 and G7 Summits, and is a priority for the World Health Organisation. Just last year, the Thai government together with the UK, Ghana and the Wellcome Trust called for international initiatives to reduce inappropriate antibiotic use, improve access to existing and new antibiotics and treatments, and build new partnerships across industry, governments and civil society. 
Global battle comes to Bangkok
This week, public health experts, academics, NGOs and businesses are gathering in Bangkok for the Prince Mahidol Award Conference 2018, where discussion will focus on how to make the world safe from the threats of emerging infectious diseases.
Despite the rising concern, we still have not seen anything equivalent to the alarm shown for other pandemics. One reason may be that AMR lacks the recognisable “face” of a disaster like an Ebola or Zika outbreak, which has the power to scare us all. AMR is more of a silent killer. 
To move from talk to action, over 100 biotechnology, diagnostic, generics and research-based biopharmaceutical companies and trade associations have united to combat antimicrobial resistance. Companies working together under the banner of the AMR Industry Alliance have released a report tracking the action being taken by the life sciences industry. It shows that in 2016 alone, AMR Industry Alliance companies invested at least US$2 billion in R&D to counter the threat. The private sector investment is good news, as are the more than 40 new products in late-stage development, but these moves are nowhere near sufficient. High-risk investments for new and desperately needed antibiotics will be difficult to sustain under current conditions where the new drugs should remain on shelves and only be used as a last resort, meaning there is no economic return on these products. To avoid a looming public health disaster, there is an urgent need for action on sustainable R&D incentives that reward success.
We can be more upbeat in terms of actions that safeguard how we use existing antibiotics more effectively. The Alliance report shows that 80 per cent of all responding companies are engaged in activities to support appropriate use. For example, one company has created IDStream.asia, a video-streaming platform for Thai healthcare professionals and policymakers which provides information on complicated bacterial and invasive fungal infections. Also notable is the Antibiotics Smart Use (ASU) programme which emphasises that the common cold with sore throat, acute diarrhea and simple wounds do not require antibiotic treatment. Another company has teamed up with the Thai government on a four-year plan to tackle multi-drug resistant tuberculosis, with drug donations, as well as educational workshops, drug resistant treatment guidelines and active pharmacovigilance. To address the free availability highlighted in the TripAdvisor forum, one company has developed a patient-education campaign to combat overuse of antibiotics, including a self-diagnosis product for sore throat, and displays and brochures in pharmacies to help patients differentiate viral from bacterial infections. 
We applaud the Thai government for its global leadership and the measures it is taking to tackle AMR. Thailand’s national strategic action plan on AMR has some impressive goals, including achieving a 50-per-cent reduction in AMR deaths by 2021. It can rest assured that the AMR Industry Alliance companies intend to live up to their commitments – leading the way on how the private sector can act to fight antimicrobial resistance.

Busakorn Lerswatanasivalee is CEO of PreMA.
Thomas Cueni is chairperson of the AMR Industry Alliance. The Prince Mahidol Award Conference 2018 runs until Saturday at Centara Grand Convention Centre, CentralWorld, Bangkok.