Vaccinating against superbugs

By Seth Berkley and Jeremy Farrar

GENEVA — Whether you live below the poverty line in the slums of Karachi or work as a banker on Wall Street, drug-resistant “superbugs” are among the gravest threats to your health. But while the problem is ubiquitous, we are not entirely defenseless. On the contrary, in the race to prevent antimicrobial resistance (AMR), the world has a potent if underused tool: vaccines.

One epidemic currently plaguing Pakistan illustrates vaccines’ potential. For two years, health professionals have been trying to contain an outbreak of extensively drug-resistant (XDR) typhoid. Cases linked to Pakistan have even been reported among travellers returning to the United States and the United Kingdom. Unfortunately, diagnosing XDR typhoid is difficult, and doctors often prescribe antibiotics that are ineffective. This, in turn, prolongs the length and severity of the illness, and can lead to death.

But what if doctors in Pakistan could prevent typhoid in the first place? We believe they can. Gavi, the Vaccine Alliance, is helping to distribute a new vaccine, and if the immunisation drive is successful, it will eventually lead to a reduction in unnecessary antibiotic use, which is the main factor fuelling the rise and spread of deadly superbugs everywhere.

Each year, some 700,000 people die from drug-resistant infections worldwide. But superbugs also pose a threat to the effectiveness of modern medicine; if left unaddressed, AMR could make more infections untreatable, cancer therapies ineffective, routine surgeries impossible and even childbirth unsafe.

We already know that vaccines help reduce the risk of AMR. For example, immunisations against bacterial brain and lung infections, like childhood pneumococcal illnesses and Haemophilus influenzae type b, or Hib, have dramatically reduced the disease burden in the US and around the world, lowering the need for antibiotics in the process. Most important, while superbugs develop resistance to medications, they do not become resistant to vaccines.

And yet, despite vaccines’ effectiveness in the fight against AMR, we are not taking full advantage of them. For example, global coverage for the Hib vaccine is 72 per cent, but only about 44 per cent of the world’s children receive the complete course of the pneumococcal vaccine. Universal vaccination for the pneumococcal vaccine alone would lead to an estimated annual reduction of 11.4 million days of antibiotics for children under five.

Simply put, there is an urgent need to increase uptake of vaccines that are already available, including for typhoid, and to develop new ones. For existing vaccines, the top priority should be to ensure universal access, which will require a huge expansion in international coordination. A new report commissioned by Wellcome highlights many further opportunities for vaccines to make a positive impact on global health and AMR.

The World Health Organisation has created a list of deadly pathogens that require new antibiotics, with those that cause salmonella, gonorrhea and shigella at the top. But vaccines are also needed to prevent these diseases in the first place. To accomplish that goal, and stave off AMR in the process, significantly more money must be spent on vaccine research and development. By increasing investments now, new vaccines will be available to help care providers stay ahead of superbugs.

Over the coming decades, demographic shifts, climate change and human migration, will compound AMR by making it easier for pathogens to spread. In fact, if the current trajectory is not slowed or reversed, by 2050 some 10 million people could succumb to drug-resistant diseases every year, costing the global economy $100 trillion. We have no time to waste in bringing new vaccines to market.

Although more needs to be done to strengthen R&D pipelines for new diagnostic tools and antibiotics to treat drug-resistant infections, similar attention must be devoted to vaccine discovery, development and uptake.

When health professionals have the right tools to tackle AMR, millions of lives around the world will be saved. And when effective vaccines are deployed widely, superbugs will cease being so menacing.

Seth Berkley is CEO of Gavi, the Vaccine Alliance. Jeremy Farrar is director of the Wellcome Trust, a global charitable foundation dedicated to improving health. Copyright: Project Syndicate, 2018. www.project-syndicate.org