In life’s great design, microbes are the original masters, setting the stage long before humans came into the picture, outnumbering us in an astonishing display of their survival skills. These tiny beings are everywhere, from the farthest corners of the earth to the inner workings of our own bodies, reminding us that we are as much microbial as we are human. This fact is a mixed blessing: although many microbes play a positive role in our health, there are those that have learned to defy the medicines we rely on, leading to a challenging issue known as antimicrobial resistance (AMR).
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Our confrontation with these ancient organisms can’t be about winning; it’s about learning to live alongside them. This calls for the creation of new medicines, quick disease detection methods, and cutting-edge technologies, all part of a larger plan that considers the intricate microbial ecosystem. Our approach to AMR shouldn’t be combative but should aim for a careful balance with these microscopic life forms. The future of our health depends on how well we adapt and innovate to coexist with the microbes that are so intricately woven into the fabric of our lives.
The Next Chapter in Antibiotics: What’s Coming Up
In our fight against the rising challenge of antimicrobial resistance (AMR), the search for new antibiotics is critical. Zosurabalpin stands out as a promising new candidate, offering a potential new way to tackle drug-resistant Acinetobacter infections. Its early promise has been noted in Nature magazine and it’s now going through the first phase of clinical trials. It’s a start, but there’s a long road ahead — it could take five years or more to become available, if it passes all the necessary checks. This development is significant because it’s been decades since the last new class of antibiotics for harmful Gram-negative bacteria was approved. If zosurabalpin proves effective, it could be an important tool in our medical kit against a tough set of bacterial enemies. Right now, it’s a sign of progress, but we must wait and see how it fares in the next stages of its development.
The Indian pharmaceutical landscape is witnessing a leap forward with Wockhardt’s cefepime-zidebactam, which is currently in international Phase 3 trials. This molecule holds immense promise, showing the capacity to neutralise most resistance mechanisms exhibited by Gram-negative bacteria. The in-vitro and clinical data available point to its potential as a ‘Brahmastra’—a formidable weapon—against the drug-resistant Gram-negative bacterial infections that are causing havoc not just in India but globally. We are hopeful that this drug will soon become a part of our medical arsenal.
On another front, cefiderocol, already approved for use in various countries, stands out as another beacon of hope. Developed by the Japanese firm Shionogi and now distributed by GARDP (Global Antibiotic Research and Development Partnership), cefiderocol is making its mark as a potent agent against resistant infections. For India, where such infections are a growing concern, the timely availability of these drugs is critical. They show great promise and should be fast-tracked for use, bypassing the usual requirement for local data. The urgency is real; as we face the grim reality of patients succumbing to drug-resistant infections, the luxury of waiting for additional clinical trial data from Indian patients is one we cannot afford. The immediate licensing of cefepime-zidebactam and cefiderocol -could save countless lives and bring a new dawn in the treatment of resistant bacterial infections.
Also Read | A manifesto for tackling the silent pandemic of Antimicrobial Resistance
Catalysing Startup Innovation
The landscape of pharmaceutical innovation is changing, with many new and promising molecules being developed by startups rather than established pharmaceutical giants. A notable example is the Pfizer COVID-19 vaccine, which was developed by the relatively small German startup BioNTech, underscoring the pivotal role that nimble, innovative companies play in advancing medical science. This trend highlights the need to foster a supportive environment for startups in India and beyond, ensuring they have the necessary financial and research support to continue their crucial work. Encouraging and nurturing these ventures is not just about funding; it’s about building an ecosystem that values innovation and rapid development of life-saving drugs.
Moreover, India has a burgeoning biotech landscape, with companies like Bug Works in Bangalore leading the way in antibiotic development. Supporting these enterprises is not just an investment in their individual success but an investment in the future health of our population. By championing these innovators, we can ensure a steady pipeline of new treatments and maintain the momentum in our ongoing battle against antimicrobial resistance.
Rapid Tests, Swift Start-ups
The urgency for advanced rapid diagnostics is unambiguous. Prompt and precise detection of infections is essential for effective treatment and curbing the spread of resistant microbes. As a jury member and adviser for the Longitude Prize—a ten million Sterling pound initiative aimed at fostering transformative rapid diagnostic tests—I’ve witnessed a remarkable array of innovative solutions from startups around the globe, including those from India, over the past decade. These ventures are pioneering the frontier of rapid diagnostics, with Indian companies like Module Innovations making notable advancements. Despite these successes, there’s a pressing need for more Indian enterprises to venture into this vital field. Expanding the pool of innovators is crucial to accelerating the development of diagnostics that are not only rapid but also accessible and reliable, thereby fortifying our defenses against the ever-evolving threat of antimicrobial resistance.
Phages: Turning Viruses on Bacteria
Alongside the usual medical treatments, it’s crucial we explore alternative methods like bacteriophage therapy. Bacteriophages, simply known as phages, are viruses that specifically target and annihilate bacteria. They’re emerging as a potent weapon against bacterial infections in humans, thanks to their ability to selectively hit harmful bacteria. Phages’ benefits stretch across human health to animals, agriculture, and food processing. They hold the promise of preventing bacterial illnesses in livestock, reducing antibiotic use and thereby antibiotic resistance. For crops, phages present a natural solution to fight plant diseases, and in the food industry, they can help keep edibles safe from bacterial spoils, thus ensuring consumer health and lengthening the storage life of food items.
Currently, India imports high-quality phages from seasoned phage producers in Eastern Europe, like the Eliava Institute in Georgia. But there’s a pressing need for India to cultivate our indigenous phage therapies. Several Indian researchers are also making strides in phage research, with Gangagen, a start-up leading the way. It’s about time we channel investment and hasten research in this field to develop home-grown phage solutions.
Empowering Vaccine Entrepreneurs
India’s prowess in vaccine manufacturing is well-recognised on the global stage, but there’s tremendous scope for further contribution, particularly in the development of new, innovative vaccines, such as therapeutic ones. These aren’t your usual preventive vaccines; instead, they are designed to prevent the recurrence of infections, which are particularly troublesome for immunocompromised patients, like those repeatedly suffering from E. coli urinary tract infections. Given India’s robust biotech sector and pool of scientific talent, the country is well-positioned to take the lead in this cutting-edge area. It’s imperative that we support and invest in these efforts, as developing therapeutic vaccines isn’t just a step towards advanced healthcare; it’s a stride towards effectively combating persistent infections, improving patient outcomes, and cementing India’s status as a frontrunner in medical innovation globally.
Pioneering Paths in Service Delivery
Ensuring robust infection control is paramount in curbing the spread of bacteria and warding off hospital-acquired infections. Regrettably, out of the 1 lakh hospitals across our nation, fewer than 1,000 meet satisfactory standards for infection control. This alarming scenario indicates that the vast majority of our hospitals lack the requisite policies, committees, and expertise essential for effectively preventing the transmission of drug-resistant infections to patients, leading to increased morbidity and mortality. To tackle this critical issue, innovative service models that go beyond mere academic training or theoretical courses are urgently needed.
As we explore the intricate world of microbes, the adverse effects of overusing and misusing antibiotics in humans, livestock, and crops become starkly clear. The crux of the problem isn’t about cutting down on necessary treatments; it’s about fine-tuning them. The aim is to prescribe antibiotics only when absolutely needed and in the right doses. This careful management is vital to keep current antibiotics working and to make sure that new ones remain effective for longer. Yet, in India, a significant hurdle is that most hospitals don’t have enough trained specialists to put such careful antibiotic use into practice. This calls for innovative service models that can provide the needed guidance and support for hospitals to start and keep up effective antibiotic stewardship and infection control measures.
QuorumVeda, an innovative Indian startup (which I am involved with), has introduced a pioneering online service delivery model aimed at enhancing the quality of infection control and antibiotic stewardship in mid-size and small hospitals across India. This program is not just about imparting knowledge; it’s about providing continuous, on-ground support through a digital platform. infection control and antibiotic stewardship experts from across the country come together to provide hands-on assistance to hospitals in need, all via an online interface. This collective approach holds the potential to revolutionise infection control measures and antibiotic stewardship, offering a scalable and accessible solution to support thousands of hospitals across the nation and significantly reduce the incidence of hospital-acquired infections.
Entrepreneurial Hope
Entrepreneurship emerges as the beacon of hope in this crisis. To conquer the AMR challenge and pioneer new antibiotics, rapid diagnostics, vaccines, preventive strategies, and service models, we must adopt an entrepreneurial approach. My experience in AMR policy-making has taught me that policies, while crucial, are not enough without tangible implementation and cutting-edge technology. Thus, fostering entrepreneurship to innovate and develop new technologies and service models is critical. India, blessed with ample resources, has the capacity to stimulate entrepreneurship in the AMR domain and take a leading role in this global fight. It’ sthrough entrepreneurship that we can find sustainable solutions to the AMR conundrum. In the entrepreneurial spirit, we find our most potent weapon and our greatest hope against AMR.
AMR, isn’t just a health concern but a complex socio-economic puzzle, deeply entwined with factors such as sanitation and education. Without tackling these foundational issues, our fight against AMR resembles a battle with a hydra — chop one head, two more spring up.
(Dr. Abdul Ghafur is consultant in Infectious Diseases, Apollo Hospital, Chennai and Lead Strategist, QuorumVeda Consulting Services.)
