Prioritization of Pathogens to Guide Discovery, Research and Development of New Antibiotics for Drug Resistant Bacterial Infections, Including Tuberculosis
(2017; 88 pages)

Abstract

Antimicrobial resistance is one of the most complex global health challenges today. Worsening antimicrobial resistance could have serious public health, economic and social implications. The past three years have seen unprecedented global political momentum to address antimicrobial resistance. WHO is working closely with the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health in leading global efforts against antimicrobial resistance and ensuring that the necessary momentum is consolidated and sustained. These efforts are guided by an ad-hoc interagency coordination group established in 2017. A global development and stewardship framework to combat antimicrobial resistance is being drafted to support the development of new antimicrobial medicines, diagnostics, vaccines and other tools.

One of the gravest global concerns about antimicrobial resistance currently is that antibiotic resistance has emerged in so many pathogens, including TB. In 2016, in the wake of the increasing global awareness of the need for new antibiotics, and to support the implementation of the Global Action Plan on Antimicrobial Resistance, WHO developed a priority pathogens list (PPL) of antibiotic-resistant bacteria to support research and development into new and effective drugs. This action also followed recommendations in the 2016 United Nations report of a high-level panel on the global response to health crises, which emphasized the threat posed to humanity from a number of under-researched antibiotic-resistant bacteria that urgently require enhanced and focused investment in research and development.

Prioritization of pathogens for research and development is highly challenging given the absence of established criteria defining the impact of pathogens on human health. As a result, no consensus exists on the most effective methodology to develop prioritization in infectious diseases. The diversity of communicable diseases is a major challenge for prioritization of pathogens. As a result, the scope and focus of the work underlying this document was agreed beforehand to allow the deliverables requested by Member States to be 11 achieved within a realistic timeframe. Pathogens were considered separately, according to their natural history in terms of acute or chronic course of the diseases. It was not possible to apply the same framework to both TB and to other bacterial pathogens, thus they were considered and are reported separately.

This document therefore addresses Mycobacterium tuberculosis, a prioritized programme of WHO, and other antibiotic-resistant bacteria, which have been overlooked until recently despite their considerable health and economic burden. It is acknowledged that similar assessments would be useful for communicable diseases caused by viral and fungal pathogens (e.g. following the recent publication of the WHO HIV drug resistance report. Pesticide, parasitic and vector resistance fall outside of the scope of this document.

The priority of TB for research and development has been previously articulated by WHO and is reiterated here.

Section 1 of this report therefore focuses on TB and Mycobacterium tuberculosis as a priority pathogen.

Section 2 reports the priority list of other antibiotic-resistant bacteria developed through a multi-criteria decision analysis.

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