Global and regional burden of attributable and associated bacterial antimicrobial resistance avertable by vaccination: modelling study

Abstract

AbstractIntroductionAntimicrobial resistance (AMR) is a global health threat with 1.27 million and 4.95 million deaths attributable to and associated with bacterial AMR respectively in 2019. Our aim is to estimate the vaccine avertable bacterial AMR burden based on existing and future vaccines at the regional and global levels by pathogen and infectious syndromes.MethodsWe developed a static proportional impact model to estimate the vaccination impact on 15 bacterial pathogens in terms of reduction in age-specific AMR burden estimates for 2019 from the Global Research on Antimicrobial Resistance project in direct proportion to efficacy, coverage, target population for protection, and duration of protection of existing and future vaccines.ResultsIn the baseline scenario for vaccination of primary age-groups against 15 pathogens, we estimated vaccine-avertable AMR burden of 0.51 (95% UI: 0.49 - 0.54) million deaths and 28 (27 - 29)million DALYs associated with bacterial AMR, and 0.15 (0.14 - 0.17) million deaths and 7.6 (7.1 - 8.0) million DALYs attributable to AMR globally in 2019. In the high-potential scenario for vaccination of additional age groups against 7 pathogens, we estimated vaccine-avertable AMR burden of an additional 1.2 (1.18 - 1.23) million deaths and 37 (36 - 39) million DALYs associated with AMR, and 0.33 (0.32 - 0.34) million deaths and 10 (9.8 - 11) million DALYs attributable to AMR globally in 2019.ConclusionThe AMR burden avertable by vaccination in 2019 was highest for the WHO Africa and South-East Asia regions, for lower respiratory infections, tuberculosis, and bloodstream infections by infectious syndromes, and forMycobacterium tuberculosisandStreptococcus pneumoniaeby pathogen. Increased coverage of existing vaccines and development of new vaccines are effective means to reduce AMR, and this evidence should inform the full value of vaccine assessments.Key questionsWhat is already known on this topicThere is some evidence on the impact of vaccines againstHaemophilus influenzaetype b, rotavirus,Streptococcus pneumoniae, SalmonellaTyphi and influenza on antimicrobial resistance (AMR) in specific settings.What this study addsTo our knowledge, this is the first study to estimate attributable and associated bacterial AMR burden avertable by vaccination against 15 bacterial pathogens for a combined set of existing and new vaccines in the pipeline by pathogen, infectious syndrome, and region.The AMR burden avertable by vaccination in 2019 was highest for the WHO Africa and South-East Asia regions, for lower respiratory infections, tuberculosis, and bloodstream infections by infectious syndromes, and forMycobacterium tuberculosisandStreptococcus pneumoniaeby pathogen.How this study might affect research, practice or policyOur model-based projections facilitate evidence-based decision-making for scaling up of existing vaccines to regions in most need with higher AMR burden and prioritise development of new vaccines with high potential for lowering AMR burden by pathogen, infectious syndrome, and region.Our study contributes to the WHO-led value attribution framework for vaccines against antimicrobial resistance, and specifically to the criterion focused on vaccine averted AMR health burden.