AMR Action Fund’s recent backing of Basel-based BioVersys to develop new antimicrobial agents is an exciting step for the $1bn fund. No new class of antibiotic has been discovered since the 1980s, yet resistance to the antibiotics that clinicians have available to tackle infections has steadily worsened.
In 2019, nearly five million deaths were associated with bacterial antimicrobial resistance. This silent pandemic is growing and on course to take the lives of ten million people a year within three decades – the equivalent of the population of Scotland, Wales and Northern Ireland combined.
New antibiotic research
In India, it has been reported that the rate of mortality due to drug-resistant infections is 13%, independent of the reason for admission to hospital – that translates to a one in ten chance of dying from a drug-resistant infection if you are admitted to a hospital, regardless of the reason for admission.
And while the incidence of AMR is particularly severe in India, it is not confined to the sub-continent. It is an issue touching every country in the world that is worsening by the year. Without action, the cost in terms of lost global production between now and 2050 will be an estimated $100trl.
Too many new drug companies have gone bankrupt developing antibiotics for a market built on selling at scale rather at smaller volumes based on need. In the last decade, global pharmaceutical brands have pulled out of antibiotic research and production entirely.
We need more investments of the type being led by the AMR Action Fund to ensure there is a steady pipeline of new drugs available to treat evolving infections. Whilst new antibiotics are one front in the battle against superbugs, new rapid diagnostics are urgently required too.
At present, it can take two or three days in a lab to identify a bacterial infection and an antibiotic that the patient will respond to. If you’re a GP who has to decide on treatment after a 10-minute appointment, or an emergency physician presented with a potential sepsis case, the current diagnostic process does not work.
And this is the problem. Because doctors cannot wait three days, their only option when presented with suspected sepsis for example, is to prescribe antibiotics empirically – basing a prescription on their best judgement without the support of an accurate test result. It means antibiotics are prescribed when they may not be needed. It means that the wrong antibiotic might be prescribed for tackling a specific infection. When we expose bacteria to antibiotics unnecessarily, we create opportunities for bacteria to develop resistance to those drugs.
Diagnostic testing
As new drugs come to market, they need to be accompanied by a new generation of accurate and rapid diagnostic tests that can be deployed at point-of-care. Diagnostics not only need to identify whether an infection requires antibiotics, but go one step further and identify the specific antibiotic needed to kill an infection the first time round. Tests like these will help us conserve the antibiotics we currently have available to us and maximise the longevity of future drugs.
There are innovators around the world developing these new diagnostics, capable of producing accurate results in under 60 minutes. They have been incentivised to develop these tests by the Longitude Prize on AMR.
They include Sysmex Astrego, an in vitro diagnostics company based in Uppsala, Sweden. It has developed a rapid urinary tract infection (UTI) test based on single cell microscopy in a nanofluidic chip. The test detects the presence of bacteria-causing UTIs within 15 minutes and can identify the appropriate antibiotic to treat 90% of UTI-causing pathogens within 30 minutes.
Pinpointing infections
Llusern Scientific based in Pontypridd, Wales, has developed Lodestar DX, a low-cost, point-of-care molecular diagnostic platform designed to test for UTIs – an issue that half of all women in the UK will experience in their lives. The simple-to-operate machine requires limited training and with the push of a button will identify which infection is present from a small sample.
To scale and have a global impact for all of us, diagnostic innovators also require similar investments as those made by the AMR Action Fund.
AMR Action Fund’s investment in BioVersys is its first in Europe, and I am confident it will not be its last. New antibiotics are crucial if modern medicine is to retain its ability to treat bacterial infections. Without these drugs we face the very real danger of a world where a cut finger could be deadly. But we must encourage similar investments in rapid diagnostic tests that can be used at the point-of-care to ensure we preserve these precious drugs for generations.