By Dr Manica Balasegaram and Prof Kulkanya Chokephaibulkit

The unchecked growth of drug-resistant infections is a silent pandemic with long-term implications for global health security. As the world reels from the impact of COVID-19, it would be a tragedy not to apply the lessons we are learning to the fight against drug resistance.

Drug-resistant “superbug” infections kill an estimated 700,000 people each year, a number set to rise to 10 million per year by 2050 as drug resistance grows and weakens our ability to treat even common infections. A worrying number of infections are becoming harder – and sometimes impossible − to treat due to drug resistance.  Drug-resistant infections are on the rise due to the overuse of antibiotics. In Thailand and many other countries in the region, antibiotics are accessible without a prescription and many people take them without needing them, further fuelling resistance. The consequences of not addressing the silent pandemic of drug-resistant infections now could result in a future where we are unable to treat common infections like pneumonia, urinary tract infections and infections in newborns. There is an opportunity now to avert this potential catastrophe through strong leadership, collaboration and investment in measures to counteract drug resistance.

COVID-19 has been our first experience of a pandemic in a generation that has been both devastating and far-reaching. It has highlighted that governments must be willing to make substantial and long-term investments in preparedness to tackle global health crises. With limited tools to prevent or treat COVID-19, the pandemic has disrupted health systems and global economies in ways the world has not seen before. Despite solutions being at hand, a similar situation could be on the cards for the evolving pandemic of drug-resistant infections unless urgent action is taken to address decades of disinvestment in late-stage antibiotic research and the lack of access to effective antibiotic treatments.

If COVID-19 has taught us one important lesson, it is that pandemic control requires a global coordinated effort, and no country can do it alone. Strengthening our ability to fight drug-resistant infections requires a sustained, coordinated response, which must also ensure affordable access to solutions. Particularly critical to tackling drug-resistant infections is the One Health concept, recognising the importance of connecting the health of people to both the health of animals and our shared environment. Drug-resistant infections move silently within populations and between animals, humans and environments; they do not know boundaries, and neither should our responses.

Recognising the critical role antibiotics plays in modern medicine, including pandemic responses such as COVID-19, the German government recently announced additional funding for the Global Antibiotic Research and Development Partnership (GARDP), a not-for-profit developing new treatments for antibiotic-resistant infections, bringing its total investment in GARDP to 60 million Euros. Germany will also host the World Health Summit in Berlin during 25−27 October, a forum where leading academics, politicians, global health experts and private sector representatives will come together to address pandemic preparedness, universal health coverage, health systems strengthening, and universal access to health.

We are also seeing some progress in collaborative initiatives to address drug resistance, such as plans to develop a new European biomedical research agency to protect against future cross-border threats. There are also signs the private sector is recognising the failure of business as usual in tackling this silent pandemic. This includes the establishment of the AMR Action Fund, a new initiative that aims to bring 2−4 new antibiotics to patients by 2030. However, these initiatives will not be enough without a drastic change in approach from governments and the private sector.

COVID-19 has reinforced the concept of a global community, where our health and well-being are inextricably linked regardless of where we live. Solutions will therefore only be successful if they are

available to everyone around the world, including those in low- and middle-income countries, and if their reality, know-how and capacity are part of a comprehensive response. Ensuring universal R&D, equitable, and affordable access to solutions needs to be a cornerstone of pandemic preparedness and response.

Overseas development aid will be critical to support the much-needed solutions to prevent the devastating effects from drug-resistant infections in populations that are already vulnerable, mostly in countries with limited resources. This aid will also be an essential investment for the preparedness and response to this silent pandemic in donor countries.

The evolving pandemic of drug-resistant infections has the potential to cripple the world in the same way that COVID-19 has done this year. However, unlike with COVID-19, we know what it will take to combat drug resistance and that meaningful change can be achieved with sufficient political will and resources. There is an opportunity now to significantly step up our response to drug-resistant infections and prepare ourselves to handle the unpredictable and silent nature of the pandemic, where the true extent of damage done remains somewhat invisible.

The fight against drug-resistant infections will rely on governments seizing this opportunity to develop a more robust, coordinated and equitable approach to pandemic preparedness and global health security. Our success in fighting this pandemic will depend on the motivation now to secure investment and ensure access to solutions like better surveillance of resistant infections, tests to identify resistance and treatments like novel antibiotics.

Dr Manica Balasegaram is the Executive Director of GARDP.

Prof Kulkanya Chokephaibulkit is Director of Siriraj Institute of Clinical Research (SICRES), Mahidol University.