Increased likelihood of pandemics means AMR development is critical—aff is try or die

Historically, some of the most consequential pandemics have been caused by bacterial diseases such as the bubonic plague or cholera. With the advent of effective public health interventions and the introduction of antibiotics, recent pandemics have been associated with viruses while bacterial pandemics have diminished in frequency and scale. The COVID-19 pandemic has highlighted the many challenges faced in preparing for and responding to modern public health emergencies (PHE), and it has spurred efforts to prevent future ones; these efforts, however, have largely focused on viral pathogens. It must not be forgotten that secondary bacterial infections have also played an important role in exacerbating morbidity and mortality during viral pandemics, as observed during the 1918 influenza pandemic, and, to a lesser degree, during COVID-19.1,2 With the diminishing power of antibiotics to treat infections due to increasing antimicrobial resistance (AMR), the threat of a bacterial pandemic or a viral pandemic—accompanied by secondary bacterial infections resistant to our available stock of antimicrobials—remains possible. Antimicrobial resistance is a material threat to the health of all Americans, even in the absence of a pandemic. Nearly 1.27 million deaths were attributed, globally, to difficult-to-treat bacterial infections in 2019.3 A PHE such as a pandemic or other large-scale infectious disease outbreak is likely to exacerbate the problem of AMR and the conditions that support its spread. Therefore, efforts to tackle AMR through crisis-mode planning are our best defenses against a PHE caused by an untreatable bacterial pathogen or a PHE caused by a virus with inevitable secondary bacterial or fungal infections.4 As we have witnessed during the most recent example of a PHE with COVID-19, there were challenges with our ability to maintain infection control and antimicrobial stewardship practices due to overcrowded healthcare settings, stresses on the healthcare workforce (including staffing shortages), a lack of rapid diagnostics to guide treatment decisions, and shortages of routine medications and medical supplies, among other factors. Furthermore, the frequent movement of pathogens between humans, companion and food animals, and the environment, profoundly affected the health of the animal care workforce. Moreover, the depletion of the agricultural workers by illness had a negative impact on animal health and food security.5