REASONS TO BE CHEERFUL…
Lately, I’ve been feeling a little more hopeful about our prospects for this year.
Maybe it’s the few sunny days that have graced us. Or the daffodils’ reliable splash of gold in the verges, the crocuses pushing their heads up despite us all being barricaded indoors.
Or maybe it’s sheer relief because I just met my submission deadline for my next book.
Forty-two years ago, Ian Dury found many Reasons to Be Cheerful in a song apparently inspired by the near-fatal electrocution of his roadie by a microphone stand whilst on tour in Italy.
His list is much more entertaining than mine, although, in my defense, many of his reasons are currently off-limits under lockdown: the Hammersmith Palais and The Bolshoi Ballet two cases in point.
Dury was also a victim of a virus: one that left him with a paralysed arm and leg but which, through concerted global vaccination efforts, had largely been wiped out: polio. But with the pandemic and the Taliban thwarting vaccination programmes, and rogue strains on the rise, polio cases are once more making a worrying comeback.
Whilst thinking about this blog, I read one I posted last spring, when we were (in the UK at least) still pretty cheerful as a nation, most of us blissfully ignorant of the impact the pandemic was about to have on our lives.
Three weeks before the UK first went into lockdown, global case numbers for Covid 19 were 90,000 and deaths were 3000: shocking numbers back then, but incomparable to the 116 million cases and 2.584 million deaths we’ve reached one year on.
In my blog, I wrote about the large number of antibiotics being prescribed to prevent or combat secondary bacterial infections in Covid 19 patients which would potentially drive up levels of antimicrobial resistance (AMR): the cause of the crisis in my first book, The Waiting Rooms.
We now know that excessive amounts of broad spectrum antibiotics have been prescribed to Covid 19 patients over the past fourteen months. A review of studies from the US and Asia showed 71.9% of hospitalised patients diagnosed with Covid 19 had been prescribed antibiotics whereas only 7-8% of patients were diagnosed with a bacterial or fungal infection.
Another issue has been the potential spread of resistant pathogens on personal protective equipment (PPE). Many clinical institutions have been forced to reuse PPE due to limited supplies, which risks transmission of bacteria between patients. A survey last summer from the American Nurses Foundation showed that 68% of nurses had to reuse PPE because there wasn’t enough, and regional flare-ups of resistant infections in hospitals during the pandemic correlated with a shortage of PPE.
“Covid’s a lobster dropped into boiling water, making a lot of noise as it expires, whereas AMR is a lobster put into cold water, heating up slowly, not making any noise.”
The full impact of the pandemic on antimicrobial resistance levels is unknown. AMR research, surveillance and monitoring programmes have suffered as resources have understandably been prioritised elsewhere. This is particularly acute in lower and middle income countries where resources were already constrained. But we urgently need to reinstate AMR stewardship programmes and take stock. Because, while our attention is consumed by Covid 19, the ‘silent pandemic’ of resistance is gaining ground, as Dame Sally so eloquently states above.
But I said I was feeling more hopeful, right?
So where’s my cheerful list?
My reasons to be cheerful: 1,2,3:
1) Better hygiene practices and lockdown have reduced transmission of other diseases
A recent report in Nature claims that the measures employed against Covid 19 such as social distancing and improved hygiene have quashed the number of influenza cases and most other respiratory diseases, with the exception of rhinoviruses, responsible for the common cold.
In fact, researchers are suggesting that, with an absence of hosts, some flu variants may be killed off for good. Given the annual death toll for influenza, that is seriously good news.
2) Cross-border collaboration has achieved remarkable results
This pandemic has catalysed cross-border cooperation and transparency on an unprecedented scale. The development of rapid diagnostic tests and the quest to find an effective vaccine and cure have united governments, scientific & medical institutions, philanthropic foundations and corporates in a common purpose. Thanks to their efforts and investment, and the global sharing of data, processes that would normally take decades, like the development of drugs and vaccines, have been accelerated to a matter of months.
3) New finance and incentive models are stimulating development of new antibiotics
In the last year we have seen new funding models for antibiotic development being trialled.
In the UK, the NHS will pay for antibiotics up-front with an annual ‘subscription fee’ based on their public health value, as opposed to how many they sell, to give financial guarantees to drug-developers. This will help galvanise the stalling pipeline of new drugs.
New pots of money have been made available to incentivise antibiotic research and development. An AMR Action Fund was launched last summer with a pharmaceutical industry investment of US$1 billion to stimulate investment in new antibiotics.
Ineos recently announced £100 million funding for a new AMR research institute in Oxford.
And the global non-profit partnership CARB-X, led by Boston University, just donated $18 million to GSK for the development of two vaccines to prevent two bacterial diseases responsible for a significant number of deaths globally and which currently require huge volumes of antibiotics to treat. Vaccines play an important role in combatting drug resistance, too.
“Vaccines are powerful weapons in the global fight against antibiotic-resistant bacteria. Vaccines not only prevent infections, they also reduce the need for antibiotics, helping to curb the spread of drug resistance.”
I consider the above splendid reasons to be cheerful.
The challenge now is to apply the lessons from this pandemic to the management and containment of AMR. Because these two public health crises require many of the same things:
investment in research, surveillance & monitoring programmes, open sharing of data, and the training and education of the political and medical communities and the public at large.
If governments can integrate AMR stewardship into their Covid 19 strategies and continue listening to what the scientists and the medics are telling them, we may just avert a second global health crisis.
Which will give us even more reasons to be cheerful next spring, and all the springs beyond.
My debut novel, The Waiting Rooms, set in the aftermath of an antibiotic crisis, is available as an audiobook, e-book or good old-fashioned paperback and you can find out more here.