Scientists in race to fight drug resistance
What happens if antibiotics stop working? The scientific world describes this threat to global health as antimicrobial resistance, or AMR. One study warns more than 39 million people could die by 2050 unless further measures are taken.
Scientists from Japan and the United Kingdom have teamed up in the race to find a solution.
Dr. Tamura Tsuyoshi sees plenty of patients at his Tokyo clinic who present with the common cold. He does not prescribe antibiotics for them because the drugs are ineffective against a virus. Nevertheless, some patients want them.
"There are patients who feel secure when they take antibiotics," he says, adding, "I cannot refuse them unless I completely rule out a bacterial infection." Dr. Tamura Tsuyoshi of Tamura Clinic in Tokyo
Tamura runs tests to identify the cause of his patients' illnesses to help determine the best treatment. He makes a conscious effort to avoid over-prescribing antibiotics.
Bacteria are constantly evolving: changing their membranes to keep drugs out, expelling drugs, or altering drugs' targets to render antibiotics ineffective. The overuse and inappropriate use of antibiotics are key drivers in accelerating that process – making AMR a global problem. Core of modern medicine
Dr. Matsunaga Nobuaki is an AMR expert at the Japan Institute for Health Security. He warns that if antibiotics stop working, the effects would be far-reaching. Dr. Matsunaga Nobuaki is an AMR expert at the Japan Institute for Health Security.
"People need to realize that antibiotics are the infrastructure behind all modern medical care," he says. "If people can't use them, then cancer patients are at risk, not just from cancer, but infectious diseases. Also, doctors need to consider the risk of resistant bacteria when they do surgery."
Patients undergoing surgery are routinely administered antibiotics to prevent infection, including women giving birth by cesarean section. Cancer patients whose immune systems are weakened by chemotherapy are also at risk. Developing new antibiotics
While the appropriate use of antibiotics is essential to tackle AMR, there is also a need for new antibiotics to replace those that have become ineffective. According to the World Health Organization, the matter is urgent.
Research institutions in both Japan and the UK are teaming up to try and meet this challenge.
Dr. Alicia Demirjian is an infectious disease specialist from the UK Health Security Agency who visited Japan in February. The country used to be a medical powerhouse back in the 1980s, and she says it has the potential to reclaim that mantle. Dr. Alicia Demirjian, UK Health Security Agency, fourth from left, in Japan
"I think we can rely on some of the science that has been done before," she says. "The fact that the public is aware that there have been some very strong Japanese scientists to build on this and bring back the notion that AMR is an important topic, infectious diseases are an important topic, and we know it is possible within Japan." Dr. Alicia Demirjian, UK Health Security Agency
Matsunaga and Demirjian visited Japanese institutions that could make a difference, including Kitasato University in Tokyo.
The laboratories there have collected soil from across Japan, isolating hundreds of microorganisms with the goal of seeing if any can be used to make new drugs. A collaboration is now underway with the University of Warwick in the UK. A researcher outlines the laboratory work to Matsunaga, third from left, and Demirjian, fourth from left.
Kitasato University's President Sunazuka Toshiaki says while the basic research is underway, finding new compounds with potential is a long, difficult process.
"The project offers us a good chance, and I think we can have a win-win relationship," he says of the joint enterprise.
Private companies are also involved. Pharmaceutical firm Shionogi is behind one of the latest antibiotics that works against drug-resistant bacteria. It was approved in the United States in 2019. With approval of the antibiotic's safety and efficacy, it is now used in 26 countries and regions.
Shionogi vice chairperson Sawada Takuko told Matsunaga and Demirjian that many companies around the world do not work on developing antibiotics because it is simply not profitable. Sawada Takuko, Vice Chairperson of the Board, Shionogi
Sawada notes some fledgling drug companies have gone bankrupt even after the successful development and launch of products to market, which risks discouraging progress.
"If young researchers saw that situation, why can they choose infectious disease area for their research?" she says.
Sawada is calling for more government support to sustain the development of new antibiotics. Matsunaga and Demirjian meet with Sawada. Market challenges
In countries like Japan and the UK, governments are allocating funds towards the production of new medicines to tackle AMR.
Japan is investing 1.3 billion yen or more than $9 million annually as incentives for firms that have launched drugs targeting a specific type of drug resistant bacteria onto the market.
The way in which new antibiotics are introduced ― and saved for use at appropriate times ― makes it a long, expensive process. Overusing newly developed drugs would feed into the existing problem. Raising awareness
At a workshop hosted by Matsunaga and Demirjian, participants discussed how to raise public awareness of AMR.
"I think we all now have some homework," says Demirjian. "We have to go back within our respective organizations, continue the advocacy work that needs to be done and then continue to touch base every now and then so that we can keep progressing the work." Reducing AMR's death toll
The estimated number of deaths associated with AMR was nearly five million in 2019. Last year, world leaders at the United Nations committed to reducing that total by 10 percent by 2030.
For now, the WHO wants countries to develop and implement their own AMR action plans. But lower- and middle-income countries have difficulty funding the required initiatives, and also struggle to get testing kits and appropriate medicines. Inadequate sanitation on top of those issues creates a perfect storm for the growth of resistant bacteria.
AMR used to be called a "silent pandemic." Many researchers have dropped that name now that it has become an urgent problem with grave consequences.
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