Antimicrobial resistance is increasing due to wars in Ukraine and Gaza

More and more multi-resistant bacteria circulate in war zones in Ukraine and Gaza. These so-called superbugs often do not respond to antibiotics. In turn, infections are becoming increasingly difficult to treat, which can lead to serious illness or death among both military personnel and civilians. With relatively few new antibiotics in the pipeline, increased research and development funding for drug development targeting antimicrobial resistance is critical, along with creating new reimbursement models to ensure manufacturers are adequately rewarded.

In areas of armed conflict such as Ukraine and Gaza, the lack of clean water and sanitation and inadequate infection prevention and control promote the spread of microbes. The Lancet notes that widespread lack of sanitary conditions and crowded areas are exacerbating the increase in infections and drug resistance.

Moreover, epidemiologists have long been aware of the possibility that military conflict could exacerbate the situation transmission of antimicrobial resistant superbugs, due to the enormous amounts of heavy metal waste from bombs, spent ammunition and the wreckage of destroyed towns and cities ending up in waterways. This in turn can be a breeding ground for antibiotic resistance pathogens.

The World Health Organization says antimicrobial resistance occurs when “bacteria, viruses, fungi and parasites change over time and no longer respond to drugs, making infections more difficult to treat and increasing the risk of disease spread, serious illness and death. ” Globally, antibiotic-resistant infections are estimated to be linked to five million deaths annually.

The Centers for Disease Control and Prevention issued a warning shortly after Russia invaded Ukraine, reporting the emergence of multidrug-resistant infections in eastern parts of the country. The agency stated that the emergence of AMR constitutes an “urgent crisis” requiring immediate attention, in light of the near-constant influx of injured soldiers and civilians with infected wounds, contributing to the high transmission rates of hospital-acquired infections and subsequent spread within the community. .

The WHO speaks of a “alarming trendin both Ukraine and Gaza, where superbugs can be transmitted from wounded fighters and civilians to others in hospitals. And as refugees escape armed conflict, pathogens also move. To illustrate how quickly this can happen, doctors started on the ground in Gaza documenting the spread of AMR, just a month after Israel began its military retaliation campaign following the October 7 Hamas attack in Israel.

In July, Krystel Moussally, epidemiologist at Doctors Without Borders, spoke to the Dutch broadcaster NOS. sees the danger of proliferation outside war-affected countries: “New forms of resistance, arising from the war in Ukraine, are now also documented in the Netherlands, in Denmark and even in the United States.”

“The environment that war creates is like a feast for bacteria in which they quickly become resistant and are easily transmitted,” says Moussally, “Sometimes you receive 300 to 400 wounded in half an hour. Then cleaning wounds is not optimal. is an ideal means of spreading infections.”

And even in the absence of war, the misuse and overuse of antimicrobials is driving the rise of drug-resistant microbes. In addition, antibiotic use in livestock farming contributes to the spread of resistance.

New antibiotics to the rescue?

Academic institutions and small and medium-sized companies usually form the support base around which antibiotic research is conducted. However, these entities generally do not have sufficient financial resources to bring the compounds from basic science research through clinical trials to the market.

For decades, the drug industry has largely left the development of antibiotics behind. And in 2022, the Biotechnology Innovation Organization released a report on the development of antibacterial drugs, which concludes that the pipeline is insufficient to address the growing threat of antimicrobial resistant pathogens, with only 64 new chemical entities currently in clinical trials. By comparison, around the date of the report’s publication, approximately 160 NCEs were conducting breast cancer research alone.

Government agencies and private sector entities around the world have filled the void to some extent with certainty financing mechanisms. For example, the AMR Action Fund is supported by several major pharmaceutical companies that have allocated money $1 billion to tackle resistant bacterial infections.

And the FDA has approved a handful of new antibiotics in recent years, including: Zevtera (ceftobiprole medocaril sodium for injection) in April this year for the treatment of adults with staphylococcus aureus bloodstream infections; adults with acute bacterial skin infections; and adult and pediatric patients with community-acquired bacterial pneumonia.

But despite successes here and there, the The business model seems broken. The Wall Street Journal reported in 2023 that six startups had received FDA approval for new antibiotics since 2017. Yet all six have filed for bankruptcytaken over or closed down.

An article in Nature suggests Drug developers have long been wary of the lack of a sustainable market for approved products. And insurers often don’t seem to have a reimbursement model that can easily accommodate new entrants into the antibiotic space.

The Pasteur Act, which was introduced by Congress in 2023 but has not yet been voted on, would create a new law innovative payment contract where the federal government would reimburse drug developers a total of $6 billion in installments for “very new antibiotics and antifungals” in exchange for free patient access to drugs as they become available. This subscription model separates the compensation from the volume or amount of sales.

As the ongoing wars in Ukraine and Gaza intensify and the threat of new military conflict looms, the problem of AMR is likely to worsen. It therefore seems imperative that stakeholders continue to work on creative solutions to finance R&D while creating appropriate market incentives for antibiotic manufacturers targeting antimicrobial-resistant infections.