Why Pharmas/Biotechs Should Champion Non-Pharmaceutical Interventions For MDR Pathogens
By David Wheeler, acting executive director, Reckitt Global Hygiene Institute (RGHI)
Multi-drug resistant (MDR) pathogens are an escalating concern for healthcare and public health. The WHO considers MDR pathogens to be one of the principal threats to global public health1 and researchers predict that deaths from these microorganisms could increase worldwide to more than 10 million by 2050.2,3 Yet, the urgent need for innovative antimicrobial solutions to combat these life-threatening microorganisms stands in stark contrast to the current insufficient levels of investment directed toward the development of these solutions. Recognizing the potential for MDR pathogens to persist over the long term underscores the imperative for an unwavering commitment to developing measures to address existing infections and forestall future outbreaks.
While the primary focus of MDR pathogen treatment strategies has revolved around the creation of innovative therapeutics, diagnostic tools, and antibiotic stewardship, there has been a relatively limited emphasis on fostering behavioral changes and implementing non-pharmaceutical interventions (NPIs).
One reason for this may be that the fields of infectious disease treatment and prevention are highly specialized. Drug discovery, diagnostics, and antibiotic stewardship typically fall under the purview of researchers, clinicians, and pharmaceutical companies, while behavior changes and the implementation of NPIs are the domain of public health experts and policymakers.
Despite this specialization of these fields, the substantial threat posed by MDR pathogens to global health security necessitates a comprehensive, multifaceted approach that encompasses treatment and prevention strategies. Behavior changes and NPIs assume pivotal roles in curbing the emergence and dissemination of MDR pathogens by measures including promoting responsible antibiotic usage, enforcing infection control efforts, and advocating for public health hygiene practices. Over time, as the global health community increasingly recognizes the significance of these measures, this could lead to a growing emphasis on the integration of the measures into an overarching strategy to combat MDR pathogens. Public health campaigns, education initiatives, and policy reforms all have the potential to play a key role in advancing these efforts.
What are the advantages for pharmas and biotechs to champion NPIs? In drug discovery and preclinical development, a reduction in MDR transmission rates provides researchers with an invaluable opportunity to delve deeper into the biology of drug-resistant pathogens. In turn, this enhanced understanding could pave the way for identifying novel drug targets and developing innovative therapeutic strategies that can address resistance mechanisms. It also allows for pharmaceutical resources to be focused on tackling non-communicable disease and disease states with high unmet need.
NPI efforts result in advantages for pharma/biotech companies conducting clinical trials as well. Let’s take a closer look.
Advantages Of Conducting Investigational Clinical Trials In Regions With Reduced MDR Transmission
By directing clinical trials toward populations with lower transmission rates of MDR pathogens, researchers can increase the probability of successfully demonstrating the efficacy of new treatments. This is because these populations are less likely to harbor drug-resistant strains, thus allowing for a more accurate assessment of the therapeutic impact of experimental drugs. This enhanced success rate can expedite the drug development process by providing robust evidence of a drug's effectiveness.
Regions with reduced MDR transmission rates also offer a more accurate picture of a compound’s efficacy during a clinical trial. This clarity enables researchers to distinguish the specific therapeutic effects of the experimental drug from other variables that might influence patient outcomes. This distinction is vital for accurately assessing a drug's performance.
Positive clinical trial results in low MDR transmission regions can expedite the regulatory approval process for new drugs. Regulatory agencies are more likely to grant approvals when there is strong evidence of a drug's efficacy, which is often easier to establish in populations with lower MDR transmission. This expediting ensures that effective treatments more swiftly reach patients in need.
In regions with reduced MDR transmission, researchers can craft clinical trials with a more nuanced understanding of the local pathogen landscape. This knowledge enables the development of highly targeted and efficacious trial designs, which can optimize resources and expedite the drug development timeline.
The Power Of A Collaborative Approach
Collaborative approaches between pharmaceutical companies, the WHO, and local public health agencies, can slow and prevent the transmission of MDR pathogens.
To date, collaborative approaches have included data surveillance and sharing, identification of primary pathogens, research collaboration, regulatory support and monitoring, and stewardship. However, the role of primary prevention strategies tends to sit in isolation. Yet it is clear that primary prevention plays a crucial role in reducing multidrug-resistant (MDR) diseases by addressing the root causes and risk factors that contribute to the emergence and spread of drug-resistant pathogens. There are countless examples of where public health campaigns have been successful in reducing infection transmission in various parts of the world. Polio eradication, HIV Prevention, Malaria prevention, and tuberculosis control. Not to mention the role NPIs played in the recent COVID-19 pandemic.
We need to ensure the role of NPIs form part of these strategic discussions and collaborations. By effectively implementing hygiene measures, we can significantly slow the rate of disease transmission and alleviate the burden on healthcare systems. The emergence and spread of multi-drug resistant pathogens pose an ever-increasing threat to both healthcare and public health, which is compounded by the glaring disparity between the dire need for innovative antimicrobial solutions and the limited and insufficient investment directed toward their development. Understanding the potential for MDR pathogens to persist over the long term underscores the pressing need for an unwavering commitment to developing comprehensive measures aimed at addressing existing infections and preempting future outbreaks.
References
- WHO, Worldwide Country Situation Analysis: Response to Antimicrobial Resistance. World Health Organization; Geneva, Switzerland: 2015. WHO Library Cataloguing-in-Publication Data. [Google Scholar]
- Abat C., Rolain J.M., Dubourg G., Fournier P.E., Chaudet H., Raoult D. Evaluating the Clinical Burden and Mortality Attributable to Antibiotic Resistance: The Disparity of Empirical Data and Simple Model Estimations. Clin. Infect. Dis. 2017;65:S58–S63. doi: 10.1093/cid/cix346. [PubMed] [CrossRef] [Google Scholar]
- Dye C. After 2015: Infectious diseases in a new era of health and development. Philos. Trans. R. Soc. Lond. B Biol. Sci. 2014;369:20130426. doi: 10.1098/rstb.2013.0426. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
About The Author:
David Wheeler is acting executive director of the Reckitt Global Hygiene Institute (RGHI). RGHI is dedicated to conducting focused research on hygienic behaviors while bringing together relevant experts to explore how this research can lead to tangible and meaningful changes. David can be reached at publications@mail.rghi.org.