Antimicrobial resistance (AMR) is one of the most urgent public health challenges of our time, threatening not only human health but also world economies and global security. In recent years, the problem has been well publicised, but the development of new, innovative solutions has been painfully slow. In fact, research published in The Lancet earlier this year showed that, without any significant progress, there will be an estimated 39 million deaths from AMR between 2025 and 2050 – that’s one person every three minutes.

AMR is a complex, multidimensional problem, requiring change on a global scale across a broad spectrum of areas including research and development, education, investment, policy and regulation. This week marks Antimicrobial Resistance Awareness Week (18 to 24 November) and the theme is “Educate. Advocate. Act now.”

So, let’s look at some of the main challenges and the improvements we need to see over the coming years to tackle the problem and save lives. LifeArc’s Chief Scientific Officer, Dave Powell, explains how LifeArc is helping to overcome barriers:

1. Antibiotic misuse: A prescription for disaster

The overuse and misuse of antibiotics in humans, animals and agriculture are key drivers of AMR. In high-income countries, antibiotics are still prescribed unnecessarily for viral infections, and without confirmation of bacterial infection. One of the main reasons for this is a lack of rapid, point-of-care diagnostic tools. Patients with viral and bacterial infections often have similar symptoms, making it difficult for doctors to differentiate between the two.

In many situations the risk of not prescribing antibiotics is perceived to be greater than prescribing them unnecessarily and, in other instances where a bacterial infection is known, doctors end up prescribing an antibiotic that the bacteria is resistant to.

The problem also presents via our food chain and water supply; animals are prescribed clinically-essential antibiotics that are either transferred to humans via direct contact or end up in our own food supplies. In addition, our water supplies are often contaminated with antibiotic-resistant pathogens and their genes – a problem that is not always resolved via wastewater treatment systems. And, of course, the more that antibiotics are used, the higher the chances are that resistance will develop.

While excessive use of antibiotics remains a major problem, in poorer parts of the world there is lack of access to antibiotics. Weak health systems and unstable drug distribution systems mean that there is often a shortage of essential medicines. Older, cheaper antibiotics end up being used but some are losing their efficacy, while newer drugs are unavailable due to high costs.

At LifeArc, we’re trying to overcome some of these issues through partnerships and initiatives that will improve antibiotic stewardship. Earlier this year, we partnered with ReAct Africa to launch the “ASPIRE” (Antibiotic Stewardship Programme through Innovation, Research, and Education). This ambitious three-year project aims to transform how antibiotics are used in Zambia and Kenya by integrating innovative digital solutions with targeted interventions that will hopefully lead to long term policy and practice improvements.

We’re also supporting research to develop improved diagnostic tools. Last year, we funded DOSA2 – a project in India that is trialling an easy-to-use test for a urinary tract infection that will enable healthcare providers to determine the best treatment option.

Through these projects and many others we’re funding, we hope to reduce the emergence of resistant pathogens.

2. Research and development: Fixing the broken pipeline

Between 2017 and 2023, only 10 new antibiotics or combination therapies were approved – none of which are considered to be a new class of antibiotics. In addition to this, there is just one antibiotic candidate in Phase III clinical trials across the four ‘critical priority’ bacterial pathogens defined by the World Health Organisation. Put simply, the number of new antibiotics and antimicrobials in development is not enough to meet current nor anticipated patient needs. So, what are the problems and how can we fix them?

Developing new antimicrobials is expensive and the development timelines are lengthy, meaning that it’s a difficult investment proposition. Antibiotics, meanwhile, are used for short durations and are less profitable. To make matters worse, clinical trials for new antibiotics face many regulatory issues, including necessary but stringent safety requirements and trial design. There is also a need for sustainable and predictable financing – especially for low- and middle-income countries – to incentivise innovation.

These issues mean that the pipeline for new antibiotics and antimicrobials is worryingly sparse. To address this gap, governments and international organizations must step up funding and provide greater incentives, particularly through public-private partnerships, grants, and alternative funding mechanisms. We also need a real focus on research for rapid point-of-care diagnostics and alternative therapies, which could help to reduce antibiotic misuse and reliance on antibiotics and also ensure a personalised approachthat ensures the right antibiotic is prescribed first time.

Through our PACE partnership, LifeArc is focusing on early-stage antimicrobial drug and diagnostics projects. This will help our best innovators move their research forward with greater speed and confidence. Through the right funding, partnerships, and expertise, we will give their ideas every chance of succeeding and build a world-leading, pre-clinical AMR pipeline that can save lives.

Earlier this year, LifeArc also invested in a £3 million programme through the CF AMR Syndicate, to support six early-stage novel antimicrobial projects over the next two years. The aim is to accelerate new treatments for lung infections in people with cystic fibrosis. Growing resistance to antimicrobials combined with lack of effective treatments for CF means that there is an urgent need to identify new therapies in this area. 

And finally, we recently announced the launch of the Centre for Translational AMR Research (CTAR) Programme with the University of Cape Town – a groundbreaking collaboration between UCT’s H3D Centre and LifeArc, aimed at identifying and developing first-in-class therapeutics for infections caused by multidrug-resistant (MDR) Gram-negative bacteria. This partnership not only targets the development of new antibiotics but also focuses on strengthening local research capacity in Africa. This is important as Low and Middle Income Countries (LMICs) have the greatest burden of AMR related deaths.

3. Policy: A global approach for a global problem

While AMR is a global threat, there is no consistent global approach to solving it. This is partly due to the fact that it is a ‘silent crisis’, resulting in a lack of urgency and policy inaction. When it comes to antibiotic stewardship, different countries have varying levels of regulation and, in some parts of the world, policies are outdated and poorly enforced.

Policy also affects R&D; the current lack of market incentives to develop new antibiotics will require robust financial and political change. However, creating new policies often requires significant investment and this can be challenging in countries where healthcare systems are weak or under resourced. Systemic change also requires strong will and leadership to manage implementation, but is critical to enable our early translational efforts to eventually impact patients.

Tackling the policy issue is a key aim of the Fleming Initiative. As a founding partner, LifeArc will support the initiative to bring together policymakers from different organisations – and connect them with the public – uniting them with the common mission of using policy tools to tackle antimicrobial resistance, domestically and internationally. This work will be delivered through the Policy Workstream, which aims to:

1. Developing a ‘Model national action plan for tackling antimicrobial resistance’: An exemplar plan that can be tailored according to country context and available resourcing.

​2. Sharing case studies of engaging with the public and professionals in policy making that could be replicated in other contexts.

​3. Innovating financial policies to incentivise the development of new antibiotics, diagnostics, and other technologies to reduce antimicrobial resistance.

AMR isn’t going to be a quick fix and so education, and the training of future healthcare leaders, prescribers, users, and policymakers, will also be vital in the effective management and development of new solutions.

Here at LifeArc, we will continue to invest in new projects and partnerships to address these big challenges and affect change before it’s too late.

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