As we all know, by 2050 about 10M may die from AMR each year, according to the O’Neill report. One of the assumptions is that “all infections (=100%) of a certain bacterium will be caused by a fully resistant variant.” How likely is that scenario? Yesterday, Marc Lipsitch shared his thoughts on this question with us.
He’s already thinking on this for years. At night he lie awake and wondered “if serotypes from pneumococci differ in their transmissibility and duration of carriage why do we not see a clear winner that occupies the ecological niche”. Like a firm that can produce candy for a price of 11 cents, where others need to spend at least 13 cents, will drive the market to a price of 12 cents, outcompeting all others while still making profit. His team delivered some fundamental insights on this, see, for the pneumococcus (read it before you drink your beer).
Now, can we address a similar question to AMR? We all think to know from our data that AMR is never 100% or 0%. Do we really? At least from surveilance data: MRSA increased (and decreased) but I never saw a country with 100% of S. aureus infections being MRSA (or it is because EARSS doesn’t have a colour fort hat). In all ICU studies I was involved in, AMR of a certain pathogen never reached 100% of all isolates or all patients carrying that bug. And once colonized in the gut with VRE are all enterococci VRE?
These are simple questions, probably with simple answers that can be used by simple people in (not so-)simple mathematical models to provide basic insights in AMR epidemiology. There are at least 2 Marcs that think that we urgently need such data for better prediction of what we can expect from AMR in the (near) future.
May be, the economists in the O’Neill group did know, but considered such knowledge as highly classified.
marcbonten 