To celebrate the launch of the PLOS Antimicrobial Resistance Channel PLOS ONE Associate Editor George Vousden summarizes the key themes from the official launch in Geneva at the end of May 2018.
The last decade has seen dramatic decreases in the efficacy of first line treatments against many infectious diseases caused by bacteria, parasites, viruses and fungi. New resistance mechanisms are emerging in more and more micro-organisms and threaten our ability to treat common infectious diseases. For example, according to the World Health Organisation (WHO), it was estimated that 480 000 people developed multi-drug resistance to tuberculosis in 2014. It is clear that antimicrobial resistance (AMR) is a serious threat to global health involving multiple stakeholders. Without action the WHO predicts that AMR could increase the cost of health care and hinder developmental goals in low and middle-income countries.
In recognition of the importance of this threat and the potential research can play, PLOS has collaborated with the Global Antibiotic Research & Development Partnership (GARDP) to launch a new PLOS Channel devoted to Antimicrobial resistance. Overseen by 8 Channel Editors, the PLOS AMR Channel will act to serve the community by highlighting research from across the four pillars of AMR research: basic science, research and development, appropriate use and access and surveillance and epidemiology. In addition to research content, the Channel will also serve as a centralized hub to feature commentaries, blogs and other news items.
As the GARDP is a joint venture between the Drugs for Neglected Diseases Initiative (DNDi) and the WHO, the PLOS AMR Channel was recently launched on the 22nd of May to coincide with the 71st World Health Assembly, organized by the WHO. To celebrate the launch of the Channel, five of the Channel Editors, Manica Balasegaram, Carmem L. Pessoa-Silva, Ingrid Smith, Peter Bayer and Ursula Theuretzbacher joined Clare Stone, Managing Editor of PLOS Medicine in a panel discussion. With the focus on the four pillars of the Channel, panellists discussed a variety of topics, from how stakeholders must move away from working in silos to finding integrated and prioritised ways to address the complexity of AMR, which we summarize below.
Diagnostics and surveillance
One of the first key themes to emerge from the session was the importance of collecting data that are representative of the populations affected by AMR. As discussed by Manica Balasegaram, the Director of the GARDP, accurate disease surveillance is necessary to adequately understand the populations affected by resistance. This information can then be used to understand where to prioritise registration and early access to newly developed products.
Carmem L. Pessoa-Silva, who joined the WHO in 2005 as the leader of the program ‘Antimicrobial Drug Resistance’ echoed these sentiments saying that we need better surveillance data to better understand who is being affected by AMR, where it is happening, and the severity of the issue at hand.
In recognition of the importance of collecting accurate surveillance data the WHO has in fact just recently launched the Global Antimicrobial Resistance Surveillance System (GLASS). GLASS aims to provide a standardized approach to the collection, analysis and sharing of AMR surveillance data, combining patient, laboratory and epidemiological surveillance information.
Whilst Carmem praised the progress made by the WHO in the development of GLASS, she explained that low- and middle-income countries still often lack the resources to effectively monitor AMR, stressing that financial support must be provided to these countries to assist in disease surveillance.
Another topic extensively discussed by panel members was antimicrobial stewardship. This is a set of principles to follow when handling antimicrobials to reduce the risk of AMR that should guide drug use at all levels of society. Ingrid Smith, a technical officer for the WHO, explained that at the core of any stewardship program is the appropriate use of antibiotics – the key driver of resistance in the world today is massive overuse. Ursula Theuretzbacher, a microbiologist and an expert on antibacterial drug research and development (R&D) strategies, emphasised that we must stop using antibiotics where they do not work, and refrain from using broad-spectrum antibiotics when we can use more narrow-spectrum drugs.
In an effort to guide clinicians regarding the appropriate use of antibiotics the WHO have recently revised their List of Essential Medicines. Since 1977 the list produced by the WHO has outlined medicines that it considers necessary to meet the most important needs of a health system. As explained by Peter Bayer, Senior Advisor for the WHO, in the most revision of this list antibiotics were grouped into three categories – ACCESS, WATCH and RESERVE. All individuals should have access to antibiotics in the ACCESS group and the WATCH group should only be used when needed and their use should be dramatically reduced. RESERVE group treatments should not be used at all in animals, and only in humans if really necessary, including cases of life-threatening infections due to multidrug-resistant bacteria.
Breaking down silos
The central theme of the discussion was breaking the silos of research in AMR and the importance of multidisciplinary, collaborative research. The panel were unified in the view that we must ensure that there is communication between the multiple stakeholders involved in AMR.
Channel editor Ursula Theuretzbacher discussed the importance of basic science in the fight against AMR, explaining how many of the pipeline discoveries have been through basic science projects; this information is critical to inform new potential drug targets. Basic science is also essential for other aspects of AMR research, including stewardship and methods of surveillance.
The panel agreed that collaboration from multiple stakeholders is required to optimise the use of existing antibiotics, which are significantly more effective than newly developed compounds. Ingrid explained that we need basic science research to provide information as to when bacteria are most sensitive to antibiotics. This information can be used when creating stewardship programs that optimise the use of existing antibiotics to maximise efficacy and minimise toxicity.
Manica also stressed that the ability to share experiences and bring partnerships together is critical. This emphasises the value of the AMR channel. This will act as a community resource and allows individuals with very limited time to get updates on a range of cross-cutting issues on this important topic.
For details of how to submit your work to PLOS AMR Channel please see here.
Featured Image, PLOS CC-BY 4.0
Image of Panel Discussion, PLOS CC-BY 4.0
Antimicrobial Resistance Plate Iqbal Osman CC-BY 2.0 from flickr