Antibiotics have revolutionized healthcare.
With the advent of modern medicine, life threatening diseases such as smallpox, pertussis (whooping cough), tetanus (lockjaw) and measles have essentially been eradicated. More importantly, complicated procedures that increase our risk of infections—including plastic surgery, joint replacement, cancer treatments, and organ transplant, among others—have become routine because any resulting infection can be treated effectively.
But modern medicine depends on antibiotics to treat and cure many kinds of infections—infections that could impact anyone from the premature baby to the elderly. Unfortunately, antimicrobial resistance (AMR) has made some infections impossible and others increasingly difficult to treat, threatening the progress we have worked so hard to achieve.
AMR causes 700,000 deaths annually across the globe, a number projected to skyrocket to 10 million by 2050 without intervention.
What is antimicrobial resistance?
Antimicrobial drugs target the microorganisms that cause infection, such as bacteria, viruses, fungi, and parasites, and either kills them or inhibits their growth.
Anytime an antibiotic is used, either appropriately or inappropriately, the 30 trillion or more bacteria that live in or on our bodies undergo selective pressure to become resistant. Any that are sensitive to the antibiotic are killed, while those that remain are resistant or immune from the effects of that antibiotic. This is called AMR. Once a bacterial pathogen has reached a state of resistance to several types of antibiotics, it is colloquially referred to as a "superbug."
The consequences of AMR can be stated simply: Commonly used antibiotics are rendered ineffective against that pathogen. If an infection caused by resistant bacteria is treated by that antibiotic, the bacteria are unaffected, resulting in disease persistence, worsening of the infection and/or even death. Treatments for both minor and serious infections are compromised, surgeries and other routine procedures become riskier, and the treatment of diseases like pneumonia and tuberculosis becomes very complicated. For example, according to the World Health Organization, resistance in Klebsiella pneumoniae—a common intestinal bacterium that is a major cause of hospital-acquired infections, bloodstream infections, and infections in newborns and intensive-care unit patients—has spread to all regions of the world. In some countries, because of resistance, carbapenem antibiotics (often the "last resort" treatments) do not work in more than half of people treated for these types of infections. This results in prolonged hospitalization, increased medical costs and higher rates of death for infections that were easily treated only a few years ago.
"What's more, AMR is a truly global issue—it can affect anyone, of any age, in any country," Jill Inverso, Pfizer's Vice President of Global Medical Affairs and Anti-Infectives, told Big Think.
AMR causes 700,000 deaths annually across the globe, a number projected to skyrocket to 10 million by 2050 without intervention. The rise of resistant pathogens is causing many countries to accrue significantly higher healthcare costs due to longer duration of illness, additional tests, and the need for different medicines to treat patients.
And these costs add up. The World Bank Group estimates that AMR could reduce annual global gross domestic product from 1.1–3.8 percent depending on severity, with up to $10.8 trillion in additional health expenditures.
At Pfizer, we take this growing threat very seriously and are driven by our desire to protect global public health and address the medical needs of people suffering from infectious diseases.
Giving antimicrobial resistance a helping hand
The development of bacterial resistance to antibiotics is a natural process. Unlike almost every other class of drugs, antibiotics drive their own obsolescence by selecting antibiotic-resistant bacteria, even when used appropriately according to guidelines. When this happens, resistant bacteria survive and continue to multiply, causing the infection to worsen. These resistant bacteria can then also spread to other patients, causing new infections with these bacteria that are difficult to treat.
Overuse and misuse of antibiotics accelerates this process without providing any benefit to the patient. This happens when patients take a drug without need, do not finish their dose or stop taking the medication mid-course; it could also happen when a drug is either overprescribed or prescribed for the wrong duration/type of illness. All of these misuses create environments in which pathogens are exposed to drugs more often, allowing them to acclimate and breed resistance without any benefit to the patient.
Hence, antibiotics must be used wisely and sparingly.
Fighting the resistance
WHO calls AMR an "increasingly serious threat to global public health" and one that "requires action across all government sectors and society." Its widespread growth is threatening the United Nations General Assembly's Sustainable Development Goal of Good Health and Well-Being.
Companies like Pfizer are heavily committed to the fight against AMR, taking action across a variety of areas such as surveillance, stewardship, and prevention and treatment.
On the surveillance front, Pfizer is proud to sponsor one of the largest AMR surveillance programs in the world, the Antimicrobial Testing Leadership and Surveillance (or ATLAS). ATLAS monitors real-time changes in bacterial resistance and tracks these trends in real-time. Gathering information from more than 760 hospitals across 73 countries in many underserved areas, ATLAS has generated 14 years of continuous global data on bacteria. Researchers and healthcare professionals can access ATLAS's data—free of charge—to study resistance trends, even in emerging market countries like Africa, Asia, and Latin America.
"At Pfizer, we take this growing threat very seriously," Inverso added, "and are driven by our desire to protect global public health and address the medical needs of people suffering from infectious diseases."
Pfizer also encourages good stewardship practices and supports education and training programs to help ensure patients receive the correct antibiotic only if needed, at the right dose and for the right duration.
"We believe that everybody can play a part in AMR stewardship by not taking an antibiotic unless provided by a healthcare professional, sticking to antibiotic regimens when prescribed, and keeping their vaccinations up to date," said Inverso. She added, "Vaccines are administered to help prevent infections from happening in the first place, thereby reducing the need for antibiotic usage that can lead to the development of resistance."
To date, several studies have demonstrated the beneficial role vaccines play in the reduction of AMR, such as reducing the use of antibiotics by preventing bacterial infections which may, in turn, prevent antimicrobial resistant infections from developing. Pfizer is committed to continue the development of new, innovative vaccines to help prevent infectious diseases globally.
We believe that everybody can play a part in AMR stewardship by not taking an antibiotic unless provided by a healthcare professional, sticking to antibiotic regimens when prescribed, and keeping their vaccinations up to date.
Given this, we should ask ourselves the following:
- Have I ever not finished an antibiotic given to me by my doctor?
- Have I ever used an antibiotic given to someone else?
- Am I up-to-date on my vaccinations that prevent infections that would need antibiotics?
- Have I ever demanded an antibiotic for myself or a child that the doctor thought was caused by a virus?
- Have I ever saved antibiotics given to me for one infection and used it at a different time?
The key takeaway? AMR is a pervasive, growing threat that cannot be tamed without the collective efforts of government, industry, health systems, society and others. Working together, we may have a fighting chance.
Community healthcare workers are often the only point of contact with the health system in many underserved areas in the developing world. These noble public servants work within the community to bring health coverage closer to people who need it. Millions of babies around the world are at risk every day from vaccine preventable diseases and many of them live in very remote communities. This means that health care workers must sometimes travel long distances over mountains, across desserts and through rivers while carrying vaccine coolers.
These are some of the reasons why Pfizer is proud to partner with organizations that share a vision of increasing the health and well-being of children around the world. Susan Silbermann, Global President of Pfizer Vaccines, recently sat down with Big Think to discuss how the company is helping to improve vaccine access in developing countries.
Pfizer is helping to improve vaccine access
The constraints people face in other countries requires companies to develop more novel and innovative approaches to help improve vaccine access.
So the question for Pfizer was: Tell us what innovating a vaccine means to you?
Silbermann brought a vial to show Big Think what innovation looks like.
"This tiny vial is an incredible testament to scientific innovation. Until 2017, it provided one dose to vaccinate one child. But now it provides four doses and can vaccinate four children. By combining multiple doses into one vial we have reduced the storage space and the shipping requirements."
Innovations like this multi-dose vial are just the beginning of making it easier to get vaccines to children. Here are a few facts that Pfizer wants to help change.
- Sub-saharan Africa bears nearly 25% of the disease burden in the world.
- It only has 3% of the global health workers.
The critical role of health care workers in the developing world
A health care worker administers a vaccine in Malawi.
Photo: Courtesy of Pfizer.
When Pfizer's new multi-dose vial (MDV) became available in 2017 in Gavi countries, it was a priority to ensure health care workers were properly trained. For this, Pfizer partnered up with the AMP and the World Health Organization to develop a pneumococcal conjugate refresher course and new training program for the multi-dose vial.
As part of the partnership program, Pfizer developed a "train the trainer" model that is a tiered system of training. For example, "master trainers" will go on to train the next round of health care workers.
Last year, Pfizer trained over 27,000 health care workers across 15 different countries. And this year, it's extended the program to an additional nine countries with the goal of reaching an additional 17,000 new health care workers by the end of the year.A future dedicated to vaccine development
The overall impact vaccines are having on global public health are astounding. It's been estimated that vaccinations have prevented 26 million cases of childhood infections in the last decade alone.
Right behind clean water, immunizations are the most important health investment we have. Pfizer employees are passionate about vaccine development because they know it will translate into a tremendous public health impact.
Once logistical barriers and other obstacles are overcome, Pfizer believes that we will be working toward building a better future in communities around the world. One the best ways to remove barriers is through working with and supporting partners.
Why partnerships matter
Pfizer supports many projects that work to empower and equip community health workers. It recognizes that supporting health care workers is a critical part of achieving universal health coverage.
Silbermann talked with Big Think about making sure vaccines get to where they are needed.
"We have to make sure that vaccines get to those who need it. I have often said that our job doesn't end when we make a vaccine and ship it to a distribution center. What good is a vaccine if it isn't reaching the people who need it the most?"
Pfizer is a strategic partner of AMP Health (Aspen Management Partnership for Health), a cross sector, public private partnership to strengthen healthcare systems. AMP Health partners with Ministries of Health to help grow community health and immunization programs by providing leadership and management training and has worked in Ghana, Kenya, Malawi, Sierra Leone, and Zambia.
National governments in Sub-Saharan Africa are committed to deploying thousands of community health workers, but often don't have the strategic, managerial, or financial skills to run a large-scale program.
Pfizer believes that professional, supported community health workers play a critical role in reaching underserved populations and that partnering with organizations like AMP Health advances this objective.
The unsung heroes
Vaccines must stay refrigerated as they travel and be stored at very specific temperatures until they are used. Health care workers often worry about the vaccine refrigerators which can be old and if they were to break down the quality of the vaccines could be at risk.
Silbermann told us a story about how a healthcare worker in Ghana ensured vaccines were available in her clinic.
"Let me tell you a story about a healthcare worker in Ghana that we recently met. She works in a clinic in a small village in the Ho region of Ghana which is approximately three hours north of the capital. In her clinic, there is no electricity or running water. These two elements are critical to ensure safe and effective use of medicines. For example, vaccines need to be stored at a specific temperature to maintain their effectiveness and therefore are stored in fridges which are powered by electricity.
"Instead of storing the vaccines in her clinic, the healthcare worker travels one hour each way on the bus to get fresh vaccines and transport them in a cooler. She then works all day at the clinic administering these vaccines and seeing mothers, children and babies. Without the dedication of healthcare workers like this one in Ghana it is very likely that communities of children would not have the opportunity to be vaccinated."
Why is Pfizer so committed to vaccines?
Pfizer colleagues are passionate about vaccine development and innovation because they know it can translate into a tremendous public health impact. Immunization not only saves lives and improves health, it also unlocks the potential of a community—a vaccinated community is not only healthier, research has shown it is stronger and more productive.
Silbermann left us with this thought:
"When I think about the future, I know we can make a significant difference by ensuring that no logistical issue is an obstacle to a child getting vaccinated. But we can't do it alone. We need to work together to build on our experiences and capabilities to make the world a healthier place to live."
Here's what it takes to get vaccines from the lab to the field
