How surveillance programmes can help prevent a post-antibiotic apocalypse (Guest blog)
Surveillance programmes are necessary because they help effectively identify, understand and predict shifting antibiotic resistance patterns. A recent study found that since the year 2000, one-third of antibiotic resistance surveillance programme run in low and middle-income countries have been conducted by pharmaceutical companies, with the WHO, governments and academic networks accounting for the rest.
For well over 25 years, GSK has run antibiotic resistance surveillance programmes. Initially it was through the Alexander Project and then, for the last 15 years, through our Surveillance of Antibiotic Resistance (SOAR) programme which is currently running in 30 countries. Our data show increasing levels of antibiotic resistance in community-acquired infections, which are often less-well studied than hospital-acquired infections.
Long-term surveillance programmes run by pharmaceutical companies produce high-quality data that is of immense strategic and practical value to policymakers, healthcare professionals and the public in the following ways:
Informing local antibiotic prescription guidelines
Firstly, policymakers find surveillance data valuable in helping them establish national antibiotic prescribing guidelines and setting antibiotic usage policies. For example, data from GSK’s SOAR cycle in Turkey resulted in the Ministry of Health updating their antibiotic prescribing guidelines. In 2016, SOAR data led to the introduction of the first-ever antibiotic prescribing guidelines in Ukraine. It is encouraging that, through the 2016 Davos Declaration on Antimicrobial Resistance, pharmaceutical companies committed to sharing their surveillance data with public health bodies and healthcare professionals, and to working with them to improve understanding of resistance trends and inform appropriate antibiotic and vaccine use.
Ensuring antibiotics continue to be effective
Secondly, healthcare professionals use surveillance data to monitor the effectiveness of antibiotics locally for appropriate antibiotic prescription, and to determine infection control strategies and antibiotic usage policies. GSK’s SOAR began as a response to serious concerns that many infections were being treated without identifying the causative pathogen and testing the effectiveness of available antibiotics against them. Unnecessary or ineffective antibiotics promote the emergence of resistant bacteria.
To ensure that the data from GSK’s SOAR is widely available, they are published in an open-access journal. On 12 April 2018, results from the latest SOAR cycle were published in the Journal of Antimicrobial Chemotherapy. They are the first-ever SOAR data for eight countries, namely Bulgaria, Romania, Croatia, Serbia, Slovak Republic, Czech Republic, Russia and Greece; and the second SOAR cycle in Ukraine. In 2017, GSK organised standalone meetings to bring SOAR data to the attention of over 21, 000 healthcare professionals in the relevant countries. The new data will also be proactively shared with relevant healthcare providers. In fact, 60% of companies surveyed in the 2018 AMR Industry Alliance’s Progress Report said they shared data externally. For example, Pfizer provides access to cumulative surveillance data, from their ATLAS program, through a publicly available website. The site supports an interactive platform enabling physicians to evaluate and data, conduct analyses, and export tables and figures. Pfizer also offers ATLAS as a mobile application to enable rapid access. Both the ATLAS webs site and App are regularly updated with new and emerging data from the active surveillance program.
Defining new drug discovery and development strategies
Lastly, the public further benefits from surveillance programmes that help ensure fit-for-purpose antibiotics are developed to treat current and future bacterial diseases patterns. Surveillance data can assist with the identification of emerging medical needs, allow modelling of future resistance trends, and identify high-profile isolates for screening the activity of new agents. In 2016, Merck & Co., Inc. announced a collaboration where it agreed to provide OpGen, a precision medicine company, with access to their antibiotic surveillance programme database, called SMART, which has gathered data over the last 15 years. The hope is that this will accelerate the development of rapid diagnostic tools to enable prompt and informed antibiotic prescribing.
Data obtained through different systems are often complementary. The recently released Access to Medicine Foundation’s AMR Benchmark found that the pharmaceutical companies it assessed ran surveillance programmes across 147 countries, including 94 out of 106 countries where access to medicine is often limited. Leading pharmaceutical and clinical research organisations have recently come together, under the aegis of the Wellcome Trust and the Open Data Institute, to work towards publicly sharing their surveillance data. It is important that governments, international bodies like the World Health Organization and academics also continue to produce other surveillance data, especially macro-level data, and share it with others.
Antibiotic resistance is a dynamic and fast-evolving global health threat, and the timely identification and reporting of resistance patterns continues to be a critical factor in addressing it. We need to continue investing in surveillance programmes, particularly in low and middle-income countries where antibiotic resistance has a disproportionate impact. The UK’s Fleming Fund is a positive model for this. We all must capitalize on the value of antibiotic resistance surveillance programs. Patients should be prepared to provide samples; those that run surveillance programmes should employ the highest ethical and scientific standards and share the data widely; and, policymakers, healthcare professionals and drug companies themselves should use the data for effective decision-making to benefit patients. Otherwise, what many have been described as an impending post-antibiotic apocalypse will become less of a fantasy and more of a real possibility.