‘Vaccines can be a potent weapon to fight AMR’

A webinar international non-profit International Vaccine Institute discussed the importance of vaccines in the fight against antimicrobial resistance (AMR) on March 23, 2023.

Titled Vaccines and AMR: Considerations for AMR Policy and Practice in Low- and Middle-Income Countries, the webinar was conducted by International Vaccine Institute, International Centre for Antimicrobial Resistance Solutions and Ministry of Foreign Affairs of Denmark.

Vaccines protect individuals and communities by preventing infections and their spread, whether the pathogen is antimicrobial-resistant or not, thereby preventing infections and reducing antibiotic use. It also reduces the selective pressures on microbial populations that cause resistance to emerge.

At a community level, vaccination prevents the spread of resistant infections and reduces the burden on healthcare systems, thus preserving the effectiveness of antibiotics and slowing the development of resistance, the experts discussed. 

An estimated 1.27 million deaths were directly attributable to drug-resistant infections in 2019, according to the Institute for Health Metrics and Evaluation, reported journal The Lancet. 

This makes bacterial AMR a comparatively more important health issue than many other diseases, such as malaria or human immunodeficiency virus (HIV). 

The World Health Organization has developed a global action plan on AMR to ensure the ability to treat and prevent infectious diseases for as long as possible. 

The Global Action Plan on Antimicrobial Resistance by WHO mentions the use of vaccines for AMR containment in two of their objectives, said Mateusz Hasso-Agopsowicz from WHO’s Department of Immunization, Vaccines, and Biologicals. 

The objectives are, Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures

The second is Objective 5: Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions. 

As of now, 61 vaccines are in the active clinical development phase, with the highest number of vaccine candidates for S pneumoniae, TB and Shigella flexneri, said Hasso-Agopsowicz. 

While AMR is mentioned in most countries’ AMR national action plans, there is a lack of objectives targeting immunisation and no measurable indicators are devised to track progress, highlighted Erta Kalanxhi of One Health Trust, a health research organisation. 

An equal representation of stakeholders is desirable in governing structures is needed to address this, and an operational and monitoring and evaluation plan to monitor progress. Funding is also an important aspect of institutionalising AMR and vaccine projects, therefore, a dedicated government budget is essential. 

In developing countries, where antibiotics are widely overused, using available vaccines for infectious disease control is a short-term solution for mitigating multidrug resistance, according to Firdausi Qadri of the International Centre for Diarrhoeal Disease Research in Bangladesh.

However, much more work on AMR stewardship and policy changes regarding antimicrobial agent access is needed, Qadri added. 

Globally, less than 20 per cent of national action plans are costed and even fewer are funded; this remains a challenge for their implementation. There is also a need to present an investment case for increasing domestic investments by conducting a cost-effective analysis of vaccine roles in preventing AMR, added Mukta Sharma from WHO Indonesia.

In their opening remarks, Jeroeme Kim, director general of the International Vaccine Institute, noted that less resistance to vaccines is reported compared to antimicrobials, so efforts are needed to increase advocacy around mainstreaming vaccination for AMR.

While vaccine development is a long-term activity, the world must also focus on preventive approaches as a critical step in reducing the incidence of AMR. These include disease prevention, less antimicrobial use in humans, and food-animals.

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