News and Opinions  –  2023

3 reason why a new Pandemic Accord should address antibiotic resistance

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In the latest available draft of the WHO CA+ text - also known as the pandemic accord - language on antimicrobial resistance have throughout the text been marked for potential removal.

This would not only be a major missed opportunity to leverage pandemic prevention efforts towards addressing one of today’s biggest health threats, but would also mean that the provisions of the pandemic accord may not be triggered if the next pandemic is of bacterial origin - and it may very well be!


On the 12-16th of June, the Intergovernmental Negotiating Body (INB) resumed negotiations to discuss the latest version of the WHO CA+ text as proposed by the INB Bureau, based on input from member states.

This text includes options which could entail the removal of all paragraphs:

  • principle 8,Art. 4.3 & 4.6 and
  • Art 5.3 & 5.7

containing a reference to either antibiotics, antimicrobials or antimicrobial resistance.

This is of course highly concerning given the essential role effective antibiotics plays in pandemic response – regardless whether it is of viral or bacterial origin for the following three reason:

1. Throughout history pandemics have been caused by bacterial infections

Several pandemics have been caused by the plague which is classified by WHO as a re-emerging infectious disease. Similarly, cholera has been the cause of a number of pandemics since the 1800’s.

While the risk that the next pandemic is caused by bacteria may be lower than viruses, due to more limited transmission and growth of bacterial pathogens, it should not be ignored that resistant bacteria already are a major cause of death today, and have enormous potential to change and mutate in ways we cannot foresee. The WHO’s existing list of pathogens of epidemic and pandemic potential, as well as the ongoing efforts to revise the list, include bacteria.

Therefore, in order to stand the test of time and account for rapid, unforeseen developments, the text should incorporate the possibility that the next pandemic may be either viral or bacterial in origin, including being caused by resistant bacteria. This should be acknowledged in the concept of “pathogens with pandemic potential”. No one expected Covid-19 to become the next pandemic. Member States should avoid making the mistake of preparing only for viral pandemics as the most probable – particularly as history shows otherwise.

2. Even in the event of another pandemic caused by a virus, effective antibiotics are essential for pandemic response

During viral pandemics, secondary bacterial infections are often a major cause of death, as seen during the COVID-19 pandemic where numerous lives were lost due to bacterial pneumonia. The same was evident during the Spanish Flu where secondary infections such as bacterial pneumonia caused more deaths than the actual influenza virus.

In addition, effective antibiotics are needed to be able to continue to provide basic and advanced medical care during a pandemic. Neonatal care, cancer treatments, transplantations, treating sepsis and diabetic complications all require working antibiotics.

As such, addressing the ever-growing problem of bacterial resistance to antibiotics should be considered a central element under pandemic preparedness and response. Effective antibiotics should therefore be integrated in the text, and included in the Accord’s definition of “pandemic related products”.

3. New antibiotics cannot be developed at the same speed as the COVID-19 vaccine (and our currents antibiotics are withering away)

Bacteria are often associated with lower risk of causing outbreaks than viruses due to the more limited transmission and growth of bacterial pathogens, along with the availability of antimicrobials. However, existing antibiotics are not equitably distributed and developing new antibiotics is cumbersome and slow.

The time it took to respond effectively to the Covid-19 pandemic depended heavily on the speedy development of novel vaccines. As such, the likely lead time to develop new treatments, vaccines and diagnostics is a factor that should be considered in terms of probability and preparedness.

Even with significant funding being mobilised for R&D, as seen during the Covid-19 pandemic, new antibiotics, bacterial vaccines and diagnostics would most likely still take years to develop. Not least given the current dire state of the pre-clinical and clinical pipeline which the WHO calls “stagnant and far from meeting global needs”. Indeed, just two compounds are being considered innovative while targeting the most critical pathogens, according to the WHOs most recent pipeline analysis.

In addition to these considerations, ReAct has previously outlined in a briefing note how several elements of an effective global system for pandemic prevention, preparedness and response are in strong alignment with what is needed to address antibiotic resistance.

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