Rationale

The crises raised by antimicrobial resistance (AMR) to the drugs used for treatment of infectious diseases and emerging infections have received renewed emphasis. Although these threats are global, there is, in fact, little actionable evidence on where AMR is most serious. The true prevalence of resistance in most diseases is unknown, and there is little capacity to detect either resistance in tropical pathogens or the early presence of emerging infections in resource poor countries.

IDDO is responding to these challenges by engaging research institutions working on infectious diseases around the world. Our aim is to facilitate responsible data sharing and the assessment of data from infectious diseases that are managed with drug treatment (eg malaria, visceral leishmaniasis and schistosomiasis) or needing new therapeutic approaches (eg Ebola virus disease).

Comprehensive surveillance of the prevalence of a pathogen in well-chosen sites, and assessment of the efficacy of particular drug treatments, is the first step in any strategy for disease control and ultimately for elimination. Exposing pathogens to sub-therapeutic levels of active ingredients is a major driver of resistance, so identifying the factors that undermine drug efficacy is the most efficient approach for identifying emerging resistance.

To identify the factors that determine an optimal drug regimen, researchers must integrate information from clinical treatment, pharmacology, and in vitro analysis of pathogens, and on the quality of the antimicrobials used in treatment. These data are scarce for many infectious diseases common in low- and middle-income countries. Assembling global data for in-depth analysis of drug efficacy is the only way to reach the critical mass of information needed to understand the distribution of infectious diseases and generate new evidence to optimise the use of current medicines.

Individual patient data pooled analyses of studies undertaken in many geographic regions will provide evidence for improved treatment, prolong the therapeutic life of existing drugs on the market, and be part of a global strategy to control AMR. Lessons learned can then be applied to new drugs in development.

The same approaches are needed to define effective surveillance for the earliest signs of emerging infections. Research and operational groups will be at the forefront of future responses to emerging infections; they need to work together now in a constructive and transparent collaborative framework to be prepared to respond effectively to existing challenges and future outbreaks.