WHO publishes action framework on leveraging vaccines to reduce antibiotic use

The World Health Organization (WHO) recently published an action framework on leveraging vaccines to reduce the spread of antibiotic resistance, laying out seven discrete objectives towards this goal. These objectives include 1) increasing coverage rates of vaccines; 2) increasing data collection on the intersection of vaccines and AMR; 3) developing value estimates of vaccines with regard to addressing AMR; 4) increasing funding for novel vaccines; 5) developing policy mechanisms to accelerate vaccine development; 6) increasing awareness on the intersection of vaccines and AMR; and 7) updating normative guidelines on both AMR and vaccines to help reduce the spread of AMR. An accompanying Viewpoint was also published in Clinical Infectious Diseases, providing an overview of key priority actions, as well as how best to support activities between antimicrobial resistance and vaccine partners. Because vaccinations directly block transmission of pathogens, including resistant strains, widespread adoption can reduce the consumption of antibiotics. As a result, in addition to the recently published action framework, WHO is also developing two additional frameworks: 1) a value attribution framework for vaccines related to AMR and 2) a pipeline analysis of vaccines in pre-clinical and clinical development that might target the twelve priority pathogens (which include Clostridium difficile and tuberculosis).

Estimation of the impacts of vaccination campaigns in low- and middle-income countries

Improvements in vaccine coverage rates and novel vaccines in low- and middle-income countries (LMICs) are responsible for 37 million lives saved between 2000 and 2019, according to a new modelling study examining ten main pathogens (hepatitis B, Haemophilus influenzae type B, HPV, Japanese encephalitis, rotavirus, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rubella, and yellow fever). By modeling disability adjusted life years (DALYs) and deaths attributable to these pathogens across 98 LMICs, the researchers found that vaccination against just these ten pathogens could result in 69 million lives saved between the years 2000 and 2030, with the majority of these being children younger than the age of 5. Of note, vaccination campaigns for measles are estimated to account for the majority of these averted deaths, followed by hepatitis B vaccinations. Moreover, for those born in the year 2019, vaccination programs in the included countries could result in a 72% reduction in mortality, compared to those born without such immunizations. And especially for children below the age of five, researchers estimate that a lack of immunizations would result in a 45% higher all-cause mortality rate, highlighting the need for continued investments into these campaigns globally, especially among LMICs.

Review examines policy interventions to decrease vaccine hesitancy and encourage decreased antimicrobial use

Princeton University researchers have conducted an overview of the economic and behavioral influencers behind vaccine hesitancy and antimicrobial use. In this literature review, they also identified potential policy interventions to encourage decreased antibiotic usage and increased vaccination. The article spans from covering individual perceptions of risk, to free-riding, social norms, and economic and clinical consequences to health behaviors. The authors also contrast individual and community perceptions, such as individuals balancing the perceived risks of vaccine adverse effects against contracting the disease or the perceived risk of not taking an antibiotic against that of emerging antimicrobial resistance within a community.

Economic principles such as free-riding (whereby individuals benefit from a public good without contributing to it) are introduced in the context of non-vaccinated individuals benefiting from herd immunity, where conversely antibiotic users may benefit from overprescribed treatments without bearing the brunt of the societal consequences of inappropriate antimicrobial use. Social norms and individual perceptions of responsibility and altruism are shown to be powerful motivators to enforce or dismantle individual behaviors from a patient to prescriber level. Finally, the consequences of undervaccination and overuse of antibiotics are presented alongside potential policy interventions including controlling the cost or supply of health goods; altering prescriber practices; changing social behavior, e.g., by excluding individuals who are not vaccinated from public schools; and carefully crafting the messaging behind educational campaigns to better empower viewers.