Vaccines in the fight against antimicrobial resistance – from evidence to policy - perspectives from South Africa

Introduction: The rising prevalence of drug-resistant infections presents a challenge to modern medicine by limiting life-saving therapeutic options, especially for those who cannot afford more expensive second-and third-line antibiotics, and exacerbating the morbidity and mortality associated with infectious diseases. It is clear that interventions such as immunisation and infection prevention and control programmes should be given high priority at national, provincial and local levelsOur aim is to guide vaccine stakeholders in efforts to maximize the impact of vaccines in preventing and containing AMR. Methods: Previous mathematical modeling work on the estimated and potential impact of various vaccines on AMR by the ARVac Consortium has highlighted the specific impact in South Africa. Considering this estimated potential, the Global Antibiotic Resistance Partnership – South Africa (GARP-SA) Technical Working Group (TWG) convened to discuss what barriers there are to effective communication and collaboration between immunization and AMR groups in the country and what solutions exist. Results: Despite being a critical tool in AMR mitigation, vaccination as a strategy is unrecognized in this context. Several factors undermine the relationship between AMR and vaccines, such as inadequate health literacy, inequities in access to health care, infrastructure and data gaps, and overall lack of coordination between health programmes. In order to overcome each of these barriers, the TWG discussed possible facilitators and strategies in order to find a way to use the modelling data to raise awareness and inform immunization and AMR policies in ways that can impact policy at the national level. It was concluded that leveraging on existing platforms, including the communities in decision making, and prioritising research into vaccines and AMR, would be some of the solutions to overcome the hurdles identified. Discussion: Using modelling data for antibiotic resistance is a good metric to use when considering the value of vaccines. The growth in resistance can be curbed and even reversed, and the health of the public enhanced, by preventing many infections through vaccination and by better targeting antibiotic use for curable bacterial infections, eliminating much of the current inappropriate use for viral, fungal or parasitic illnesses Conclusion: Faced with evidence on the burden of AMR and the mitigating power of vaccines within an antimicrobial stewardship programme, it is critical for AMR and immunisation initiatives to harness the full potential of their collaboration. Data must be used to inform policies at the national level and support integrated research projects that can quantify vaccine impact on infectious diseases and AMR. It will not only form the foundations of a One Health approach but also provide a platform for more complex stewardship interventions.