Hand washing, disinfection and vaccination could prevent 750,000 superbugs-related deaths per year | Planet of the future

An Indian university student with tuberculosis, a Kenyan veterinarian hospitalized for months due to an infection after surgery, an American gymnast infected with staph, or a child in Indonesia with breathing problems, vomiting and diarrhea: they have all been affected by the “silent pandemic.” how the World Health Organization (WHO) describes antibiotic-resistant bacteria. They are present in nearly five million annual deaths (that is, those affected had an infection even if another cause of death was recorded), and they are the direct cause of 1.27 million of them. Sub-Saharan Africa and South Asia are the two regions with the highest rates of deaths associated with antibiotic resistance: more than 20 per 100,000 inhabitants, compared with an average of 13 in developed countries.

About 750,000 superbugs-related deaths could be avoided each year, especially in low- and middle-income countries, by improving measures such as hand washing and disinfection in health care settings, access to clean water, or the distribution of childhood vaccines. This is one of the findings of a series of four papers published in the scientific journal. Lancet this Thursday (early Friday morning on the Spanish mainland) about “sustainable access to effective antibiotics.” The authors, 38 experts in antimicrobial resistance and global health from around the world, warn that it is a growing problem that will cause more and more deaths if it is not addressed. A 2016 study estimated that it will cause 10 million deaths per year by 2050. year – and this especially affects the most vulnerable groups.

“The small supply of effective antibiotics has declined, especially in resource-limited settings, and the very young, the very old and the very sick are particularly susceptible to resistant infections,” says the first of four texts, which focus on the global scale of the problem and how to measure it . Antibiotic-resistant bacteria “represent a major obstacle to achieving the Sustainable Development Goals, including the goals of neonatal survival, progress in healthy aging and the fight against poverty,” he continues.

Without action, more people will become infected and die from resistant infections, and treatments will become more expensive and potentially unavailable to people in the most resource-limited settings.

Iruka Okeke, Professor of Pharmaceutical Microbiology, University of Ibadan, Nigeria

One of the co-authors, Iruka Okeke, a professor of pharmaceutical microbiology at the University of Ibadan in Nigeria, describes by email the scenario if action is not taken now: “More people will become infected and die from resistant infections. In 2035, resistance to last resort drugs could be more than twice as common as in 2005. Treatment will be more expensive and potentially unaffordable for people in the most resource-constrained settings.”

These environments, which in turn experience higher rates of infectious disease and lower health systems capacity, are precisely “those that stand to gain the most from curbing antimicrobial resistance” with existing tools, Okeke explains. Thus, in low- and middle-income (or developing) countries, 337,000 deaths per year could be avoided due to resistant bacteria acquired in health centers – one of the most common forms of infection – compared with 1.7 million deaths per year today. , improving the prevention and control of infections in them.

These measures include increased adherence to hygiene standards, most notably hand washing by health care workers, as well as improved environmental cleaning, antiseptic techniques, and disinfection and sterilization measures to prevent infections through central or intravenous peripheral devices, catheters, or ventilators. , as well as surgical intervention. According to the mathematical model developed by the authors and discussed in the second article in the series, to achieve such mortality reductions, the standards of prevention and control in these countries must be brought in line with those of high-income countries.

Guarantee universal access to water, sanitation and hygiene services, thereby preventing 247,800 deaths related to antimicrobial resistance.

The study also estimates how many deaths could be avoided in these countries by preventing infectious diseases in the population and reducing the use of antibiotics to combat them. One method is to guarantee universal access to water, sanitation and hygiene services, which would prevent 247,800 deaths related to antimicrobial resistance, although the article warns that achieving this figure requires better measures than currently proposed.

Another tool is to achieve universal coverage of pediatric vaccines, which would prevent 181,500 deaths through both direct prevention of resistant infections and reductions in antibiotic consumption, according to the analysis.

Triple Aim

Okeke said the measures, which would reduce the death rate associated with resistant bacteria in developing countries by 18%, are “realistic even in resource-limited settings.” The authors of the series have a triple global goal by 2030, outlined in the fourth article: reduce antimicrobial resistance by 10%, reduce inappropriate use of antibiotics in humans by 20%, and inappropriate use in animals by 30%. To this end, they are calling for prioritization of actions proposed at the UN General Assembly in September.

“Our results show that a 10% reduction in the global incidence of antimicrobial resistance by 2030 is achievable with current measures. Our results should direct investments in public health measures towards those with the greatest potential to reduce them,” the text says.

However, these actions are not enough to ensure that everyone who needs it has access to affordable and effective medicines. “The growing number of bacterial infections around the world that do not respond to available antibiotics highlights the need to invest in and ensure access to new antibiotics, vaccines and diagnostics,” says the third article in the series.

Guaranteed access

“The traditional drug development model, relying on significant revenues to motivate investment, is no longer economically viable without incentives,” he says. “Moreover, drugs developed through these mechanisms are unlikely to be available to all patients who need them, especially in low- and middle-income countries.” The text advocates “new government funding models based on public-private partnerships” to support investment in antibiotics and new alternatives while reducing costs for patients.

Nour Shamas, a 36-year-old Lebanese woman, is a clinical pharmacist specializing in infectious diseases and a member of a working group established by WHO in 2023 for survivors of antimicrobial resistance. She knows the problem very well, not only because of her work, but also because several years ago her mother, now 69, contracted a persistent and recurring urinary tract infection after being hospitalized for spinal surgery. Shamas appreciates the measures proposed in the articles in Lancet, But he warns that although they seem very simple, “each of them has its difficulties.” “For example, washing your hands: even if you have clean water and soap, the hospital may not have enough nurses, so those who are there are very overworked. Sometimes they don’t wash their hands, sometimes they wash them but don’t spend 30 seconds rubbing them. Or maybe they forget because they move from one patient to another. And sometimes people get tired and burn out,” he explains.

In a video call from Riyadh, where she works, Shamas admits she is privileged to be able to afford the expensive antibiotics and tests her mother in Lebanon still needs every two or three months. The country is in crisis, where even with money it is difficult to find medicine. “We paid for lab tests to check what type of resistance he had and determine the best antibiotic to treat the initial episode. And now, every time he gets infected again, he has to take another test to find out which antibiotic to use. Often he starts with one, and after two or three days he has to move on to another,” he describes.

The WHO working group he is on, made up of 12 survivors or relatives of victims (some of whose stories were quoted at the beginning), wrote a commentary, also published in a scientific journal, that addresses “all those” who are working on the issue of sustainability to antimicrobials, taking the patient’s perspective into account in our work and taking a person-centred approach.” “Antimicrobial resistance transcends borders, visa requirements and conflict zones. It can affect anyone, regardless of their wealth, race or region in the world,” they recall.

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