Antimicrobial resistance on the rise due to the wars in Ukraine and Gaza

Increasingly, drug-resistant bacteria are circulating in war zones in Ukraine and Gaza. These so-called superbugs often do not respond to antibiotics. In turn, infections are becoming more difficult to treat, which can lead to serious illness or death among both military and civilian personnel. With relatively few new antibiotics in the pipeline, increasing R&D funding for drug development targeting antimicrobial resistance is critical, along with creating new reimbursement models to ensure manufacturers are adequately paid.

In areas of armed conflict such as Ukraine and Gaza, lack of clean water and sanitation and inadequate infection prevention and control encourage the spread of germs. Lancet notes that widespread unsanitary conditions and crowded areas exacerbate the growth of infections and drug resistance.

Furthermore, epidemiologists have long known of the potential of military conflict to increase the transmission of antimicrobial-resistant superbugs, due to the large amounts of heavy metal debris from bombs, spent munitions, and the rubble of destroyed towns and cities that spill into waterways. This in turn can create a breeding ground for antimicrobial resistant pathogens.

The World Health Organization says that antimicrobial resistance occurs when “bacteria, viruses, fungi and parasites change over time and no longer respond to drugs, making infections more difficult to treat and increasing the risk of disease spreading, of serious illness and death”. Globally, antimicrobial-resistant infections are estimated to be associated with five million deaths annually.

The Centers for Disease Control and Prevention issued a warning shortly after Russia invaded Ukraine, reporting the emergence of multidrug-resistant infections in eastern sections of the country. The agency stated that the rise in AMR constitutes an “urgent crisis” that requires immediate attention, in light of the near-constant flow of wounded soldiers and civilians with contaminated wounds that contributes to the high rate of transmission of hospital-acquired infection and subsequent spread in the community. .

The WHO speaks of an “alarming trend” in both Ukraine and Gaza, where superbugs can be transmitted in hospitals from wounded fighters and civilians to others. And as refugees escape armed conflict, pathogens also move. To illustrate how quickly this can happen, doctors on the ground in Gaza began documenting the spread of AMR just a month after Israel began its retaliatory military campaign following the October 7 Hamas attack on Israel.

Speaking to Dutch broadcaster NOS this July, Krystel Moussally, an epidemiologist with Doctors Without Borders, sees the risk of spreading beyond war-affected countries: “New forms of resistance, emerging from the war in Ukraine, are now being documented in the Netherlands as well, in Denmark, and even in the United States.”

“The environment that a war creates is like a party for bacteria, in which they quickly become resistant and pass easily,” says Moussally, “Sometimes you receive 300 or 400 wounded people in half an hour. Then the cleaning of the wounds is not optimal. an ideal vehicle for the spread of infection.”

And even in the absence of war, the misuse and overuse of antimicrobials is driving the emergence of drug-resistant microbes. Furthermore, the use of antibiotics in livestock contributes to the spread of resistance.

New antibiotics to the rescue?

Academic institutions and small and medium-sized companies tend to be the fulcrum around which antibiotic research is conducted. However, these entities generally lack sufficient funding to take compounds from basic science research through clinical trials and to market.

For decades, the pharmaceutical industry has largely emerged from the development of antibiotics. And in 2022, the Biotechnology Innovation Organization published a report on antibacterial drug development, which concluded that the pipeline is insufficient to meet the growing threat of antimicrobial-resistant pathogens, with only 64 new chemical entities in trials. clinic at that time. By comparison, around the report’s publication date, approximately 160 NCEs were in trials for breast cancer alone.

Government and private sector entities around the world have filled the gap to some extent with certain financing mechanisms. The AMR Action Fund, for example, is supported by several large pharmaceutical corporations that have committed $1 billion to treat drug-resistant bacterial infections.

And the FDA has approved a handful of new antibiotics in recent years, including Zevtera (ceftobiprole medocaril sodium for injection) in April of this year to treat adults with Staphylococcus aureus bloodstream infections; adults with acute bacterial skin infections; and adult and pediatric patients with community-acquired bacterial pneumonia.

But despite successes here and there, the business model seems to be broken. of Wall Street Journal reported in 2023 that six startups had won FDA approval for new antibiotics since 2017. However, all six filed for bankruptcy, were acquired, or are shutting down.

An article in Nature suggests that drug developers have long been wary of the lack of a stable market for approved products. And insurers often don’t seem to have a reimbursement model that can easily accommodate new entrants into the antibiotic space.

Introduced in Congress in 2023, though not yet voted on, the Pasteur Act would establish an innovative payment contract where the federal government would reimburse drug developers a total of $6 billion in installments for “very new antibiotics and antifungals” in free patient exchange. access to medicines once available. This subscription model decouples reimbursement from sales volume or quantity.

As the ongoing wars in Ukraine and Gaza intensify and threats of new military conflicts loom, the AMR problem is likely to worsen. Therefore, it would seem imperative that stakeholders continue to work on creative solutions for funding R&D while creating appropriate market incentives for antibiotic manufacturers targeting antimicrobial-resistant infections.