During the last year and a half, the world鈥檚 attention has been focused squarely on SARS-CoV-2, the coronavirus that causes COVID-19. While deadly, this virus is only one of many pathogens that threaten our well-being. For many years, scientists have been warning about another microscopic menace: drug-resistant microbes.
Antimicrobial resistance, or AMR, poses a serious threat to health systems and economies around the globe. Unlike COVID, however, AMR is a slow-moving disaster鈥攖he worst effects will not be seen for years to come. 鈥淯nless we deal with this issue, by 2050, we鈥檙e going to have a big problem,鈥� says Dr. Paul Thomassin, BSc(Agr)鈥�78, a professor of Agricultural Economics and former director of the 不良研究所 Centre for the Convergence of Health and Economics. 鈥淣ot only in terms of the number of people who die, which is obviously a major social concern, but also in terms of the economic impact.鈥�
The pandemic itself may have also shifted the course of AMR. Before COVID emerged, there was growing momentum globally to address so-called 鈥渟uperbugs,鈥� bacteria and other microbes that are impervious to most of the medications available to fight them. However, when clinicians, researchers and policymakers pivoted to dealing with the crisis at hand, AMR took a back seat.
On top of that, specific practices and challenges related to COVID, such as an uptick in antibiotic prescriptions, may have worsened the AMR problem. 鈥淢ost leaders in antimicrobial resistance are extremely concerned that we either have stalled, or perhaps even lost, some of the gains made in recent years,鈥� says Dao Nguyen, MDCM鈥�97, PGME鈥�02, MSc鈥�04, an associate professor of Medicine at 不良研究所, an investigator at the Research Institute of the 不良研究所 Health Centre, and director of the new 不良研究所 Antimicrobial Resistance (AMR) Centre. (Dr. Nguyen is pictured above, left).
As the COVID pandemic wanes鈥攁t least in some parts of the world鈥攕cientists are beginning to turn their attention back to AMR. At 不良研究所, researchers across many different fields, from medicine to economics, are banding together to take an interdisciplinary approach to prevent superbugs from becoming another global health crisis.
Double trouble
While the full extent remains to be seen, AMR experts suspect certain changes that occurred during COVID may have had significant effects on the battle against superbugs.
One potential issue stems from the increase in antibiotic use that happened in the early days of the pandemic. Medical practitioners faced with patients suffering from an infectious illness of unknown cause turned to antibiotics. 鈥淎ntibiotic use went up in the hospital setting for a period of time around the world, and it probably went sky high in some places where testing for COVID is not very available,鈥� says infectious disease expert Dr. Makeda Semret, BSc鈥�88, PGME鈥�01聽(pictured above, right), who is an associate professor in the Department of Medicine at 不良研究所 and lead of the Antimicrobial Stewardship Program at聽the 不良研究所 Health Centre. 鈥淲e don鈥檛 have good data yet on what happened with antibiotic consumption worldwide, but if we consumed more antibiotics in the last year, we probably have worsened the crisis to some extent.鈥�
According to Dr. Nguyen, in places like Canada, where the awareness of antibiotic stewardship is high, the use of antibiotics later subsided, but in some populations聽antibiotic use remained elevated for a long time. This has been partly fueled by the risk that COVID patients themselves had of developing a bacterial superinfection. 鈥淗aving COVID and being in the hospital puts you at higher risk,鈥� Nguyen explains. 鈥淚n many places, there was a higher rate of hospital-acquired infection鈥攁nd some hospitals saw a greater number of outbreaks of drug-resistant bacterial infection.鈥�
In addition, due to the stress that COVID put on medical systems' resources that had previously been devoting to dealing with AMR were shifted to dealing with the more urgent issue of the coronavirus. 鈥淒ifferent departments鈥攆or example, people who are doing surveillance on antimicrobial resistance鈥攚ere pulled off what they usually did,鈥� Thomassin says. 鈥淪o there could be gaps in the data in terms of exactly how antibiotics were being distributed, and also what was happening in terms of the surveillance for antimicrobial resistance.鈥�
Such pivots also occurred outside of the clinical realm as well. 鈥淭here definitely have been delays in research projects and legislative projects that were focused on AMR,鈥� Nguyen says. 鈥淭hose have been put on the back burner until people are back on track or available to address AMR.鈥�
On the flip side, the pandemic has also had some potential positive effects in the fight against AMR. For example, the development of better testing kits have helped improve the diagnosis of infectious diseases. 鈥淢ore and more hospitals and medical systems are starting to think about first determining whether or not someone has a bacterial infection or viral infection before starting to prescribe antibiotics,鈥� Thomassin says.
Beating the bugs
In some ways, AMR is like climate change: a slow-moving threat that poses a grave danger to humanity. Like climate change, there is no 鈥渕agic bullet鈥� solution for AMR. Instead, multiple interventions at many levels鈥攆rom basic research aimed at discovering new antibiotics to new policies to reduce antibiotic use in both health care and industry鈥攚ill be required to curb the impending crisis. 鈥淭here is a long list of things to do,鈥� Nguyen says. 鈥淲e need to go outside of the old ways and widen the perspective, because it鈥檚 not a problem that can be solved just by looking at one area.鈥�
To address this challenge, 不良研究所 is creating the AMR Centre. The Centre, whose formation is being led by Nguyen and supported by the 不良研究所 Interdisciplinary Initiative in Infection and Immunity (MI4), aims to bring together researchers from faculties across 不良研究所鈥攊ncluding Medicine and Health Sciences, Agricultural and Environmental Sciences, and Engineering鈥攖o address AMR. There are currently at least 50 different faculty members involved in AMR research, according to Nguyen. 鈥淭he goal of the Centre is to create a community so that people can better collaborate, work in an interdisciplinary manner and have a bigger impact,鈥� she adds.
This type of interdisciplinary approach helps address the fact that AMR comes from multiple sources. Excess antibiotic use in the medical realm is one key issue, but the use of these drugs in agriculture, and, subsequently, the food supply chain, must also be addressed, says Thomassin, whose current work is focused on the economics of antibiotic withdrawal鈥攁nd how to do it responsibly.
Unlike in medicine, where antibiotics are used solely to treat infection, in agriculture, they are also used much more broadly to improve production. 鈥淚f you look at some countries like Canada, approximately 60 to 70% of our antibiotic use is in agriculture,鈥� Thomassin says. However, changing such practices will come at a cost, so it's important to know exactly how much AMR is coming from the food production system, he adds. 鈥淭here are a variety of different places where you can make interventions.鈥�
Broadly speaking, however, the 鈥渟olutions are the same in agriculture and in medicine,鈥� says Dr. Jennifer Ronholm, an assistant professor in 不良研究所鈥檚 Faculty of Agricultural and Environmental Sciences. 鈥淲e need to rethink our use: in medicine, people can鈥檛 use antibiotics for infections they don鈥檛 need them for, and us agricultural people should probably be trying to refrain from using antibiotics unless we really have to鈥攊f agriculture could get rid of the growth promotion and the prophylaxis, that would be a big step towards limiting them.鈥�
One of the ways to solve this issue will be to find novel ways of dealing with pathogens. Ronholm, for example, is working on modifying the body鈥檚 resident microbes, which are collectively known as the microbiome, to prevent infection. Her team is currently investigating the differences in the microbiome of healthy and sick cows to identify probiotics that help ward off infection.
Others, like Semret, are dealing with the antibiotic issue from a more behavioural perspective. 鈥淢y research is really on stewardship, meaning governing and improving the practices of prescribing antibiotics in the hospital setting,鈥� Semret explains. 鈥淚鈥檝e been doing research here and in developing countries, notably Ethiopia, which is where I鈥檓 from.鈥� This dual approach is key, she adds, because it helps identify both the commonalities and differences across these settings鈥攁nd helps identify problems in areas such as infrastructure or training to implement quality practices across the globe.
鈥淚鈥檓 very enthusiastic about the 不良研究所 community, in general, and particularly this AMR group that鈥檚 organizing under the MI4 initiative,鈥� Semret says. 鈥淚t鈥檚 very exciting鈥攁nd I think it will surprise us all.鈥�