Vaccines: Vital in fighting antimicrobial resistance

In this online exclusive, Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), looks at the importance of vaccines in the fight against antimicrobial resistance (AMR).

We have been lucky to live through a period of improving global public health, facilitated in part by innovation from and partnerships with the pharmaceutical industry. However, we now find ourselves facing a new threat from an old foe — infectious disease through AMR. The challenge ahead is extensive but this World Immunization Week reminds us that we already have access to an underused AMR defence — vaccines.

AMR develops when an infectious microorganism (bacteria, virus, parasite and fungus) no longer responds to a drug to which it was originally sensitive. Drugs can lose their effect because the microbes change; either they mutate or acquire genetic information from other microbes to develop resistance. The phenomenon is accelerated by use, and especially misuse, of antimicrobial medicines whereby resistant strains survive and aggregate.

Antibiotic resistance has the power to transport us back to a time when minor infections were deadly. As an example, since the 1970s the typhoid bacteria has been evolving and typhoid, an otherwise vaccine-preventable infectious disease, is becoming increasingly resistant to antibiotics, resulting in the emergence of multi-drug resistant typhoid. AMR is responsible for around 700,000 deaths annually but this could rise to 10 million by 2050, surpassing the number of deaths expected from cancer, if major action isn’t taken soon. Beyond the tremendous increase in mortality, direct medical costs and loss in productivity could cause a huge financial burden of around 60–100 trillion US dollars a year.

Immunisation has a crucial role to play in the reduction of AMR. Vaccines are one of the most cost-effective health tools; every dollar spent on immunisation is estimated to provide returns of $44 in economic and social benefits.¹ In regards to AMR, vaccines can help to:

• Reduce the use of antibiotics by preventing bacterial infections before they occur, thus removing any need to treat the infection. Increasing access to vaccines such as pneumococcal and meningococcal conjugate can decrease infection rates and consequently antibiotic use
• Reduce the prevalence of viral infections, which are often inappropriately treated with antibiotics and can give rise to secondary infections that require antibiotic treatment. Immunisation against viral influenza can reduce antibiotic use by as much as 64% in vaccinated individuals²
• Reduce the number of infections in the population through direct protection of vaccinated individuals and by reducing carriage (the infection of an individual without causing symptoms), thus limiting the spread of infections within a community (herd immunity)
• Limit the spread of AMR organisms within and across communities by reducing the volume of visits to healthcare points of care, especially hospitals, which are themselves a source of infection

Vaccines can be utilised in the fight against AMR in three main ways. Firstly, current vaccination efforts through National Immunisation Programmes need to be encouraged and universal access to existing vaccines needs to be expanded. The global health efforts to eradicate smallpox show that this is a feasible prospect.

Secondly, immunisation programmes need to be offered to children and adults alike as part of a life-course approach to preventing disease, which stresses the importance of vaccination at all stages of life to help prevent illness. Adult immunisation programmes provide a cost-effective approach to promoting health and wellness in older populations (whose immune systems gradually weaken) and in people who have underlying health problems.

Finally, industry needs to prioritise the R&D of new vaccines — especially for diseases that pose the biggest threat to drug resistance (the WHO has a priority list of antibiotic-resistant bacteria). There are scientific and commercial challenges in developing new vaccines and more investments from both public and private sources, as well as economic and regulatory incentives, are needed to overcome these hurdles.

Expanding access to vaccines should be viewed as a key component to achieving Universal Health Coverage and most of the SDGs, but is it also a fundamental strategy in achieving other health priorities such as AMR. The scale of antimicrobial resistance has never been so large, and with that global attention is high. In 2016, over 100 companies signed the Industry Declaration on AMR and 193 countries committed to fighting AMR by signing a UN declaration on antimicrobial resistance.

The AMR Industry Alliance is an industry initiative that brings together over 100 companies breaking silos between different sectors such as biotechs, diagnostics, generics and R&D pharma. It ensures signatories deliver on specific commitments made in the Industry Declaration on AMR and the Industry Roadmap. One of the key pledges is to foster innovative approaches to using alternatives to antimicrobials and new technologies for diagnosis and vaccines. The Alliance calls for an integrated deployment of vaccines and medicines, diagnostics, antibiotics and other therapies to address the multiple challenges across the continuum of care — from prevention, monitoring and screening to treatment.

Universal vaccination and the successful development of new or improved vaccines are important measures in the long-haul fight against AMR. We are dedicated to working together as an industry to address AMR and partnering with world leaders and donors to ensure immunisation can play its full role in achieving global health security.

References:

1. Ozawa S, et al.Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011–20. Health Affairs. 2016;35(2)
2. Wilby K, Werry D. A review of the effect of immunization programs on antimicrobial utilization. Vaccine. 2012;30(46):6509–6514