AMR.Solutions

Vaccination to prevent AMR: Insights from Wellcome

Dear All (and with thanks to Vega Masignani for co-authoring this newsletter),

Waaaay back in 2019 (pre-COVID … remember that?), Wellcome put out a call for grants focused on understanding the value of vaccines in combatting AMR (4 June 2019 newsletter entitled “Why vaccines for AMR? What is their value? Grant opportunity for research on this topic / Great NPR TED Radio Hour on vaccines”).

Well, it turns out that 13 projects were funded as a result of that call!

At the 5-year mark for these projects, a two-day workshop was organized (Nov 2024) with the twofold aim of: (i) having representatives from the funded projects discuss their findings, and (ii) fostering a broader discussion among a set of stakeholders on both the status of current perception of the impact of vaccines on AMR and how to address existing evidence gaps to make the impact of vaccines on AMR more quantifiable.

Wellcome has now assembled the results of 11 of those projects and the outcome of the group discussion into a fascinating whitepaper that is well worth your time (and note also that Vega participated in the Nov 2024 workshop). Here are the links you need:

So, now on to the report from Wellcome. Compared to a few years back when the two words “vaccines” and “antimicrobial resistance” would only rarely appear in the same paper, remarkable progress has been made in recognizing that vaccines have an important role to play in AMR control. However, despite the 2024 UN political declaration on AMR calls and the recent WHO analysis indicating how vaccines could avert >500k AMR-associated deaths and >2.5 billion antibiotic doses yearly, the full value of vaccines has yet to be demonstrated.

Why has this been so hard to show? As a mental framework, let’s consider the excellent figure from Wellcome’s report that summarizes the many pathways through which vaccination could address AMR and deliver related clinical and economic benefits. The ideas here are equally true of vaccines for both bacteria and for viruses:


So, one might expect that demonstrations of value would be straightforward. Well, no, as the level of available evidence varies across the depicted tree and is not equally strong for each of the points.

As Wellcome summarizes: “… the effects of vaccination on AMR are dependent on a ‘pathway to impact’ which includes many uncertainties – hence there is rarely a straightforward relationship between vaccination and impact on AMR. These uncertainties reflect complex effects at multiple levels such as:

  • “At the microbial level, the effects of vaccination on AMR will depend on factors such [as] shifts in microbial population dynamics, the frequency of horizontal gene transfer, …
  • “At the health system level, multiple behavioural and economic factors influence antimicrobial use and antibiotic-prescribing behaviours. As a result, it remains difficult to quantify how vaccination does affect antibiotic use or AMR gene prevalence.”


In short, both the microbes and the human beings act in surprising ways! Thus, it turns out to be (relatively) easy to show that vaccines have value in directly preventing infections. But it is very hard to show the indirect benefits of reduction in overall AMR burden (or reduced antibiotic use, or both).

Why is this so? There’s no single, specific answer but the tour of the results of the projects makes for fascinating reading:

  • For influenza, complexities include the year-to-year variability in the efficacy of influenza vaccines, as well as the syndromic treatment approach generally adopted for respiratory infections.
    • Furthermore, as these vaccines are only rolled out in HIC (High-Income Countries), no data would be available from LMIC (Low- and Middle-Income Countries).
    • Studies conducted in 3 geographic settings (UK, US and Australia) resulted in different outcomes, with only Australian data showing some reduction in antibiotic use, although only in low risk groups.
  • For the pneumococcus (Streptococcus pneumoniae), the existence of 100+ serotypes (of which only a minority are covered by vaccines) is a problem.
    • Reduction in carriage of the vaccine serotypes is counterbalanced by an increase in non-vaccine serotypes, which may occur both by selective pressure and through mechanisms of horizontal transfer of AMR genes between both vaccine and non-vaccine strains.
    • Furthermore, as for influenza, respiratory disease is generally treated according to symptoms rather than pathogen-specific diagnosis in most settings, and this may mask the effects of a reduced incidence of pneumococcal disease following vaccination. 
  • Malaria vaccine usage was associated with less use of antibiotics but (oddly!) use of a rapid diagnostic for malaria increased the likelihood of antibiotic treatment!
  • Vaccines for enteric diseases (e.g., rotavirus) would seem an easy win but the great variety of causes of diarrheal diseases limits the impact of any specific vaccine and also reduces the impact of antibiotic prescribing (the episode of diarrhea could still be due to so very many things).

 
Ugh! That’s frustrating! There is no simple fix for this. Wellcome provides a list of implications and actions that broadly call for augmentation of empirical data collection and standardization of the methods to analyze those data.

Additional empirical data will need to address long-term follow-up, and measurement of the impacts of vaccination on different aspects of AMR. But how to go about that? The discussion highlighted how such evidence could come from studies embedded in vaccine trials or from observational studies in real-world settings.

And even getting answers to these questions would be a research project in itself! There appears to be a project underway entitled “WHO framework on considerations for research” that will hopefully provide some concrete ideas.

Many thanks to our colleagues at Wellcome for first envisioning this call for research and then for bringing the results together for us. We would all have wished for a clear and positive answer, but at least now we have these data with which to refine our next wave of projects. Onward!

All best wishes, John & Vega

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://amr.solutions/blog/. All opinions are my own.

Vega Masignani, PhD | CARB-X Alliance Director. | vmasigna@bu.edu. All opinions are my own.

Current funding opportunities

  • The AMR Industry Alliance is again offering a Stewardship Prize of 10,000 CHF to recognize innovative approaches to combating AMR in low-to-moderate-income countries. This year’s prize focuses on utilizing diagnostics in stewardship efforts. Applications are due by 1 Sep 2025. Go here for details and to apply.
  • NNF (Novo Nordisk Foundation) have announced their “Challenge Programme 2026 – Unravelling the Pathways of Human Invasive Fungal Diseases. The call seeks applications from EU-centered consortia (global partners are possible) for research in 4 areas: (i) fungal virulence factors, (ii) host-pathogen interactions, (iii) mechanisms of anti-fungal resistance, and (iv) fungal disease markers. Applications are due by 8 Oct 2025. Go here for details. 
  • ENABLE-2 has continuously open calls for both its Hit-to-Lead program as well as its Hit Identification/Validation incubator. Applicants must be academics and non-profits in Europe due to restrictions from the funders. Applications are evaluated in cycles … see the website for details on current timing for reviews. 
  • CARB-X will have two calls during 2025 that span two areas: (i) Small molecules for Gram-negatives (the focus is on Pseudomonas aeruginosa) and (ii) Diagnostics for typhoid (the focus is diagnosis of acute infections in 60 minutes or less). See this 26 Feb 2025 newsletter for a discussion of the call and go here for the CARB-X webpage on the call. The first cycle is now closed (it ran16-30 April 2025); the 2nd round will be open 1-12 Dec 2025.
  • BARDA’s long-running BAA (Broad Agency Announcement) for medical countermeasures (MCMs) for chemical, biological, radiological, and nuclear (CBRN) threats, pandemic influenza, and emerging infectious diseases is now BAA-23-100-SOL-00004 and offers support for both antibacterial and antifungal agents (as well as antivirals, antitoxins, diagnostics, and more). Note especially these Areas of Interest: Area 3.1 (MDR Bacteria and Biothreat Pathogens), Area 3.2 (MDR Fungal Infections), and Area 7.2 (Antibiotic Resistance Diagnostics for Priority Bacterial Pathogens). Although prior BAAs used a rolling cycle of 4 deadlines/year, the updated BAA released 26 Sep 2023 has a 5-year application period that ends 25 Sep 2028 and is open to applicants regardless of location: BARDA seeks the best science from anywhere in the world! See also this newsletter for further comments on the BAA and its areas of interest.
  • HERA Invest was launched August 2023 with €100 million to support innovative EU-based SMEs in the early and late phases of clinical trials. Part of the InvestEU program supporting sustainable investment, innovation, and job creation in Europe, HERA Invest is open for application to companies developing medical countermeasures that address one of the following cross-border health threats: (i) Pathogens with pandemic or epidemic potential, (ii) Chemical, biological, radiological and nuclear (CBRN) threats originating from accidental or deliberate release, and (iii) Antimicrobial resistance (AMR). Non-dilutive venture loans covering up to 50% of investment costs are available. A closing date is not posted insofar as I can see — applications are accepted on a rolling basis; go here for more details.
  • The AMR Action Fund is open on an ongoing basis to proposals for funding of Phase 2 / Phase 3 antibacterial therapeutics. Per its charter, the fund prioritizes investment in treatments that address a pathogen prioritized by the WHO, the CDC and/or other public health entities that: (i) are novel (e.g., absence of known cross-resistance, novel targets, new chemical classes, or new mechanisms of action); and/or (ii) have significant differentiated clinical utility (e.g., differentiated innovation that provides clinical value versus standard of care to prescribers and patients, such as safety/tolerability, oral formulation, different spectrum of activity); and (iii) reduce patient mortality. It is also expected that such agents would have the potential to strongly address the likely requirements for delinked Pull incentives such as the UK (NHS England) subscription pilot and the PASTEUR Act in the US. Submit queries to contact@amractionfund.com.
  • INCATE (Incubator for Antibacterial Therapies in Europe) is an early-stage funding vehicle supporting innovation vs. drug-resistant bacterial infections. The fund provides advice, community, and non-dilutive funding (€10k in Stage I and up to €250k in Stage II) to support early-stage ventures in creating the evidence and building the team needed to get next-level funding. Details and contacts on their website (https://www.incate.net/).
  • These things aren’t sources of funds but would help you develop funding applications
    • The Global AMR R&D Hub’s dynamic dashboard (link) summarizes the global clinical development pipeline, incentives for AMR R&D, and investors/investments in AMR R&D.
    • Antimicrobial Resistance Research and Innovation in Australia is an actively updated summary that covers Australia’s AMR research and patent landscape. It is provided via collaboration between The Lens (an ambitious project seeking to discover, analyse, and map global innovation knowledge) and CSIRO (Commonwealth Scientific and Industrial Research Organisation, an Australian Government agency responsible for scientific research). Lots to explore here!
    • Diagnostic developers would find valuable guidance in this 6-part series on in vitro diagnostic (IVD) development. Sponsored by CARB-X, C-CAMP, and FIND, it pulls together real-life insights into a succinct set of tutorials.
  • In addition to the lists provided by the Global AMR R&D Hub, you might also be interested in my most current lists of R&D incentives (link) and priority pathogens (link).

John’s Top Recurring Meetings
Virtual meetings are easy to attend, but regular attendance at annual in-person events is the key to building your network and gaining deeper insight. My personal favorites for such in-person meetings are below. Of particular value for developers, the small meeting format of BEAM’s AMR Conference (March) and GAMRIC (September-October; formerly, the ESCMID-ASM conference series) creates excellent global networking. IDWeek (October) and ECCMID (April) are much larger meetings but also provide opportunities for networking with a substantial, focused audience via their Pipeline sessions. Hope to see you there!

  • 1-3 Oct 2025 GAMRIC, the Global AMR Innovators Conference (London, UK). Formerly the ESCMID-ASM Joint Conference on Drug Development for AMR, this meeting series is now in its 10th year and is being continued under the joint sponsorship of CARB-X, ESCMID, BEAM Alliance, GARDP, LifeArc, Boston University, and AMR.Solutions. The ongoing series will continue the successful format of prior meetings with a single-track meeting and substantial networking time (go here to see details of the outstanding 2024 meeting).
    • Registration is now open and the preliminary agenda can be found at that same link (https://www.gamric.org/). The meeting will be limited to approximately 300 attendees, so please be sure to register promptly to avoid disappointment! 
    • The abstract submission window (same link as registration) runs until 13 June.
    • Application for travel grants (same link as registration) are accepted through 2 June.
  • 19-22 Oct 2025 (Georgia, USA): IDWeek 2025, the annual meeting of the Infectious Diseases Society of America. Go here to register. For those who would like a substantial opportunity to present a product to a large audience (see also adjacent note about ESCMID), note the call for applications to present at an IDWeek Pipeline Session; go here to submit an application for your compound or diagnostic.
  • 3-4 Mar 2026 (Basel, Switzerland): The 10th AMR Conference. Sponsored by the BEAM Alliance, the 9th AMR Conference has just concluded and it’s again been an excellent meeting! Please mark your calendar for next year. You can’t register yet, but details will appear here! 
  • 17-21 April 2026 (Munich, Germany): ESCMID Global 2026, the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases. You can’t register yet, but you can go here for details on the outstanding 2025 meeting. For those who would like a substantial opportunity to present a product to a large audience (see also adjacent note about IDWeek), I know that the meeting schedule will again include Pipeline Monday; go here to see details from 2025.

  Upcoming meetings of interest to the AMR community:

  • 22 July 2022 (virtual, 9.30-11.00 CEST) Webinar entitled “Repurposing drugs to address the crisis of antimicrobial resistance”, organized by GARDP REVIVE. Go here to register. Note also that recordings of prior REVIVE webinars are available for replay.
  • [NEW] 24 July 2022 (14.30-16.00 CEST): Webinar hosted by the WHO Taskforce of AMR Survivors that will discuss the intersection of Antimicrobial Resistance (AMR) and Noncommunicable Diseases (NCDs). As discussed in the 7 May 2025 newsletter entitled “Impact of AMR on cancer therapy”, this is a big deal — NCDs and AMR share some of the same drivers and those with NCDs are more vulnerable to the consequences of AMR. Go here to register.
  • 9 Sep 2022 (virtual, 9.30-11.00 CEST) Webinar entitled “Overcoming challenges of tuberculosis drug discovery and development”, organized by GARDP REVIVE. Go here to register. Note also that recordings of prior REVIVE webinars are available for replay.
  • 10-11 Sep 2025 (Ghent, BE): Organized by a group at Ghent University in collaboration with the ESCMID Study Group for Non-Traditional Antibacterial Therapy (ESGNTA), the Phage Protein Meeting is an interdisciplinary conference dedicated to advancing the field of phage proteins for infection control that seeks to bring together academic researchers and professionals working with phage proteins such as phage lysins, tail fibers, tailspikes, depolymerases, and tailocins. Note that the focus here is on phage proteins rather than phage themselves. Go here for details and to register.
  • 12 Sep 2025 (Ghent, BE): The 10-11 Sep 2025 meeting just above is followed in Ghent on 12 Sep by the 4th annual meeting of BSVoM (Belgian Society for Viruses of Microbes). This meeting is broader than therapeutics, providing an “interdisciplinary perspective on virus of microbes, ranging from basic research to industrial developments and clinical use.” Go here for details.
  • 10-13 Sep 2025 (Lisbon, Portugal): 6th ESCMID Conference on Vaccines. Go here for details.
  • 15-19 Sep 2025 (virtual): US CDC-sponsored the 9th Annual Fungal Disease Awareness Week (FDAW). Daily themed events include “Think Fungus” on 15 Sep, “Fungi are everywhere” on 16 Sep, and “Fungal diseases and drug resistance (19 Sep). Signup for the Mycotic Diseases Branch newsletter to stay updated.
  • 1-3 Oct 2025 GAMRIC, the Global AMR Innovators Conference (London, UK; formerly the ESCMID-ASM Joint Conference on Drug Development for AMR). See list of Top Recurring meetings, above..
  • 11-19 Oct 2025 (Annecy, France, residential in-person program): ICARe (Interdisciplinary Course on Antibiotics and Resistance) … and 2025 will be the 9th year for this program. Patrice Courvalin orchestrates content with the support of an all-star scientific committee and faculty. The resulting soup-to-nuts training covers all aspects of antimicrobials, is very intense, and routinely gets rave reviews! Seating is limited, so mark your calendars now if you are interested. Applications are being accepted from 20 Mar to 21 Jun 2025 — go here for more details.
  • 17-20 Sep 2025 (Porto, PT): 14th International Meeting on Microbial Epidemiological Markers (IMMEM XIV). Go here for details.
  • 9-13 Nov 2025 (Portland, OR, USA): ASM Conference on Biofilms. Go here for details and to register.
  • 18-24 Nov 2025 (global, multiple locations): World Antibiotic Awareness Week (WAAW) is convened annually on 18-24 Nov by WHO with national events (e.g., CDC’s US Antibiotic Awareness Week (USAAW); ECDC’s 18 Nov European Antibiotic Awareness Day) occurring around the globe. Details will follow as events become visible.
  • 19-22 Oct 2025 (Georgia, USA): IDWeek 2025. See list of Top Recurring meetings, above.
  • 29-31 Oct 2025 (Bengalaru, India): ASM Global Research Symposium on the One Health Approach to Antimicrobial Resistance (AMR), hosted in partnership with the Centre for Infectious Disease Research (CIDR) at the Indian Institute of Science (IISc). Go here for details and to register.
  • 28-30 Jan 2026 (Las Vegas, NV, USA): IDSA and ASM have announced a new US-based meeting series entitled IAMRI (Interdisciplinary Meeting on Antimicrobial Resistance and Innovation) and described as a “forum for collaboration and exploration around the latest advances in antimicrobial drug discovery and development.” You can’t register yet (further details anticipated June 2025) but you can go here to see general details about the new meeting.
  • 3-4 Mar 2026 (Basel, Switzerland): The 10th AMR Conference sponsored by the BEAM Alliance. See list of Top Recurring meetings, above.
  • 8-13 Mar 2026 (Renaissance Tuscany Il Ciocco, Italy): 2026 Gordon Research Conference (GRC) entitled “Antibacterials of Tomorrow to Combat the Global Threat of Antimicrobial Resistance.” A Gordon Research Seminar (GRS) will be held the weekend before (7-8 Mar) for young doctoral and post-doctoral researchers. Space for the GRS and the GRC is limited; for details and to apply, go here for the GRC and here for the GRS.
  • 17-21 April 2026 (Munich, Germany): ESCMID Global 2026, the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases. See Recurring Meetings list, above.
  • 4-8 June 2026 (Washington, DC): ASM Microbe, the annual meeting of the American Society for Microbiology. The meeting format is evolving and next year will combine 3 meetings (ASM Health, ASM Applied and Environmental Microbiology, and ASM Mechanism Discovery) into one event. Go here for details.

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