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Fears that existing antibiotics may become redundant in tackling infection in the coming decades have helped research into antimicrobial resistance (AMR) to become one of the hottest topics in science in recent years.
The warnings have in large part been driven by experts sitting in positions of policy influence, such as the UK’s chief medical officer Dame Sally Davies, leading to funders and universities committing resources to tackling the problem.
A major part of this effort is now also being focused on improving the data about the impact that AMR is having on global health in a bid to convince policymakers that more needs to be done, and faster, to meet the challenge.
Key to this approach will be use of the Global Burden of Disease (GBD) project – a hugely influential epidemiological study that has mapped the worldwide impact of diseases and other health risks since the 1990s – to publish comprehensive data on how many people are being affected and being killed by drug-resistant infections.
Alan Lopez, a co-founder of the original study and now laureate professor at the University of Melbourne, said much like GBD data on lung cancer had helped to press home the case for governments to tackle smoking, incorporating AMR into the project could be vitally important.
“The whole idea [of the GBD project] is to try and put in front of policymakers just what is causing the biggest amount of health loss in their population,” said Professor Lopez.
He added that there was “complete ignorance” about how much and where in the world AMR was having the biggest impact on health compared with other diseases.
“We are a long way from being able to quantify at a population level the burden of disease from AMR...compared to say lung cancer…or road traffic accidents,” Professor Lopez said.
“Once you saw the population-level impact of tobacco, governments started to act,” he added.
Although plenty of data exist in Western countries on the prevalence of AMR in hospitals or the use of antibiotics, one of the key challenges will be getting enough data from the developing world to extrapolate reliable global estimates on its impact.
However, it is hoped that important collaborative networks centred around the University of Washington, where the GBD project is based at the Institute for Health Metrics and Evaluation, and the University of Oxford, through its Big Data Institute and Centre for Tropical Medicine and Global Health, will be a catalyst for filling the gaps.
The powerful impact of these collaborations can already be seen in analysing citations data on the research published on AMR in recent years.
Oxford, Washington and Mahidol University in Thailand – which hosts a tropical medicine research unit with Oxford – all achieved citation impacts of more than three times the world average for publications on AMR in 2015 and 2016.
Another important player in the AMR battle, according to these data, has been the National Institutes of Health in the US.
Among upcoming publications from the NIH is work conducted jointly with experts at Elsevier to review how much research has been already done using mathematical modelling to estimate the population-level impact of AMR.
Anna Maria Niewiadomska, a research fellow who worked on the study at the NIH’s Fogarty International Center in New York, said that there was still a lack of modelling around certain AMR threats and especially how resistance was potentially building in the natural environment as a result of human activity.
“In terms of studying the interface between humans and animals and the exchange of resistant bacteria there is very, very little data on that,” Dr Niewiadomska said.
“There are huge, high numbers of resistant organisms in agriculture and environment samples…People suspect there is a connection [to human activity] but there is a lot more to be done…to link all these things together.”