Superhero. Superhighway. Superglue. Adding the prefix “super” highlights a thing’s unrivaled rank and elevates it above and beyond what is expected. But superbug has a different connotation. These microbes are increasingly resistant to currently available antibiotics, turning what should be easily treatable infections into deadly ones. Wiser use of antibiotics is one solution. Wider use of vaccines is another.
Each year, drug-resistant infections are responsible for 23,000 deaths in the United States. If current trends hold, a team from the United Kingdom projected that by 2050, 10 million people worldwide will die annually from untreatable infections. That’s almost as many lives as we will lose to all forms of cancer this year. The World Bank warns that the long-term economic damage from drug resistance could be worse than the 2008 financial crisis.
The increasing rate of resistance to antibiotics and other disease-fighting agents (collectively called antimicrobial resistance) is due in large part to the overuse of antibiotics in humans and livestock and the ability of organisms to rapidly evolve to bypass the effects of these drugs. One clear solution is to develop new classes of antimicrobials. Another is to improve the stewardship of their use, as outlined in the World Health Organization’s new recommendations for antibiotic use and embodied by broader efforts to limit the use of antibiotics in livestock farming.
Preventing infections in the first place will also reduce the need for antibiotics. That’s where vaccines come in as an important part of the solution.
Vaccines are an icon of prevention, well-regarded as one of the best buys in health. With immunization averting up to 3 million deaths annually, no health intervention better embodies the old adage that an ounce of prevention is worth a pound of cure.
But in the context of the global trend in antibiotic resistance, we have been undervaluing all that vaccines offer to both individuals and communities. For example, a study published in the Lancet led by Ramanan Laxminarayan of the Center for Disease Dynamics, Economics, and Policy found that if every child under 5 years old in the 75 countries studied received pneumococcal conjugate vaccines, the resulting reduction of pneumonia would avert 11.4 million days of antibiotic use each year.
Vaccines help prevent the rise of antimicrobial resistance by reducing the use — and misuse — of antibiotics. They do this in several ways. Vaccines that prevent bacterial diseases such as pneumococcal infections, bacterial meningitis, or pneumonia reduce antibiotic use by directly preventing these types of bacterial infections, for which antibiotics are the recommended treatment. Vaccines against viral diseases can reduce antibiotic use by preventing the occurrence of influenza and other viral infections that are commonly lumped together as “the flu,” which are often mistreated with antibiotics.
Antibiotics only work against bacteria and have no effect on viruses, yet a 2011 study found that antibiotics were prescribed for 79 percent of people with the flu. Preventing influenza and other viral infections through immunization would also eliminate the need to treat the secondary bacterial infections that can follow virus-caused respiratory illnesses.
But the benefits don’t stop there. Vaccines have a unique quality among health interventions by benefiting both the individuals who are vaccinated and the larger community. Referred to as herd immunity (or community immunity), it works like this: When enough people are immunized, even those who aren’t vaccinated are less likely to get sick simply because they are less likely to come into contact with someone who is infected — because they have been immunized.
These attributes have been clearly demonstrated in communities around the world when vaccines for pneumococcal pneumonia and Haemophilus influenzae (Hib) meningitis were introduced. The protection extended to the larger community, and also had an impact on the emergence of antibiotic resistance.
Slowing the rise of antibiotic resistance requires immediate, collective action. To ensure that once common infections don’t become deadly, we must preserve the effectiveness of existing antibiotics by ending misuse and overuse. At the same time, expanding access to vaccines can slow the development and spread of so-called superbugs. After all, it hardly matters how “super” these bacteria are if we can prevent them from infecting people in the first place.
Bruce Gellin, M.D., is president of global immunization at the Sabin Vaccine Institute in Washington, D.C. The institute receives funding support from public and private sources, including philanthropic organizations, governments, and pharmaceutical companies.
