Drug-resistant infections: A silent pandemic that must be tackled now

The COVID-19 crisis has primed governments to invest substantially in pandemic preparedness, a lesson that must be replicated to fight the alarming growth of drug resistance globally, write Manica Balasegaram* and Yogendra Kumar Gupta**.

doi:10.1038/nindia.2020.176 Published online 20 November 2020

Key antibiotics cannot be used without prescription but lack of enforcement can lead to significant overuse.

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Drug-resistant superbug infections kill an estimated 700,000 people each year. This annual number is estimated to rise to 10 million by 2050 as resistance to antimicrobial agents grows and weakens people’s ability to treat even common infections. Drug resistance continues to make a worrying number of infections harder and more complicated to treat. Unabated, this silent pandemic could make common diseases like pneumonia, urinary tract infections and infections in newborns untreatable in future.

COVID-19 is the world’s first pandemic experience for a generation grappling in parallel with the scourge of drug resistance. A key takeaway from COVID-19, however, is that governments are now willing to make substantial and long-term investments to prepare for such global health crises. The evolving pandemic of drug-resistant infections has the potential to cripple the world in the same way as COVID-19. Unlike with COVID-19, however, the world knows what it will take to combat drug resistance. Countries need urgent action to address decades of disinvestment in late-stage antibiotic research and the lack of access to antibiotic treatments. Strong leadership, global collaborations and national investments to counteract the threat of drug resistance could avert a potential catastrophe.

In several countries like India, antibiotics, while not effective against viruses, are being used frequently in people with COVID-19 to prevent or treat suspected or confirmed secondary bacterial infections. Even though key antibiotics cannot be used without prescription, the lack of enforcement can lead to significant overuse, further fuelling antibiotic resistance. 

COVID-19 has taught the world another important lesson – that pandemic preparedness requires a globally coordinated effort, and no country can do it alone. Strengthening the world’s ability to fight drug-resistant infections requires a sustained, coordinated response, which must also ensure affordable access to solutions. Particularly critical to tackling drug-resistant infections is the One Health concept, recognising the importance of connecting the health of people to both the health of animals and our shared environment. Drug-resistant infections move silently within populations and between animals, humans and environments; they do not know boundaries, and neither should the world’s responses.

COVID-19 has reinforced the concept of a global community, where health and well-being are inextricably linked regardless of geographies or nationalities. Solutions will therefore only be successful if they are available to everyone around the world, including those in low- and middle-income countries, and if their reality, know-how and capacity are part of a comprehensive response. Ensuring universal research and development; and equitable and affordable access to solutions must be a cornerstone of pandemic preparedness and response.

The fight against drug-resistant infections will rely on governments seizing this opportunity to develop a more robust, coordinated and equitable approach to pandemic preparedness and global health security. Our success in fighting this pandemic will depend on the motivation now to secure investment and ensure access to solutions like better surveillance of resistant infections, strong infection prevention and control, healthy enforcement of antibiotic policies, tests to identify resistance and the development of novel antibiotics.

[*Manica Balasegaram is the Executive Director of the non-profit Global Antibiotic Research & Development Partnership (GARDP). **Y K Gupta is the Principal Advisor, India Strategy Development, GARDP and President, All India Institute of Medical Sciences, Bhopal.]