Breakthroughs Blog: Antimicrobial resistance

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. Aileen Marty, who we met at the American Society of Tropical Medicine and Hygiene Annual Conference. Dr. Marty works at Florida International University and serves on the President’s Advisory Council for Combating Antibiotic-Resistant Bacteria.My name: Aileen Marty, MDWhere I work: Herbert Wertheim College of Medicine, Florida International University I’m funded by: The US government has supported my research since I began doing research back in the early 1970s. Right now, I’m involved with PACCARB, the President’s Advisory Council for Combating Antibiotic-Resistant Bacteria.My research: We’re interested in not only resistance by bacteria to antibiotics, but also by other pathogens such as fungal agents, and eventually hope to also focus on antihelminthic agents, and so forth. We are taking a look at it from a one health perspective, which means we try and understand how the agriculture industry may impact the use and availability of antimicrobial agents for humans, what is going on in the environment that’s also altering these things, as well as stewardship and appropriate use of antibiotics and antimicrobials in hospitals and in clinics throughout the United States and throughout the world, and see how those interface with one another. The CDC [US Centers for Disease Control and Prevention] recently put out a document about antimicrobial resistance that’s highly important. It says we’re already in an era where, for a number of very serious bugs or germs, we are out of antibiotics that actually work. If we do not solve this problem, we’re going to find ourselves in the situation we were in prior to the 20th century. And that impacts much more than infections directly, because modern medicine relies on us not having infections in order to do the surgeries that we’re doing. And to help people with autoimmune diseases like psoriasis or cancer treatments that decrease a person’s immune systems, we depend on the availability of good functioning antibiotics and antimicrobial agents at the right time in the right place for the right patient.Motivation: I love humanity—and I seriously believe that we all have a role to play in making sure that we leave behind a better world than the world we came into. And I become very inspired when I work with young minds, and I make sure that they see the connections between the different systems of the world and how we need to be stewards of the earth.Why US federal support is critical: We mustn’t think of it only in terms of it being global. You must realize that we in the United States are part of the globe. Moreover, individuals who live in the United States, who are citizens of the United States, travel worldwide. And what happens in Bangladesh has an impact on what happens in New York. Look at the recent measles outbreak in New York state, for example. That outbreak originated with an outbreak in Ukraine that passed via Israel and was brought to the United States—and think about what that has done. When we manage outbreaks where they arise, wherever that is, we minimize the footprint there and decrease the risk everywhere. When I’m not in the lab: In my personal life, I have a huge family, which I love dearly, and many, many good friends, and we spend a lot of time coming up with good community plans for helping people. And I belong to the Florida Clinicians for Climate Action, and through that organization we are going to synagogues and churches and other houses of worship where we are explaining the public health impacts of climate change to our people. 

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. Katie Button-Simons, who we met at the American Society of Tropical Medicine and Hygiene Annual Conference, who does research on drug-resistance in malaria at the University of Notre Dame in Indiana.My name: Katie Button-Simons, PhD, MSWhere I work: University of Notre Dame in Notre Dame, IndianaI’m funded by: National Institutes of Health and National Science FoundationMy research: We try to understand how malaria becomes resistant to drugs—so you want to find particular genes that control the resistance so that we can watch how those arise and spread in the field so that we can provide recommendations for local health agencies about what drugs they should be using to treat people and—more long-term—so that we can identify good targets for drug development and drugs that are already in the pipeline that will work well.Motivation: I am really interested in understanding how parasites and other pathogens evolve resistance. It didn’t so much matter to me which organism I worked on, although malaria is really interesting because it so quickly evolves resistance and does so to pretty much everything we throw at it—and not all pathogens can do that as readily. Why federal support is critical: The diseases that are common in other areas of the world are really putting a heavy burden on those areas and it really affects what people are able to do. If we can remove some of that disease pressure then we’re going to see a sort of revolution around the world. I’m really lucky to be where I am, and if I had been born in a different region of the world where I didn’t have everything that I’ve grown up with, I couldn’t be here. I see so much potential that goes unrecognized everywhere else because of the disease pressures that are in those regions. If we can get rid of those, then we can make great strides together.When I’m not in the lab: I really like hiking and soccer and reading.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. Drug-resistant germs sicken about three million people every year in the United States and kill about 35,000, representing a much larger public health threat than previously understood, according to an updated report released last Wednesday from the Centers for Disease Control and Prevention (CDC). The CDC previously estimated in a 2013 report that about two million antibiotic resistant infections occur every year, causing 23,000 deaths. Using previously unavailable data and by applying new methods, the CDC calculated that the 2013 estimate missed about half of the yearly cases and deaths caused by antibiotic resistant infections. Infectious disease experts say that the new numbers, though still conservative, underscore the magnitude of the problem and establish a new national baseline of infections and deaths that will help prioritize resources to address the most pressing threats. Health authorities in eastern Democratic Republic of the Congo (DRC) have introduced a new Ebola vaccine produced by Johnson & Johnson (J&J) in an effort to combat the world’s second-worst outbreak of the virus on record. The new vaccine—which has completed phase 1 and 2 clinical trials and has been endorsed by the World Health Organization (WHO) —will be administered to 50,000 people in the city of Goma, on the Rwandan border. The experimental vaccine, which requires two injections eight weeks apart, will be rolled out alongside Merck’s single-dose Ebola vaccine. Merck’s vaccine has been administered to over 250,000 people since the start of the current outbreak in August 2018 through a strategy known as ring vaccination, offering the vaccine to contacts of those likely to be infected. The J&J vaccine will be provided to “targeted at-risk populations” in areas where the virus is not yet being actively transmitted, according to WHO. The European Commission granted marketing authorization to Merck’s Ebola vaccine, known as Ervebo, last Monday, making it the world’s first approved Ebola vaccine. This authorization comes less than one month after the European Medicines Agency recommended it to be licensed. A few days following this approval, Merck also received WHO prequalification, a process in which WHO assesses vaccines and other medical products in order to assure member countries that they are safe and effective. Merck said it will also continue to work with the US Food and Drug Administration and regulatory agencies in African countries to license the vaccine. Ervebo is currently being used in the DRC under a “compassionate use” or research protocol similar to a clinical trial. Merck expects the licensed doses will become available during the third quarter of 2020 and has made a commitment to make the vaccine available to countries eligible for purchasing assistance through Gavi, the Vaccine Alliance, at the lowest possible price.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. On World Polio Day last week, the World Health Organization officially declared that type three poliovirus has been eradicated—making it the second of the three strains of the virus to be wiped out. Naturally-occurring cases of the last remaining virus strain, type one, are now limited to Afghanistan and Pakistan with a total of just 33 new cases last year. Though much progress has been made toward eradicating this disease, the number of confirmed cases this year has risen to 88 in those two countries as violence and mistrust have hindered vaccination campaigns. Cases caused by the vaccine itself have also thwarted eradication efforts. The National Institutes of Health and the Bill and Melinda Gates Foundation will jointly invest US$200 million over the next four years to develop genetic-based cures for sickle cell disease and HIV. Both partners have vowed that the cures will be both affordable and available in low-resource countries hit hardest by the two diseases, particularly in Africa. This partnership reflects growing concerns that scientific advances such as gene therapies and genome-editing are prohibitively expensive and therefore out of reach to most patients. This collaboration aims to move gene-based therapies into clinical trials in the United States and countries in sub-Saharan Africa within the next seven to ten years and eventually make treatments for sickle cell disease and HIV available in the hardest hit areas. After a two-day meeting in Okayama, Japan, health ministers of the world’s twenty largest economies issued a declaration endorsing the rapid achievement of universal health coverage (UHC), more effective support of healthy ageing, increased attention to health emergencies and their causes, and more forceful action on antimicrobial resistance. The G20 Health Ministers Declaration goes well beyond the general commitments made by G20 leaders to advance global health goals after their two-day meeting back in June. As part of the commitment to UHC, the health ministers recognized the importance of access to medicines and vaccination and reaffirmed pledges to end HIV, tuberculosis, and malaria, among other measures.