Antimicrobial Resistance (AMR) represents one of the top pressing global health threats, as ranked by the World Health Organization (WHO). It refers to when bacteria, viruses, fungi, or parasites no longer respond to antimicrobial medicines and is caused by the overuse or misuse of antibiotics, and the development of new superbugs.

Traditionally, antibiotics have been seen as the backbone of modern medicine due to their simplicity and effectiveness in treating bacterial infections in human and animal health. Today, however, AMR poses a serious threat to the advancements of medicine, to global health and to food security. Infections that were once easily treatable have become potentially life-threatening, while complex surgeries and chemotherapy, which are dependent on antibiotics, face increasing challenges, with the growing ineffectiveness of many antibiotics.

Continued misuse and overuse of antibiotics means the development of resistant bacteria will continue to accelerate, and the implications of this are staggering. By 2050 it’s predicted that multidrug-resistant (MDR) bacterial diseases could claim 10 million lives annually. This sobering thought highlights the pressing need to find alternative solutions.

G20 commitment

Recognising the urgent need to combat AMR, the G20 has prioritised this challenge within its health agenda. At the G20 High-Level meeting on One Health in Rio de Janeiro (October 2024), member nations reaffirmed their dedication to a ‘One Health’ approach that encompasses human, animal and plant health.

The declaration highlighted the significance of intersectoral collaboration and financing to support national and global strategies against AMR through sustainable practices, research and policies that safeguard the effectiveness of treatments and ensure their longevity.

Collectively, the members emphasised the need for robust international governance to combat the issue of AMR, assisted by the One Health approach. While the takeaways from the event are not legally binding, this unified response from some of the world’s largest economies represented a first step towards global solidarity in tackling AMR and pushing for alternative treatments.

Step forward phage therapy

Phage therapy is an example of an alternative treatment that is emerging as one of the most promising solutions to AMR. Phages are viruses that specifically target and kill bacteria by infecting and replicating within them, making it nearly impossible for resistance to develop against them. Phages offer a unique advantage over antibiotics because they target specific bacterial strains without harming human cells or beneficial microbes, unlike antibiotics which kill all bacteria, good or bad. Currently phages are only used as a last case scenario, once all other treatments have failed – known as “compassionate use” cases – and they can be used alone or alongside antibiotics.

Phages are not a new phenomenon – they’ve existed for billions of years and can be found in almost every environment. Phage therapy is also not a new concept. Despite their discovery more than a century ago and successful adoption in Eastern Europe, phage potential has been overshadowed in the West in favour of antibiotics, due to their simplistic and effective nature. However, with superbugs on the rise and a lack of new antibiotics in the pipeline to adequately addressing the mounting threat of AMR, phages are receiving renewed attention, research and investment.

Significant strides

The significant strides made in the past few years alone underscore the rapid pace at which the field is evolving – a momentum that is both notable and exciting. Why? Because it moves us closer to expanding access to phage therapy, representing a significant step forward in addressing the threat posed by antibiotic-resistant bacteria and offering new hope for patients battling challenging infections.

It is important that, collectively, we do not lose focus, as there is still some way to go until phage therapy can be rolled out as a mainstream treatment in the UK.

Although the potential for phage therapy is immense, we’re not quite there *yet* and implementing a tangible phage strategy in the UK requires several key steps:

• Good Manufacturing Practice (GMP) infrastructure to ensure safety, security and streamline quality control
• A phage bank to accelerate patient treatment timelines
• Funding for pre-clinical trials to meet regulatory standards
• Addressing the skills gap in engineering biology to secure the future of phages

This will require concerted efforts, and public and private investment, but crucially it will enable phage research to be translated into treatment, helping to save more lives and propel phage therapy into a viable mainstream treatment. By laying the groundwork, the UK can position itself as a leader in phage therapy, offering a holistic and synergistic solution to the global challenge of AMR.