Japan Must Face Up to Growing Danger of Drug-resistant Germs

To protect aging population, country needs to foster antibiotic development

In the wake of more than 6.4 million COVID-19 deaths worldwide and unprecedented economic destruction, the global community has no excuse to be caught unprepared for the next pandemic.

Yet right now, a devastating parallel plague is already underway and worsening. Some years, it is killing well over 1 million people, according to medical journal The Lancet.

Unlike the novel coronavirus that arrived in late 2019, the ongoing menace is not a single new germ. Rather, the danger comes from a growing number of pathogens that have become resistant to treatment with the antimicrobials currently at our disposal.

These are already causing deadly infections in Japan. More than 8,000 people are estimated to have been killed by two deadly, drug-resistant bacteria strains in 2017 alone.

This plague is not getting the attention it requires in most countries, even in Japan, where an aging population is at higher risk from antimicrobial resistance (AMR).

Japan is already experiencing reduced utilization of treatments, from heart valve surgery to knee implants, amid fears that a likely untreatable infection in an older adult could be deadly. The impact on quality of life and healthy aging is having an unrecognized economic toll too.

The AMR superbugs include bacteria, fungi, parasites and viruses. Unless Japan develops new strategies and treatments to check their spread, the consequences will be devastating.

A world without effective antibiotics would experience horrendous consequences. Routine medical procedures from hip replacements and caesarean deliveries to chemotherapy and root canal treatments would suddenly become potentially deadly with the risk of untreatable follow-on infections.

A program for stewardship of existing antibiotics is needed to combat AMR. From the creation of penicillin and other manmade antibiotics in the 20th century, pathogens began to evolve to resist them. In some cases, human beings unintentionally helped speed this evolution through inappropriate use and over-prescription of antibiotics.

Often, individuals given a prescription for an antibiotic cease taking it when they begin to feel better, even though the pathogen may not yet be fully vanquished. As surviving bacteria reproduce, they can pass on their immunity to new generations.

Likewise, especially before awareness of the danger of resistance grew, doctors often prescribed antibiotics for patients who were ill from viral maladies, such as those who developed bronchitis from a cold. Antibiotics are ineffective against such viral infections, and doctors have now been warned not to prescribe them in such cases. But for decades, mis-prescriptions gave a boost to evolving superbugs.

Fortunately for all, hospitals in Japan are increasingly aware of the AMR problem. To help address it, hospital pharmacists are instituting stewardship programs that monitor and control antibiotic use across drug selection, dosing and duration of treatment.

Hospitals in Japan are increasingly aware of the AMR problem. (Photo by Takaki Kashiwabara)

But stewardship programs, while vital, will never conquer the AMR problem by themselves. We also need new antibiotics to challenge the superbugs.

In the past, the development of new classes of antibiotics was fairly routine. Our scientists still know how to create such drugs but the pipeline of innovations in antibiotics is nearly dry.

Japan must address this problem by working with other nations to create “pull incentives” for new antibiotic development. This type of incentive ensures or increases the revenue to be earned from successful drug development so that the companies involved are better able to recoup costs. Such incentives can include longer exclusive sales rights and guaranteed purchase orders.

Once new antibiotics become available, careful stewardship programs can then ensure they are reserved to treat people whose bacterial infections are not responding to previous generations of antibiotics. Doing so will slow the spread of AMR to the newly developed treatments.

According to an AMR preparedness index developed by the Global Coalition on Aging, drug resistance does not receive the high-level political attention it deserves in Japan, especially when it comes to spurring antibiotic innovation.

Total funding for AMR research in Japan last year was a paltry 751.3 million yen ($5.2 million), which helps explain why domestic drug development lags behind other countries.

The good news is that Japan’s 2016-2020 National Action Plan on AMR successfully led to reductions in overall antimicrobial usage across the country. As Japan embarks on an updated plan, there are four critical action areas.

First, the government should pass and sufficiently fund pull incentives to encourage pharmaceutical companies to develop new antibiotics. In conjunction with these efforts, the government should also address challenges hindering the approval of new antibiotics, as Japan has some of the poorest access among high-income countries to recently launched antibiotics.

Second, the government needs to build on the efforts of organizations like AMR Alliance Japan to foster greater collaboration among stakeholders and support initiatives to further bolster antimicrobial development.

Third, Japan can work to improve uptake of vaccines, which have been shown to curb the spread of AMR by preventing opportunistic bacterial infections developing from viral illnesses, thereby reducing overall usage of antibiotics.

Fourth, Japan should strengthen existing testing and surveillance efforts, including environmental monitoring programs focused on agriculture, animals and fisheries.

A century of progress against infectious diseases has helped Japan attain one of the highest life expectancies of any nation in the world. As the recent Group of Seven Health Ministers’ communique made clear, the world can no longer afford to take antibiotics for granted.

Japan now has the opportunity to take a leadership role in fighting AMR and ensuring that the great miracle of longevity continues.

Source: Nikkei Asia

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