Antimicrobial resistance
Antimicrobial resistance could kill millions without innovation. What are the best strategies to prevent it?

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This profile is tailored towards students studying biological sciences and health sciences, however we expect there to be valuable open research questions that could be pursued by students in other disciplines.

Why is this a pressing problem?

Antimicrobial resistance (AMR) refers to the phenomenon of micro-organisms  evolving and mutating such that the drugs designed to kill them cease to be effective. This is a growing problem which threatens many aspects of modern healthcare. If AMR becomes more widespread, previously routine procedures like appendectomies could become associated with severe risks for patients, urinary tract infections could become untreatable and pneumonia could once again become a frequently life-threatening disease. The prospects for treating serious conditions such as cancer or brain damage would also be seriously impaired if we could not count on the reliable treatment of infections. While anyone can get and potentially die from a resistant infection, the problem may be significantly worse in poor countries where general infection frequencies are higher and access to healthcare is worse.

In terms of scale, this paper (2022) estimates that 4.95 million deaths were associated with bacterial AMR in 2019, including 1.27 million deaths attributable to bacterial AMR. The Review of Anti-Microbial Resistance (2014) predicts that by 2050, 10 million people could die every year, globally, because of resistant infections, and the world’s GDP will be between 2% and 3.5% less than it otherwise would be. These numbers has been debated, and one should be careful since statistics on deaths due to resistant infections are poor, especially from low- and middle-income countries where the diagnostic facilities to identify resistance are often not as robust.

While the field of antimicrobial resistance itself does not seem very neglected, there seem to be important approaches within the field that are neglected. Implementation research on the effect of public health policies, information campaigns, prescription practices, training of professionals and nudging interventions etc. is needed to be able to prioritise the best strategies and use resources effectively. The need for such knowledge is most critical in low- and middle-income countries. Another promising approach is designing and testing strategies for safely deploying new drugs in areas with poor healthcare access, where restrictive prescription practises from high-income settings may backfire due to a lack of prescribers, potentially rendering new drugs completely unavailable.

Watch the video below for an introduction to the development of antibiotics, antimicrobial resistance and possible approaches to the problem.

If you’re interested in learning more about this issue, you can check The AMR Studio podcast which features interviews with researchers working on AMR.

Explore existing research

  • CARB-X (Combating Antibiotic-Resistant Bacteria) is funding the best AMR research in the field. They have a partnership with the UK Government called the Global AMR Innovation Fund (GAMRIF)
  • AMR Action Fund is the world’s largest public-private partnership investing in the development of new antimicrobial therapeutics.
  • Novo Repair Impact Fund is investing in early-stage start-ups targeting resistant microbes.
  • JPIAMR is a European organisation involved in international coordination to reduce the burden of AMR. Their research hub contains useful resources for researchers.
  • The World Bank is conducting a number of projects related to AMR, which you can view here.
  • The WHO researches global priorities in controlling AMR. For example, see their research mapping life-threatening fungi
  • ICARS partners with low- and middle-income countries (LMICs) to develop interventions and  policies that help reduce drug-resistant infections
  • ReAct is a global network focused on antimicrobial resistance.
  • The Wellcome trust offers studentships and funding.
  • AMR Solutions publishes curated newsletters on key AMR-related events with a focus on tools that would incentivize pharmaceutical companies to produce new drugs.

Find a thesis topic

If you’re interested in working on this research direction, below are some ideas that could be particularly valuable to explore further. If you want help refining your research ideas, apply for our coaching!

In addition to the questions below, see the report Research and Innovation Objectives of the One Health AMR Partnership for research ideas.

Useful questions to consider include:

  • Which alternatives to antibiotics may be promising and scalable for low-income settings, maybe for a specific illness? This might include phage or peptide therapy.
  • How can we develop platform technologies that increase the ability to identify candidate antimicrobials?
  • How can treatment regimens be designed to prevent the development of resistance? Read more
  • How does horizontal gene transfer work and how important is it for the spread and effects of resistance?
  • How important are gene transfer mechanisms from agriculture for resistant infections in humans? This is primarily relevant for animal agriculture, but could also be relevant for fruit trees. Read more

Useful questions to consider include:

  • What is the effectiveness and cost-effectiveness of preventative interventions, such as vaccines and WASH, in preventing AMR?
  • How can healthcare hygiene most effectively be improved to prevent healthcare-acquired infections?
  • What market models, such as pull incentives, are needed to increase innovation and access to antimicrobials?
  • How can new antibiotics be used safely in low-income settings? That is, how do we make them available everywhere while still ensuring restrictive use, so that resistance to the new antibiotics is prevented?
  • How significant is the role of resistant secondary bacterial infections in the mortality rate caused by viral pandemics?
  • How can new antibiotics be used safely in low-income settings? That is, how do we make them available everywhere while still ensuring restrictive use, so that resistance to the new antibiotics is prevented?
  • Which of the drivers of infections in a population are most associated with resistant infections (and therefore most relevant to address in order to curb increasing resistance)?
  • Which public communication campaigns are effective? A lot of campaigns are done but the evidence base does not seem to be solid, and in some cases campaigns may even have adverse effects. Which messages and methods work best in low-income settings?
  • Could it be an effective approach to work on improving the communication between researchers and policymakers in the AMR field? How could this be done?
  • How can it be made financially feasible for poor farmers to decrease antibiotic use? Have there been successful interventions? Can those be transferred to other settings?

Further resources

If you’re interested in working on this research direction, apply for our coaching and we can connect you with researchers already working in this space, who can help you refine your research ideas.

You can also apply to join our community if you’re interested in peer connections with others working in this area. 

Apply for our database of potential supervisors if you’re looking for formal supervision and take a look at our advice on finding a great supervisor for further ideas.

Our funding database can help you find potential sources of funding if you’re a PhD student interested in this research direction.

Some labs in academia working on this direction (taken from the Problems Worth Solving newsletter) are below:

  1. The Collins Lab at MIT targets AI-driven solutions to treat the most dangerous superbugs.
  2. The BactiVac Network is developing vaccines against bacterial infections to save lives in low and middle-income countries (LMICs).
  3. The Coordination Group for Bacteriophage Therapy Leuven (CBL) in Belgium are developing bacteriophage therapy.

Other universities you could begin by exploring are Boston University, Yale University, Birmingham University and Exeter University.

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This profile was last updated 31/12/2022. Thanks to Cecilia Tilli for creating this profile and Akhil Bansal for helpful feedback. All errors remain our own.

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