Vaccines and antimicrobial resistance: from science to policy

Reducing the need for antibiotics is an effective way to tackling the problem of antimicrobial resistance (AMR). Vaccines, along with water and sanitation, and infection prevention and control can play a central role in lowering the burden of AMR. Expanding coverage of existing vaccines (PCV, rotavirus, typhoid) and introducing new vaccines (RSV, TB, Klebsiella pneumoniae) are among the most promising options and should considered as part of the crafting of global targets in reducing the burden of AMR.

Professor Ramanan Laxminarayan, Princeton University, One Health Trust, USA

Professor Ramanan Laxminarayan, Princeton University, One Health Trust, USA

Laxminarayan is founder and Director of the One Health Trust (formerly known as the Center for Disease Dynamics, Economics & Policy or CDDEP) in Washington, DC and New Delhi, a senior research scholar at Princeton University, and Director of the WHO Collaborating Center on Antimicrobial Resistance in New Delhi. He is an Affiliate Professor at the University of Washington, Senior Associate at the Johns Hopkins Bloomberg School of Public Health, and a visiting professor at the University of Strathclyde in Scotland and the National University of Singapore Saw Swee Hock School of Public Health. Laxminarayan chairs the board of GARD-P, a global product development partnership created by the World Health Organisation, that aims to develop and deliver new treatments for bacterial infections.  He is founder and board chair at HealthCubed, which works to improve access to healthcare and diagnostics worldwide. 

Juan Pablo Uribe:

Antimicrobials have become part of the infrastructure of modern society; but their longevity is under threat, compromising our ability to treat many health conditions cost-effectively and quickly. In 2017, the World Bank estimated that by 2050, left unchecked, AMR could wipe away 3.8 percent of global gross domestic product each year and push 28 million people into poverty (World Bank 2017). Ongoing efforts have highlighted that the socioeconomic burden of AMR remains substantial. However, the challenge posed by AMR is not universally intractable; from improving handwashing in health care settings to banning the use of antimicrobials as growth promoters in agriculture, there is much that can be done. Supporting investments in health system strengthening, such as infection, prevention and control, is an area where the World Bank, through technical assistance and financing, can positively impact the fight to preserve antimicrobials. Currently, the World Bank finances and collaborates with governments worldwide across a portfolio of more than 60 projects that are addressing AMR. In addition, the World Bank brings a comparative advantage in its multisectoral approach, and has identified 20 intervention areas (across the Health, Water, Agriculture and Food and Environment sectors) that be advanced through, its financing, to better address AMR in the coming years.

Anthony McDonnell:

Antimicrobial resistance (AMR) is one of the world’s top public health threats. It results in 1.3 million deaths every year—and without concerted action, this number is set to increase. Estimates of the economic burden of AMR have found that GDP would be trillions of dollars lower in 2050 if these trends continue. However, these estimates were made almost a decade ago, before detailed estimates of the health burden of AMR, and when our understanding of the macro-economic impact of infectious diseases was less clear.

Dr Juan Pablo Uribe, World Bank, USA

Dr Juan Pablo Uribe, World Bank, USA

Juan Pablo Uribe is the Global Director for Health, Nutrition and Population at the World Bank and Director of the Global Financing Facility for Women, Children and Adolescents (GFF). Previously, from 2018 to 2019, Dr Uribe served as Minister of Health and Social Protection of Colombia. Between 2009 and 2011, he was the World Bank´s Health Sector Manager for East Asia and the Pacific. In his vast career, first as a medical doctor specialized in public health and public administration, and later in both public and private leading health sector organizations, Mr. Uribe has contributed significantly to public health policies, health care delivery and health systems development. 

Anthony McDonnell, Center for Global Development, UK

Anthony McDonnell, Center for Global Development, UK

Anthony is a senior policy analyst in Center for Global Development's (CGD) global health policy team. He leads CGD’s work on antimicrobial resistance (AMR), including modelling the macro-economic burden of AMR and was previously the technical lead of CGD’s working group, A New Grand Bargain to Improve the Antimicrobial Market for Human Health. He has also led projects analysing the COVID-19 vaccine portfolio, examining policy interventions to protect the supply chains for pharmaceuticals from COVID-19-induced shocks, and contributed to the international Decision Support Initiative’s work in Ethiopia.

Before joining CGD, he was Head of Economic Research for the UK’s Independent Review into AMR which was set up by the UK government and the Wellcome Trust; led a Wellcome Trust project examining how it could fund more economic research; a research associate at ODI working on the political economy of why governments role out health services in LMICs, (particularly those aimed at reaching the left behind); and a senior health economist at the University of Oxford, modelling the cost of malaria interventions.

The escalating burden of antimicrobial resistance (AMR) necessitates a multifaceted intervention strategy. The WHO Global Action Plan on AMR emphasises the critical role of vaccines in mitigating AMR by reducing infection rates, antibiotic usage, and the transmission of resistant genes. Despite their potential, the impact of vaccines has been consistently underestimated and underutilised. Data collected from randomised controlled trials and observational studies demonstrate that the use of existing vaccines against Streptococcus pneumoniae and Salmonella typhi can reduce the prevalence of drug-resistant pathogens. There is evidence that the use of existing vaccines and those that are in development can significantly reduce antibiotic use associated with treating syndromes caused by vaccine-targeted pathogens. In this presentation, Dr O’Brien will give a summary of the role of vaccines in reducing AMR, highlighting key evidence and recommendations to ensure that vaccines are fully utilised as tools to tackle AMR. 

Dr Kate O'Brien, WHO, Switzerland

Dr Kate O'Brien, WHO, Switzerland

Dr Kate O’Brien is Director of the Immunization, Vaccines and Biologicals Department at the World Health Organization. She leads WHO’s vaccine and immunization strategy and implementation to advance the vision of a world where everyone, everywhere, at every age, fully benefits from vaccines for good health and wellbeing. The Department works across the vaccine and immunisation value chain (vaccine development to programme implementation), leveraging the work of WHO staff at country, regional and global level to support country programme impact and global coordination.

Dr O’Brien is a Canadian with training as a pediatric infectious disease physician, epidemiologist, and vaccine clinical trialist [BSc, University of Toronto (Canada); MDCM, McGill University (Canada); MPH, Johns Hopkins Bloomberg School of Public Health (USA)].  Dr O’Brien’s career has focused on vaccine equity, working through vaccine clinical trials, epidemiology studies and innovative policy and strategy initiatives to accelerate life-saving vaccine introductions and scale up in low- and middle-income countries.

During the last 40 years, several innovative technologies allowed development and licensure of previously impossible vaccines. These include glyco-conjugation, reverse vaccinology, structure-based antigen design of subunit and nanoparticle-based vaccines, mRNA vaccines and novel adjuvants. In this period outer membrane vesicles (OMVs or GMMas) -based vaccines also gained access to phase 1 and phase 2 clinical trials and represent a promising and accessible approach for bacterial vaccines.  

The approach that Professor Rappuoli and team currently use in their laboratory is the so-called reverse vaccine 2.0. In this approach Professor Rappuoli and team start from PBMCs isolated from convalescent donors, they single cell sort the donor’s memory B cells and they select those cells that produce monoclonal antibodies able to kill, opsonise or prevent host cell binding of target bacteria.  The antigens recognised by the most potent and broadly cross-reactive human monoclonals are selected for vaccine development, while the monoclonal antibodies can be used for passive immunisation to prevent and cure the disease. 

Dr Rino Rappuoli, Novartis Vaccines, Italy

Dr Rino Rappuoli, Novartis Vaccines, Italy

Rino Rappuoli is Global Head Research and Development at Novartis Vaccines and is based in Siena, Italy. He earned his PhD in Biological Sciences at the University of Siena and has served as visiting scientist at Rockefeller University in New York and Harvard Medical School in Boston. Prior to the present position he was head R&D of Sclavo and then head of vaccine research and Chief Scientific Officer of Chiron Corporation.

Several molecules he worked with became part of licensed vaccines. These include: CRM197 used in H.influenzae, N.meningitidis, and pneumococcus vaccines; PT9K/129G, a genetically detoxified pertussis toxin used for an acellular vaccine against pertussis; the first conjugate vaccine against meningococcus C and later against meningococcus ACYW; the MF59 adjuvant used in seasonal and pandemic influenza vaccines and the FHBP, NadA and NHBA antigens derived from the genome of meningococcus B that made possible the development of Bexsero.

He was elected member of the US National Academy of Sciences (NAS) and the European Molecular Biology Organization (EMBO). Awards conferred include: Paul Ehrlich and Ludwig Darmstaedter Prize (1991), the Gold Medal by the Italian President (2005), the Albert B. Sabin Gold Medal (2009), the Lifetime Achievement Award from the Institute of Human Virology in Maryland (2010), and the Excellence Award from the European Society of Clinical Microbiology and Infectious Diseases (2011). In 2013 he was nominated third most influential person worldwide in the field of vaccines (Terrapin). He has introduced several novel scientific concepts (genetic detoxification, 1987, cellular microbiology, 1996; reverse vaccinology, 2000; pangenome, 2005, structural vaccinology, 2008).

Richard Adegbola:

In the global fight against Antimicrobial Resistance (AMR), a recognised "top 10 threat to global health", the intersection of vaccines and AMR emerges as a crucial point. This presentation aims to elucidate the pivotal role played by pneumococcal vaccines in deepening our understanding of how vaccines can shape antimicrobial resistance. Within the broader context of "Vaccines and Antimicrobial Resistance- from Science to Policy", this discussion sheds light on the beneficial impact of pneumococcal vaccines in tackling the escalating threat of resistance. 

Commencing with an exploration of the current state of pneumococcal disease burden, the presentation identifies specific mechanisms through which pneumococcal vaccines influence bacterial resistance. Evidence suggests a decline in antimicrobial resistant pneumococcal disease and nasopharyngeal carriage following the introduction of pneumococcal conjugate vaccines. Vaccines can reduce pneumococcal resistance by curtailing the carriage of antimicrobial-resistant serotypes. This not only safeguards the vaccinated population but also prevents disease transmission and diminishes antibiotic resistance through an overall reduction in antibiotic use. Nevertheless, challenges such as serotype replacement, vaccine equity, and vaccination coverage demand attention. 

The presentation underscores the significance of formulating pertinent policies to harness the full potential of pneumococcal vaccines in mitigating antimicrobial resistance. By bridging the gap between scientific advancements and actionable policy measures, the discussion advocates for a collaborative approach involving researchers, policymakers, and healthcare professionals. Ultimately, antimicrobial resistance is a global threat that must be addressed through multiple strategies, including national vaccination programmes, antimicrobial stewardship, and ongoing surveillance.

Professor Farah Qamar, The Aga Khan University, Pakistan

Professor Farah Qamar, The Aga Khan University, Pakistan

Professor Qamar is a clinical researcher with over 15 years of experience. Her most notable achievements include spearheading the outbreak investigation of XDR typhoid in Hyderabad, Pakistan, and introducing the newly approved Typhoid conjugate vaccine (TCV) into the national immunization program. Her work has been translated into global policy. She has served on multiple national and international advisory boards, Professor Farah's expertise in clinical research has significantly impacted infectious diseases and global health policies. With nearly 100 publications and active participation in global health initiatives, she has earned the Presidential Medal of Excellence, highlighting her significant contributions to public health.

Professor Richard Adegbola, Bill & Melinda Gates Foundation, Infectious Diseases Development, Global Health Program, USA

Professor Richard Adegbola, Bill & Melinda Gates Foundation, Infectious Diseases Development, Global Health Program, USA

Richard Adegbola joined the Bill & Melinda Gates Foundation in 2009 as Senior Program Officer, Pneumonia Clinical Studies. He has over 20 years of research experience in infections of the tropics particularly, pneumonia and meningitis caused by Streptococcus pneumoniae and Haemophilus influenzae. At the foundation, his role is taking pneumonia research findings to policy, implementation and evaluation for impact. He is responsible for vaccine impact studies, including impact evaluations for pneumococcal and meningococcal conjugate vaccines and the maternal immunization program, and for studies of the many causes of pneumonia in the developing world.

Prior to joining the Gates Foundation, he was Head of the Bacterial Diseases Programme at the UK MRC Laboratories in The Gambia. In addition to his MRC appointment he was a member of WHO Meningitis Vaccine Project Advisory Group and Vice Chair of EDCTP Board at The Hague. He was awarded the title and status of Honorary Visiting Professor in the Department of Infection, Immunity and Inflammation by University of Leicester in England in 2005 and served as a member of the Gambia Government Inter-Agency Committee for immunization and member of National Polio Expert Committee for The Gambia from 2001 to 2009. 

Roberto La Ragione:

Antibiotics are critical for treating infections in livestock and poultry. However, the emergence and spread of antibiotic resistance is a major global health threat. Therefore, novel and practical alternatives to antibiotics are urgently required. Vaccines are one such alternative, which have the potential to reduce the emergence and spread of resistance by preventing infections and thereby reducing the need to use antibiotics to treat infections. Moreover, vaccines are essential for improving animal health and welfare, whilst safeguarding human health and global economies. 

Globally, vaccines are widely used to prevent a range of infections in animals, and a number of studies have demonstrated that their use in animals can lead to significant reductions in antibiotic use, alongside providing health, welfare and productivity benefits. Therefore, the development of new vaccines for use in animals is essential to help reduce the use of antibiotics and the emergence, spread and persistence of resistance.

Clearly, veterinary vaccines are a promising alternative to antibiotics and have the potential to improve animal health, welfare, and safeguard food production. However, a number of factors, including costs and administration methodologies have hampered vaccine use in some sectors. Therefore, further research and development is required to realise the potential of vaccines as alternatives to antibiotics. This presentation will focus on the development of vaccines to reduce antibiotic use and associated resistance in livestock and poultry.

Duncan Colquhoun:

Aquaculture is the fastest growing food-producing sector in the world and Norway is the leading producer of farmed Atlantic salmon worldwide, with over 1.6 million tons produced in 2022. Since its start in the late 1960s, expansion of the fish farming industry in Norway has not been without biological problems. During the early years, serious bacterial infections caused significant losses. Large quantities of antibiotics were prescribed, peaking at almost 50 tonnes of active antibacterial substances used in production of less than 100,000 tonnes of farmed salmon in 1987. AMR to several antibiotic classes was rapidly discovered. However, following development and rapid, widespread adoption of effective vaccines against the major bacterial diseases in the late ‘80s and ‘90s, antibiotic use fell dramatically. All salmon farmed in Norway are now vaccinated against as many as six bacterial pathogens. Only 425 kg antibiotics were used in Norwegian aquaculture (all fish species) in 2022. While this low antibiotic use is undoubtedly due to the success of available vaccines and recognition of the dangers of AMR development, negative consumer perception relating to antibiotic use in farmed fish may also be an important influence. AMR is now only very rarely identified amongst fish pathogenic bacteria in Norway. This presentation will introduce the main bacterial diseases in intensive Norwegian salmon aquaculture, the vaccines and vaccination strategies used to combat these challenges and the limited AMR identified over the years. 

Antibiotics are critical for treating infections in livestock and poultry. However, the emergence and spread of antibiotic resistance is a major global health threat. Therefore, novel and practical alternatives to antibiotics are urgently required. Vaccines are one such alternative, which have the potential to reduce the emergence and spread of resistance by preventing infections and thereby reducing the need to use antibiotics to treat infections. Moreover, vaccines are essential for improving animal health and welfare, whilst safeguarding human health and global economies.

Professor Duncan Colquhoun, Norwegian Veterinary Institute, Norway

Professor Duncan Colquhoun, Norwegian Veterinary Institute, Norway

Duncan J Colquhoun BSc (Hons), MSc, PhD is a senior researcher at the Norwegian Veterinary Institute, Oslo. From 2013-2023 he also held an adjunct Professor position at the University of Bergen. After graduating MSc in Aquatic Pathobiology from the Institute of Aquaculture, University of Stirling, Scotland he gained his PhD on bacterial virulence and vaccine development, at the Norwegian School of Veterinary Science in Oslo. He has over 28 years’ experience in diagnostics and research relating to bacterial pathogens of fish. His work focuses mainly on taxonomic studies and molecular epidemiology of bacterial diseases important in Norwegian aquaculture, with current focus on Tenacibaculum spp., Moritella viscosa, Aeromonas salmonicida, Yersinia ruckeri and Pasteurella spp.  

Professor Roberto La Ragione, University of Surrey, UK

Professor Roberto La Ragione, University of Surrey, UK

Professor Roberto La Ragione is a veterinary microbiologist with a particular interest in zoonotic bacterial pathogens of livestock, poultry and companion animals. His current research focuses on understanding the pathobiology of zoonotic pathogens, antimicrobial resistance, and the development of novel intervention strategies, including diagnostics, vaccines and probiotics. Professor Roberto has published over 200 peer reviewed publications in the area of veterinary microbiology and is a member of a number of scientific advisory committees. Professor Roberto is currently a Professor of Veterinary Microbiology and Pathology in the School of Veterinary Medicine and Head of the School of Biosciences at the University of Surrey.

Annaliesa Anderson:

Antimicrobial resistance (AMR) represents a significant global health threat, with over one million global deaths attributed to difficult-to-treat bacterial infections in 2019¹. Vaccines are well-positioned for helping to address this challenge by providing protection against infectious diseases that might otherwise result in antibiotic use — or misuse. Vaccines that target bacterial and viral infections each have a role to play. For example, pneumococcal conjugate vaccines (PCV) such as PCV13 is estimated to have prevented more than 175-million cases of IPD and over 600,000 deaths globally in children under five years of age alone between 2010 and 2019². Influenza vaccines prevent antibiotic misuse, in addition to bacterial superinfections that can result from the viral insult, thus resulting in an inverse relationship between influenza vaccine coverage and circulating antimicrobial resistance³. Despite this positive outlook, much more needs to be done to utilize the advantage of vaccines in AMR prevention. This presentation will focus on progress towards advancing vaccines to help answer this call-to-action.

1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655.
2. Chapman, R. et al. Ten year public health impact of 13-valent pneumococcal conjugate vaccination in infants: A modelling analysis. Vaccine 38, 7138-7145 (2020). 
3. Barchitta M, Maugeri A, Vinci R, Agodi A. The Inverse Relationship between Influenza Vaccination and Antimicrobial Resistance: An Ecological Analysis of Italian Data. Vaccines (Basel). 2022 Apr 3;10(4):554.

Frédéric Descamps:

There is more and more pressure, implementation measures and incentives to reduce antimicrobial use in food-producing animals in the European Union (EU) (and elsewhere); accordingly, the use of antimicrobials in food-producing animals has significantly decreased in EU in the recent past. On the other hand, it is widely recognized and reported that veterinary vaccines may contribute to reduce antimicrobial use and indirectly reduce the risk of antimicrobial selection and/or antimicrobial resistance (AMR) development. The vaccines against bacterial infections and immunosuppressive viruses are especially relevant in this regard. The presentation will briefly review the current status and industry trends relative to the development and availability of vaccines that may be of interest in that context. The specificities of the veterinary vaccine industry (versus human vaccine industry) will be summarized. Relevant regulatory requirements will be shortly described. Possible next steps towards the development of veterinary vaccines which may play a role in the reduction of antimicrobial use and AMR will then be discussed, together with the technical and regulatory challenges faced by the industry. Clearly, this is a topic of growing interest from a regulatory, public health and industry standpoint and support for innovation in the area will be important. 

Dr Annaliesa Anderson, Pfizer, USA

Dr Annaliesa Anderson, Pfizer, USA

Dr Anderson is the Senior Vice President and Head of Vaccine Research & Development at Pfizer. She leads an organization of approximately a thousand scientists, clinicians and professional staff, and has over 30 years of pharmaceutical research experience. She earned her PhD in biological sciences from the University of Warwick, England, and has contributed to the research and development of a multitude of vaccines, including for human papilloma virus while at Merck, and for pneumococcal disease, meningococcal disease, COVID-19, and respiratory syncytial virus at Pfizer. During the COVID-19 pandemic, she helped lead the development of an antiviral therapy for COVID-19, and currently leads the strategic development of an extensive vaccine portfolio for diseases including influenza, C. difficile infection, Group B Streptococcus, and many others.

Dr Frédéric Descamps, Zoetis, Belgium

Dr Frédéric Descamps, Zoetis, Belgium

Frédéric Descamps graduated as Veterinarian from the Faculty of Liège, Belgium, and obtained his PhD on the pathogenesis and immunology of Microsporum canis in cats in the same faculty. He has been working in the field of Veterinary Regulatory Affairs since 2003, first in the public sector where he has been acting as Senior Assessor at the Belgian Medicine Agency and as Belgian alternate CVMP member at the European Medicines Agency. Then he moved to the Veterinary pharmaceutical Industry in 2011. He is now Director of Regulatory Affairs at Zoetis. He is also Chair of the Biological Working Party of AnimalHealthEurope. His primary responsibility is to develop new biological products (vaccines in particular) and maintain existing products on the market.