Antimicrobial Resistance and Immunisation

https://doi.org/10.58248/PN581

Antimicrobial resistance (AMR) is an urgent global health threat that, if left unchecked, could account for an estimated 10 million deaths per year by 2050. A report commissioned by the UK Government and published in 2016 concluded that vaccines have been overlooked as a tool to reduce AMR and should be an investment focus.

Immunisation can reduce the AMR burden by preventing infections (including resistant ones) and therefore reducing antibiotic use, a major driver of resistance. This effect has already been seen for vaccines against pneumococcal and influenza infections. There are global differences in vaccine need and the challenges in using immunisation to reduce AMR.

There are two main approaches to this strategy: maximising the utility of existing vaccines by ensuring good uptake and offering them more widely as appropriate, and making decisions about which vaccines should be developed and introduced and when and where to use them most efficiently. Evaluating the impact and cost-effectiveness of a vaccine is an essential step in its use and introduction but how to value a vaccine in the context of AMR is complex and subject to ongoing research.

Key points:

• Antimicrobial resistance (AMR) has reached a point where some infections may become untreatable.
• Immunisation is one strategy to tackle AMR, by decreasing rates of infection and thereby antibiotic use and preventing the development of resistant infections.
• The World Health Organization has developed a list of pathogens where AMR is of most concern and new antibiotics are needed; there is no equivalent for vaccines.
• Quantifying the impact of immunisation on AMR and incorporating this into calculating the cost-effectiveness of vaccines is still an area of ongoing research.
• Using immunisation to tackle AMR depends on wider use and increased uptake of existing vaccines, and increasing the development of new ones.

POSTnotes are based on literature reviews and interviews with range of stakeholders, and are externally peer reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

Professor David Livermore, University of East Anglia*

Professor Marc Lipsitch, Harvard TH Chan School of Public Health*

Professor David Salisbury, Centre on Global Health Security, Chatham House*

Professor Andrew Pollard, University of Oxford and Chair of the Joint Committee on Vaccination and Immunisation*

Dr Katie Atkins, Professor John Edmunds, Dr Stefan Flasche and Professor Mark Jit, London School of Hygiene and Tropical Medicine*

Dr Michael Edelstein, Public Health England*  

Professor Jeffrey Almond, University of Oxford

Kevin Outterson, Professor of Law, Boston University & Executive Director, CARB-X*

Professor Steve Black, Cincinnati Children’s Hospital Medical Centre*

Dr E. David McIntosh, Imperial College London*

Dr Elizabeth Klemm and Dr Zoe Seager, The Wellcome Trust*

Professor Adam Cunningham, University of Birmingham and The BactiVac Network*

Dr Shamez Ladhani, Public Health England*

Department of Health and Social Care*

Dr Martin Friede, World Health Organization

Professor Ben Cooper, Nuffield Department of Medicine, University of Oxford*  

Department for International Development*

Dr Marco Cavaleri, European Medicines Agency*

Association of the British Pharmaceutical Industry*

Andrew Earnshaw, Joint Committee on Vaccination and Immunisation

Innovate UK*

Dr Alberto Giubilini, Oxford Martin School and Wellcome Centre for Ethics and Humanities, University of Oxford

Dr Richard Pebody, Public Health England*

Dr Jonathan Pearce, Medical Research Council*

Dr Padmini Srikantiah, The Gates Foundation*

Professor Rino Rappuoli, GlaxoSmithKline Vaccines and Imperial College London*

*Denotes those who acted as external reviewers of the briefing.