The threat of an infectious disease pandemic killing tens of thousands of people across the globe is no longer a theoretical nightmare.
The World Health Organisation’s ‘Disease X’ is here and despite consistent efforts by the WHO and others to keep the political focus on this threat, the world has been caught largely unprepared.
If there are lessons to be learnt from the coronavirus global pandemic, it is that too many political decisions are based on short-term thinking that ignores laws of nature.
Biology dictates how organisms evolve, particularly when we put pressure on them.
With our growing advances and interference into the previously undisturbed natural world, viruses will continue to jump into human populations with devastating effects.
Naturally, viruses provide an excellent opportunity for secondary infections, especially those caused by bacteria, in humans whose immune system has already been depressed by the viral infection.
But with the large-scale and inappropriate use of antibiotics to treat and manage such infections, resistance to antibiotics is bound to increase.
The link between Covid-19 and drug-resistant infections is more troubling than many may realise.
Antibiotics, while not effective against viruses, are being used frequently on Covid-19 patients to prevent or treat suspected or confirmed secondary bacterial infections.
An early study from China shows secondary infections causing bacterial pneumonia, bloodstream infections, sepsis and hospital-acquired infections were present in half of all deceased Covid-19 patients.
EXACT BURDEN UNKNOWN
Kenya is experiencing increasing levels of antimicrobial resistance (AMR) to commonly available treatment options. Although we have indication of resistance levels based on sentinel site surveillance in a few hotspots, the exact burden of AMR in Kenya is unknown and its severity may be exacerbated by the Covid-19 pandemic.
As bacterial infections increase, antibiotics will be in high demand. And many of these infections are increasingly resistant to existing antibiotics. There are also a growing concern that the increased use of antibiotics, coupled with disrupted supply chains, could soon lead to critical shortages of these key drugs.
And there is another effect of Covid-19 that is less well understood. As governments and healthcare infrastructures focus on the pandemic response, numerous research efforts, including surveillance and monitoring, to fight drug-resistant infections are slowing down or coming to a halt. This is compounded by closure of laboratories and inability of people to participate in non-Covid-19-related clinical trials, including of new antibiotics.
In the medium- and long term, the economic shocks of the pandemic may mean financial resources are diverted from investment in critical health systems, including antimicrobial research and development.
The consequences would be severe — ranging from significant delays or even cancellations of critical research and development programmes to closure of research programmes working on diagnostics, vaccines and treatments. Ultimately, it could mean the preventable loss of lives.
Ensuring the effective and prudent use of antibiotics can save lives now and during future disease outbreaks. In terms of better understanding and addressing the impact between Covid-19 and bacterial infections, there are steps that can be taken by governments, policymakers, funders and researchers.
First, let’s assess how secondary bacterial infections, antibiotic use and drug resistance affect the survival or death of Covid-19 patients. Secondly, protect global access and supply of critical antibiotics required by healthcare systems, especially while these systems are coming under intense pressure.
Thirdly, prioritise the development of treatments options, including WHO-approved vaccines to tackle drug-resistant infections. It is essential that such efforts are supported now and accelerated once the pandemic subsides. There is a need to invest in public health and healthcare systems and collaborative research and development.
Antibiotics, the backbone of our ability to respond to disease outbreaks, are also under threat. New, effective interventions are already needed now and this demand will increase.
Just like Covid-19, antibiotic resistance is a health security crisis that moves silently within populations and knows no boundaries. No country, company or organisation can fight drug resistance alone but in partnership and across different sectors of human and animal health. We must act now to prevent drug-resistant infections from becoming the next global public health emergency.
Dr Balasegaram, a British medical doctor, is the executive director of the Global Antibiotic Research and Development Partnership (GARDP) in Geneva. Prof Kariuki is the director, Research and Development, Kenya Medical Research Institute (Kemri).