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A patient receives a vaccination injection at Gorkha district hospital in Nepal. Photograph by Alex Treadway, National Geographic Creative

As Antibiotics Fail, We Need More Vaccines

The global problem of antibiotic misuse that allows bacteria to become resistant can be solved in part by more use—not of antibiotics, but of vaccines and other compounds, which could reduce the occurrence of diseases that antibiotics are otherwise used to treat.

That is the latest piece of analysis of the worldwide resistance problem from the Review on AMR, the British project that is conducting a two-year examination of antibiotic resistance at the request of UK Prime Minister David Cameron. The group, which is supported by the Wellcome Trust, is closing in on its deadline of May 2016 for presenting comprehensive recommendations to ameliorate resistance. On the way, it has examined reducing agricultural use of antibiotics, funding drug development, promoting increased use of diagnostic devices, combatting over-the-counter sales and counterfeits, and achieving better data on the occurrence and cost of resistance.

“This year, 2016, is a critical year for action on the wider issue of drug-resistant infections, and both vaccines and alternative therapies have a crucial role to play as part of the strategy to tackle this threat. Internationally there will be focus on this issue at the World Health Assembly, the G7, G20 and UN General Assembly,” the report says. “This is a crucial time for the world to make significant progress – a moment that needs to be seized.”

The project is chaired by Lord Jim O’Neill, the former chief economist for Goldman Sachs, who is also Commercial Secretary to the Treasury in Cameron’s government. “Drug resistant infections could be compared to a slow-motion car crash,” he said. “Antibiotics are important to tackle this threat, but if we can encourage the development and use of vaccines and other alternatives we give the world a better chance of beating drug resistance.”

In the newest report, the Review proposes that better use of vaccines, along with development of new vaccines and other non-antibiotic compounds, could reduce the need for antibiotic use. But what stands in the way, it says, is a lack of funding both for getting existing vaccines to vulnerable populations, and also for developing crucially needed new vaccines.

Vaccines, it says, can reduce the occurrence of bacterial infections for which antibiotics are used; viral infections, for which the drugs are often given in error, increasing resistance; infections that occur in hospitals, a setting in which bacteria often become multi-drug resistant; and infections in farm animals, forestalling the huge use of antibiotics on farms.

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Crucially needed vaccines are not being developed. Graphic courtesy the Review on Antimicrobial Resistance.

The report finds that existing vaccines are not being used as much as they might be: globally, pneumococcal and rotavirus vaccines reach only 31 percent, and 18 percent, of children eligible for them. If pneumococcal vaccine were fully deployed, it says, the lives of 800,000 children younger than 5 could be saved every year—and in addition, 11.4 million days of antibiotic consumption, almost half the global usage for that disease, could be prevented.

But there is also a need for new vaccines to address specific diseases which antibiotic resistance makes worse. In 2013, the US Centers for Disease Control and Prevention compiled a long list of the resistant bacteria that it considers the most serious threats to health. There are no vaccines for the problems that it ranked as most urgent: resistant gonorrhea, Clostridium difficile, and bacteria such as E. coli and Klebsiella that have become resistant to the last-resort antibiotic class carbapenems and collectively are known as CRE.

Unlike antibiotics, vaccines can be attractive moneymakers for pharma companies, but the size of the clinical trials needed to get them to market means that many candidates stall in development, the report notes. To improve vaccine’s prospects in the market, it proposes additional funding to buy existing vaccines for low-income countries and to support early-stage research, and the creation of reward commitments (also known as advance market commitments or market entry rewards) for vaccines that make it through the development pipeline and reach the market.

Elizabeth Jungman, director of public health at The Pew Charitable Trusts, said about the proposals:  “This report highlights the need to take a multifaceted approach to addressing antibiotic resistance. Vaccines and some alternatives can play a critical role in the fight against antibiotic resistance by preventing infections, and other alternatives can make antibiotics more effective or even replace them for treatment.”

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Vaccine syringes. Photograph by Debora Cartagena, CDC.gov.

The new report is being released just after midnight in Britain, and a number of experts gave the Review their comments to release at the time of publication.

Dr. Jeremy Farrar, Director of the Wellcome Trust, said: “Our own analysis on how we might use vaccines and other alternatives to tackle this crisis supports the O’Neill team’s report, and suggests they will be an important way we can reduce – but not replace – our need for antibiotics. Vaccines are also critical for controlling epidemics, like Ebola, and endemic diseases such as TB and dengue fever, and how we incentivise developing news ones must take the whole picture into account.”

Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance—which is praised in the report for innovative funding strategies that allow vaccines to flow to poor countries—said: “It is exciting to see such a powerful argument on the important roles vaccines play, not just in preventing diseases and therefore reducing antibiotic usage, but also in directly reducing antimicrobial resistance. New incentives are needed to further accelerate their development.”

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