Korea must act now to combat growing AMR threat

By Kim Bong-young and Mike Hodin

Kim Bong-young

Mike Hodin

Public officials are overlooking one of the gravest long-term threats to the Korean people, the health system, and economy: antimicrobial resistance (AMR).

Some pathogens ― bacteria, fungi, parasites, and viruses ― have evolved strains that resist the antimicrobial medications we currently have available to fight them. Health care professionals often must watch helplessly as patients succumb to infections that antibiotics could once have easily beaten. They know that new antimicrobials, including and especially antibiotics, could easily gain the victory ― but they have none at their disposal.

The pathogens have gained an evolutionary edge as tools used against then have remained static. This is because the market for investment in new innovation has virtually dried up, thanks to a policy framework that does not provide for swift approval of new innovations or adequately reimburse companies for the investments they make to develop new drugs.

Without action, AMR threatens to undermine the very foundations of modern medicine ― killing as many as 10 million people worldwide every year by 2050 and shrinking global GDP by as much as 3.8 percent. Yet, today, Korea currently does not even have reliable data to understand AMR's impact, much less address it.

Around the world, AMR already takes a heavy toll. According to a new Lancet report, it kills an estimated 1.27 million people globally each year. However, the response of the international community has been muted, with few incentives to invest in R&D for new antimicrobial medicines. No new class of antibiotics has been developed in 35 years, even as bacterial resistance has steadily grown and continues to strengthen each year. Older adults are more vulnerable to drug-resistant infections, and the increase in untreatable infections already being experienced among Korea's growing number of seniors is a clear and urgent warning of a crisis that puts Koreans of all ages at great risk.

The scale of the challenge demands national strategies and international collaboration on two key battlefronts. To begin, we must continue to reduce the overuse of current antibiotics, so they remain effective for more people, for longer. This buys time for the second necessary campaign: developing new antibiotics by ensuring the market and policy incentives for the investment in new antibiotic innovation, and reimbursement policies are robust. Doing so will require novel incentives and sustained investment from governments, foundations, and the biopharmaceutical industry.

Korea trails shamefully on this pressing issue. In the 2021 AMR Preparedness Index, which tracks how countries are faring in the fight against AMR, Korea scored just 47/100 ― behind Germany, Japan, Canada, and other advanced economies. In fact, Korea scored closer to India (37) and China (37) than leaders like the United Kingdom (76) or the United States (68).

A number of policy gaps account for this lack of readiness. Korean public health campaigns are limited and smaller in scale than those in many other advanced countries. Too few Koreans understand the dimension of the AMR problem and what they can do to help. Meanwhile, provider education efforts on proper antibiotic usage are too narrow and remain inaccessible to many professionals.

Additionally, the lag between the approval of a new drug and an official reimbursement decision is 10 times longer in Korea than in Japan, reducing the availability of new medicines on the market. In fact, not one of three novel antimicrobials explored in the 2021 AMR Preparedness Index has been approved yet.

Korea needs more champions, including those working on aging and longevity issues, to address these gaps. Already, Korea's first national action plan on AMR integrated best practices from the World Health Organization and established a robust surveillance and monitoring system to track AMR. In recent years, the Korea Disease Control and Prevention Agency and other government agencies have led efforts to reduce inappropriate usage of antibiotics for viral illnesses, track and compare usage rates between hospitals, and address overuse in livestock production.

It's time to extend and build on these efforts. First, Korea can fully fund and support its recently released second national action plan on AMR, slated to run through 2025. A well-designed national strategy remains the foundation of a strong AMR response, and Korea must continue to support the plan's priority areas, including antimicrobial stewardship and infection control programs in hospitals, plus R&D investments to help develop new diagnostics and drugs.

Second, policymakers and health system leaders can make AMR a public health priority. A commitment to large-scale awareness campaigns would empower both patients and providers to use antibiotics more responsibly. Making AMR training for health care professionals more accessible and more comprehensive would ensure a consistent approach across the health system. Further, Korea must invest to swell the ranks of its cadre of experts in the AMR field, including infectious disease specialists who can lead the counteroffensive against AMR.

Public officials should also design incentives for the creation and swift adoption of new antibiotics. By doing so, Korea would join AMR heroes like the U.K., which has built innovative models to pay for the public health value of new medicines. New antibiotics must be subject to careful stewardship to extend their useful life; financial success cannot depend on high unit sales. In conjunction, regulators can work to shorten the time between market approval and reimbursement approval.

If policymakers take forward-looking action to address AMR today, we can avoid desperate measures in the future. This is critical to preserving public health, economic strength, and a capable health system. It will place Korea in the global vanguard prioritizing this collective action problem with the highest possible stakes.

Dr. Kim Bong-young, Ph.D., is an associate professor of internal medicine (infectious diseases) at Hanyang University College of Medicine and director of the Isolation Ward at Hanyang University Hospital. Mike Hodin, Ph.D., is CEO of the Global Coalition on Aging.