Act now, next pandemic will not wait for world

Following a routine chest infection in August and a sputum sample, I was surprised that the culture had confirmed a Klebsiella pneumoniae infection.

But what was even more disconcerting is that the bug was resistant to the antibiotics Amoxicillin and Cotrimoxazole.

The redeeming factor, at least for now, is that the bug is susceptible to Ciprofloxacin, Co-amoxiclav and Ceftriaxone. As an asthmatic with a touch of COPD and comorbidities, a bit immunosuppressed due to the steroids I take, Antimicrobial Resistance (AMR) and surveillance is now of lived experience interest to me, as well as of my journalistic interest in public health issues such as universal health coverage, vaccine/drug accessibility and equality.

Without being alarmist, the World Health Organization (WHO) issued a Disease Outbreak News on 1 August on Antimicrobial Resistance, especially relating to Hypervirulent Klebsiella pneumoniae (hvKp) (sequence type (ST) 23) carrying resistant carbapenemase genes to the last line carbapenem family of antibiotics, which was reported in at least one country in all six WHO regions.

Cohort research studies have shown creeping, albeit still low and manageable, incidence of hvKp infections especially in Taiwan, China, Southeast Asia, across Europe including Ireland and Norway, and across the Americas including the US, Canada and Chile.

My respiratory consultant assures me that the Klebsiella strain I had was not of the hvKP variant.

In the WHO African region, cases of hvKp might be present but the extent of the problem is not yet known.

Given that South Africa has the highest incidence of HIV and HIV-related tuberculosis in the world, the AMR trajectory in Africa most likely means that hvKP is already prevalent especially in SADC states, albeit currently in low numbers.

“Detection of hvKp ST23 carrying carbapenem resistance genes or any other virulence or resistance marker,” advises WHO, “requires the use of molecular methods which may not be routinely monitored in many microbiology laboratories across the region.

“Although data on resistance of K. pneumoniae to carbapenems cannot be applied to the entire region due to the limited number of countries that reported this resistance profile and the limited testing coverage, the resistance of K. pneumoniae to carbapenems may already be a serious problem in the WHO African region that merits further investigation and calls for strengthening diagnostic capacity, infection prevention and control interventions, and access to novel therapeutic agents.”

K. pneumoniae strains, says WHO, can cause severe infections in healthy individuals and have been identified with increasing frequency in recent years as hypervirulent compared to classical strains “because of their ability to infect both healthy and immunocompromised individuals and because of their increased tendency to produce invasive infections”.

AMR occurs when bacteria, viruses, fungi and parasites no longer respond to medicines, making people sicker and increasing the spread of infections that are difficult to treat, leading to illness and deaths.

As we are all too aware following the once-in-a-century devastating Covid-19 pandemic in 2020, pathogens respect no borders, ethnicity, creed or culture.

The SARS CoV-2 virus, according to the latest WHO data, affected a staggering 776 205 140 people resulting in 7 064 380 deaths and a vaccine uptake of 13 642 098 070 doses by 8 September 2024 across the world – these are the confirmed cases, but the actual figures are most likely to be much higher.

Drug-resistant infections know no borders, meaning no single country can respond to AMR alone.

In fact, AMR and Detection and Surveillance is widely featured in several sessions at the 8th World One Health Congress, which is currently being held in Cape Town between September 20 and 23. Some of the defining Africa-specific topics being discussed include ‘Tackling Infectious Diseases and Antimicrobial Resistance (AMR) through One Health Approaches in Africa,’ and universal issues such as ‘AMR: the One Health drivers’ and ‘New antimicrobials and vaccination as tools in AMR reduction’.

Equally importantly, the second high-level meeting on AMR convenes this Thursday, September 26, as the principal official, health-focused event during the UN General Assembly (UNGA) in New York, which President Cyril Ramaphosa and a strong delegation are attending.

The final text of the draft political declaration for the meeting warns that AMR will cause even more global suffering, particularly in low- and middle-income countries. Dr Tedros Adhanom Ghebreyesus, WHO director-general, who is addressing the UNGA meeting, could not be franker.

“AMR threatens a century of medical progress and could return us to the pre-antibiotic era, where infections that are treatable today could become a death sentence. This is a threat for all countries at all income levels, which is why a strong, accelerated and well-co-ordinated global response is needed urgently.

“Strong health systems, equitable access to health services, and robust pandemic preparedness are vital for a safer and healthier world.”

Dr Tedros strongly urges harnessing the power of digital technologies to bridge gaps in access to health services and build resilient systems that can meet the multiple overlapping health challenges of the world, from outbreaks, epidemics and pandemics to climate change and the burden of non-communicable diseases.

Both UNGA79’s high-level meeting on AMR and the 8th World One Health Congress take place at a crucial moment as the world continues to recover from the Covid-19 pandemic and accelerates efforts to meet the 2030 Sustainable Development Goals (SDGs).

The consensus is that despite significant strides, progress towards health targets remains off track, exacerbated by ongoing humanitarian, conflict, demographic, governance, social, and climate crises. Millions of people still lack access to life-saving health services, highlighting the link between health and sustainable development.

Covid-19 tragically exposed global weaknesses in preparedness and dealing with pandemics.

There is no room for complacency and decision vacillation. After all, in the post Covid-19 era the world is grappling with surges in resurgent HIV, TB, malaria, polio, cholera, yellow fever and mpox outbreaks, some fuelled by AMR variants.

As WHO’s Dr Tedros warns, the next pandemic will not wait for us, whether from a flu virus like H5N1, another coronavirus, or another cohort of viruses we don’t yet know about. The world needs hope that it is possible for countries to find common solutions to common problems.

*Parker is a writer based on London.

Cape Times