What is AMR?
Antimicrobial Resistance (AMR)
Bacteria that become ineffective against antimicrobial agents are called drug-resistant bacteria. If nothing is done to address this problem, approximately 10 million people could die annually by 2050. This is because if people do not take antimicrobials as directed by their doctors and pharmacists, the remaining bacteria in their bodies will become resistant to the drugs and the previous drugs will no longer work. Using antimicrobials correctly will prevent the increase of drug-resistant bacteria and protect the health of yourself and those around you.
History of the AMR Problem
The history of the AMR problem dates back to the development of penicillin, when Alexander Fleming, who discovered penicillin in 1928, said in his 1945 Nobel Prize in Physiology or Medicine acceptance speech, "The time may come when anyone can buy penicillin in a store. At that time, an ignorant person could take it internally in doses below the required dose, exposing the microorganisms in the body to non-lethal doses of the drug and creating drug-resistant bacteria." He stated.
In fact, in 1940, five years before the above comment, penicillinase, the enzyme that disables penicillin, was discovered in bacteria resistant to penicillin. As Fleming predicted, it is no exaggeration to say that the remarkable postwar history of antimicrobial drug development has been a history of battles against drug resistance. 1960s saw the development of a succession of drugs, including methicillin, effective against Staphylococcus aureus, which penicillin is not effective against; aminopenicillin (ampicillin), effective against gram-negative bacteria; aminoglycosides ( Gentamicin) were developed one after another, and the recognition that bacterial infections were no longer incurable spread.
On the other hand, with the acquisition of powerful weapons to fight infectious diseases, such as vaccines and antimicrobial agents, and the shift in the leading cause of death in developed countries from infectious diseases to noncommunicable diseases (NCDs), the mainstream of research and development by pharmaceutical companies also shifted, and the development of new anti-microbial agents continued to decline after the 1980s. Then, from the same period, the threat of new drug-resistant bacteria increased, especially in hospitals. With the advancement of medical technology, healthcare-associated infections (HAIs) related to surgery and medical equipment have increased.
In Japan, healthcare-associated infections caused by drug-resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), followed by multidrug-resistant Pseudomonas aeruginosa (MDRP) and multidrug-resistant Acinetobacter (MDRA), have spread, These infections are still a major problem in healthcare facilities. More recently, the number of community-acquired drug-resistant infections outside of medical institutions has also increased.
In addition, the problem of drug-resistant bacteria in animals has been pointed out as the possibility that the effectiveness of antimicrobial treatment may not be sufficient when drug-resistant bacteria spread to humans via livestock products and cause infectious diseases, in addition to weakening the effectiveness of treatment in the veterinary field.
Outside of Japan, the problem of drug resistance is spreading beyond infectious diseases caused by common bacteria, such as the emergence of Plasmodium falciparum (parasite) resistant to artesunate, a specific drug for malaria, and the global spread of multidrug-resistant and ultradrug-resistant tuberculosis (Mycobacterium tuberculosis).
According to Jim O'Neill's report, if no action is taken, the number of deaths caused by drug-resistant bacteria will be 10 million per year by 2050, more than the current number of cancer deaths worldwide, and a loss of US$100 trillion in gross domestic product. Gross domestic product will be lost by 2050, more than the current number of cancer deaths worldwide, and an estimated $100 trillion. In today's globalized world, drug resistance is not just a problem for Japan, but one that all countries must face.
Reference: Action Plan for Drug Resistance (AMR) Countermeasures 2016-2020 "Introduction
Response to new resistant bacteria, development of new antimicrobial agents
Since the discovery of penicillin by Alexander Fleming, many antimicrobial agents have been developed, reducing the number of people dying from infectious diseases. However, in recent years, research and development of new antimicrobial agents has largely stagnated. One reason for this is that even if antimicrobials are successfully developed, the payback on the investment required to bring them to market is not expected to be commensurate with the investment. In the United States, there was a case in which a company responsible for the development of a drug for the treatment of drug resistance (AMR) went bankrupt despite successfully developing and launching a new drug.
To address this pressing issue, in 2020, 24 pharmaceutical companies from around the world, including pharmaceutical association member companies, have partnered with non-governmental stakeholders to launch the AMR Action Fund, a US$1 billion fund to support research and development with the goal of launching up to four new antibacterial drugs over 10 years. From Japan, Eisai, Shionogi, Daiichi Sankyo, Takeda, and Chugai have contributed to and supported this fund. In addition, in order to create a new framework for attracting sustainable and robust investment in antimicrobial R&D, the Pharmaceutical Manufacturers Association of Japan (PMAJ), as a member of the AMR Alliance Japan, has established a pull-type incentive The Pharmaceutical Manufacturers Association of Japan (PMAJ) is a member of the AMR Alliance Japan. and contribute to the development of AMR policies and concrete implementation of measures such as the introduction of pull-type incentives. Bacteria constantly mutate, and unless new antimicrobial agents are continually developed, we risk returning to an era when even a simple cut could be fatal, and when infectious diseases were the most common cause of death. We need to be prepared with AMR therapeutics before drug-resistant bacteria become prevalent, and it is possible.
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*Incentives such as guaranteed sales after marketing approval. A system aimed at promoting research and development of antimicrobials by the government, and a periodic fixed price purchasing system (subscription model) is being tried out in the U.K.
Future Challenges
In response to a request from the National Council for Drug Resistance (AMR), the Pharmaceutical Manufacturers Association of Japan (PMAJ) is conducting a wide range of activities aimed at spreading awareness of AMR countermeasures. Drug-resistant (AMR) bacteria, which do not respond to antimicrobial agents (including antibiotics) that are supposed to work, are on the rise and pose a global threat. We will continue our educational activities to prevent the increase of drug-resistant bacteria.