Herman Goossens: We must keep antibiotics effective for the next generation

Could you tell us, what motivated you to propose European Antibiotic Awareness Day as a yearly event?

Yes, of course. In 2000, we launched the first of a series of antibiotic awareness campaigns in Belgium to convince people to take less antibiotics. These campaigns had a dramatic impact on antibiotic consumption. So in 2007, I proposed to the European Commission and members of the European Parliament to organise this as an annual event.

This year marks the 15th European Antibiotic Awareness Day. What has changed over the past years?

The first European Antibiotic Awareness Day took place on 18 November 2008 with 32 European countries participating. By 2012, we grew to 47 European countries, as well as the United States, Canada, Australia and New Zealand.

At the beginning, our campaigns were targeted exclusively at the general public, but soon we started to also develop antibiotic awareness toolkits for hospitals and long-term care facilities, as well as for those self-medicating. This was because we saw that in some places, mainly southern European countries, people could easily purchase antibiotics over the counter, and this is not a good idea. Later, we also involved veterinarians to help reduce antibiotic usage in the treatment of animals.

In 2015, the World Health Organization (WHO) decided to make this a global event taking place over the course of one week. This was the start of the World Antibiotic Awareness Week.

Antibiotic resistance is not as hot a topic as climate change or COVID-19. Why should governments and societies be concerned about this threat? 

Climate change is certainly one of the biggest – if not the biggest – challenge for the survival of our planet, and so it is, of course, a much bigger threat than antibiotic resistance.

The COVID-19 pandemic had a devastating impact around the globe, but eventually it will become like a normal flu. Antibiotic resistance is also a pandemic: a silent pandemic that takes longer to grow. It is caused by a limited number of antibiotic-resistant clones that have spread worldwide. Compared to respiratory viruses, which can spread over a matter of weeks or months, antibiotic-resistant clones need 10 to 20 years to spread. Antibiotic resistance will continue to grow, and more people will succumb to infections that we can no longer treat. This is impacting not just low- and middle-income countries, but also high-income countries.

I’ve been organising campaigns in Belgium since 2000, and we have always received a lot of political support because ministers realise that antibiotic resistance is a big public health threat. Also, if you prescribe less antibiotics, governments will spend less on a social security and this money can be used on other things.

How is Ecraid contributing to the fight against antibiotic resistance?

To explain, I will have to go one step back. The business model for antibiotic development is broken: Firstly, discovering and developing antibiotics are extremely costly to drug companies. Secondly, after a new antibiotic has been found, it is very expensive and challenging to perform clinical trials. Unlike other drugs, testing a new antibiotic requires the rapid enrolment of a patient: the antibiotic must be prescribed within minutes or hours of the infection, or the patient can die. We also need clinicians and labs that are well-trained to diagnose the infection, to know that the bugs are resistant or sensitive to the new drug, and so on. Finally, trials are often stopped prematurely, and the network dismantled. This means that when another company or government wants to start a new trial, they would need to start building the clinical network from scratch.

This shows that the business of developing antibiotics is no longer sustainable, and that our current approach to performing clinical trials is no longer effective. So there is a need for a paradigm shift. Therefore, we decided to set up Ecraid – the European Clinical Research Alliance for Infectious Diseases. The industry is very excited about Ecraid and its sustainable clinical network because it can help governments and companies perform clinical trials more effectively and lower costs. Ultimately, this means speeding up the introduction of new drugs to market and saving lives.

There is so much more we can do together to help fight antibiotic resistance. What would you like to say to our readers?

The call to action really depends on who you are. If you are a potential patient, you should realise that antibiotics are not candy. They are drugs that have side effects; but they are also important to preserve because if you take them too often, you will create a very resistant flora, and those resistant bugs can eventually cause, for instance, a urinary tract infection that might be very difficult to treat with antibiotics. So if the doctor tells you that antibiotics are ineffective against your flu, you should accept their advice.

If you work for a government, it is very important that you support initiatives and campaigns such as ours. Governments need to invest in their scientists, clinicians, and experts’ efforts because these are crucial for the good of public health and will, in the long run, help reduce healthcare costs.

If you work in industry, don't give up. Create, innovate, and dare to take risks. This is a big issue: I know of several companies on the brink of bankruptcy because of developing new antibiotics. It is very important that pharmaceutical companies continue to innovate and develop new antibiotics because we need them. The academic community will help you do your clinical trials, but we need you to develop new drugs. I find public-private collaborations to be extremely important. None of us can do this on our own. Let’s work together to fight antibiotic resistance.

An overview of World Antibiotic Awareness Week and how Ecraid is prepared to tackle this global health concern.

About Herman Goossens

Herman Goossens, MD, is Emeritus Professor at the University of Antwerp and responsible for strategic alliances at Ecraid. In addition to European Antibiotic Awareness Day, he also founded the Belgian Antibiotic Policy Coordination Committee (BAPCOC) and was founding Coordinator of the European Surveillance of Antibiotic Consumption (ESAC) project (moved to ECDC in July 2011).

Herman coordinated several initiatives to collect antimicrobial use data in outpatients and inpatients across the globe and was actively involved in several EU-funded projects GRACE, PREPARE and VALUE-Dx, COMBACTE, ECRAID-Prime and more.

He received several honours and awards including the ESCMID Excellence Award 2020, 2006 Leadership Award by the American Alliance for the Prudent Use of Antibiotics for his translational research and European policy work, and the medical sciences award of the Belgian Royal Academy of Medicine for the period 2011 – 2015. His vision is to build a sustainable infrastructure for clinical research on infectious diseases in Europe.