大曲貴夫氏は、感染症専門医・医学博士。国立健康危機管理研究機構 危機管理運営局 感染症臨床政策部長、国立国際医療センター副院長および国際感染症センター長を務め、感染症危機管理や災害医療を統括している。

GARDPは、感染症診療、感染予防・制御、健康危機管理を専門とする大曲貴夫氏に、その取り組みと薬剤耐性（AMR）に対する考えについて7つの質問を行いました。

AMRはすでに日本で起きている問題でしょうか？

日本でも深刻な問題として起きています。海外より状況は軽いと言われることもありますが、決してそうではありません。現在、日本では主にMRSA（メチシリン耐性黄色ブドウ球菌）と薬剤耐性大腸菌が問題となっており、これらによる菌血症で年間推計1万人が亡くなっています。AMRは将来の脅威ではなく、すでに日本の医療現場で進行している現実です。

抗菌薬が効かなくなったら、医療はどうなりますか？

医療そのものに大きな影響が出る可能性があります。手術では感染予防のために抗菌薬を使いますが、薬が効かなければ手術自体が難しくなります。がん治療でも、抗がん剤による免疫低下に対応するため抗菌薬が不可欠です。臓器移植など高度医療も同様です。AMRは単に「感染症が治らない」という話ではありません。“医療そのものが成立しなくなる”危機なのです。

なぜ新しい抗菌薬は開発されにくいのでしょうか？

抗菌薬開発は技術的難易度が高く、莫大な費用がかかります。一方で、抗菌薬は高額薬ではなく使用量も限られるため、売上規模が大きくなりにくいという特徴があります。そのため投資回収が難しく、承認取得後に経営破綻した海外企業もあります。こうした構造的な課題があるため、抗菌薬開発を民間企業だけに依存する形では限界があります。

抗菌薬開発のあり方は、どのように変える必要があるでしょうか？

民間企業は収益の確保を前提としていますが、抗菌薬は市場原理だけでは維持しにくい分野です。そのため、政府や公的機関による関与が重要になります。抗菌薬は社会全体の医療を支える“公共財”に近い存在であり、その価値は短期的利益だけでは測れません。

こうした課題に対しては、公的な仕組みや非営利主体も含め、さまざまなステークホルダーが関与しながら、新しい開発やアクセスのあり方そのものを再構築していく動きが進められています。 その中で、GARDPは新しい抗菌薬開発のあり方を実際に示しているモデルの一つだと考えています。目標やアプローチにも共通点が多く、協業の可能性は大きいと感じています。

実際に一緒に取り組むことで、日本においても同様の仕組みを実現できる可能性があり、その結果として研究開発やアクセスの在り方そのものが変わり、より持続可能で強固な体制へと発展していくことも期待できると思います。そういう意味で、日本にとっての利点は非常に大きいのではないかと考えています。 一方で、こうした仕組みを支えるには市民の理解が非常に重要だと思います。

AMRは一国だけで対処できる問題でしょうか？

AMRは国境を越えて広がるため、一国だけで解決できる問題ではありません。薬剤耐性菌の国際的移動は増えており、海外の問題は日本の問題でもあります。治療薬の研究開発においても国際協力は不可欠です。日本は研究力に強みがありますが、臨床試験では国内だけでは十分な数の患者を集められない場合があります。各国がそれぞれの強みを持ち寄ることで、研究開発全体を前進させることができます。こうした観点からも、AMR対策において国際協調は欠かせないものだと思います。

日本にはどのような役割が期待されているのでしょうか？

日本には、国民皆保険制度、感染対策インフラ、安定した医療提供体制という強みがあります。さらに、日本の研究開発力は国際的にも高く評価されています。近年、海外関係者から「日本は逃げないでほしい」と言われることがあります。国際協調が不安定化する中でも、日本は比較的一貫して国際保健分野への関与を続けてきました。その継続性と信頼性に対する期待は大きいと感じています。

一方で、日本の課題は何でしょうか？

最大の課題は、国民の間で危機意識が十分に共有されていないことです。COVID-19やエボラ出血熱の危険性は理解されやすい一方で、AMRの脅威はまだ広く浸透していません。例えば、英国では長年にわたり公的機関による啓発や学校教育が行われてきましたが、日本ではAMRが専門家内部の問題として扱われがちです。しかし本来は社会全体の課題です。

また、自分達自身の反省も含め、研究開発、感染対策、抗菌薬適正使用、アクセス改善、政策、国際協力といった各分野の取り組みが、十分につながっていない印象があります。

バラバラに動くのではなく、ちゃんとゴールを共有して、それぞれの取り組みをつなげていくこと。

それが今、日本では大事だと思います。

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Dr. Norio Ohmagari is an infectious disease specialist and medical doctor. He serves as Director of the Department of Infectious Disease Clinical Policy at the Bureau of Health Security and Management, Specially Appointed Deputy Hospital Director and Director of the Disease Control and Prevention Center of the National Center for Global Health and Medicine in Japan where he oversees infection control, crisis management, and disaster medicine.

GARDP interviewed Dr. Ohmagari, an expert in infectious diseases, infection prevention and control, and health crisis management, about his work and the growing threat of antimicrobial resistance (AMR) globally and in Japan.

Is AMR already a problem in Japan?

Yes, AMR is already a serious problem in Japan. While it is sometimes reported that the situation is less severe than in other countries, this is not the case in reality. Currently, methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant E. coli are major concerns in Japan, and bloodstream infections caused by these bacteria are estimated to result in around 10,000 deaths annually. AMR is not a future threat—it is a growing problem within Japan’s healthcare system.

What would happen to healthcare if antibiotics stopped working?

It could have a significant impact on medical practice itself. Antibiotics are used to prevent infections during surgery, and if they no longer work, performing surgery becomes extremely difficult. In cancer treatment, antibiotics are essential to manage infections caused by weakened immunity due to chemotherapy. The same applies to advanced medical procedures such as organ transplantation. AMR is not simply a matter of infections becoming untreatable—it represents a crisis in which healthcare itself may cease to function.

Why is it difficult to develop new antibiotics?

Developing antibiotics is technically challenging and requires enormous investment. At the same time, antibiotics are neither high-priced drugs nor widely used, which limits their revenue potential. As a result, companies struggle to recover their investments, and there have even been cases where some have gone bankrupt after obtaining regulatory approval. Because of these structural challenges, relying solely on the private sector for antibiotic development has clear limitations.

How should the approach to antibiotic development be changed?

Private companies operate on the premise of securing profits, but antibiotics is a field that is difficult to sustain under market principles alone. This is why government and public-sector involvement is essential. Antibiotics are akin to a “public good” that underpins healthcare across society, and their value cannot be measured solely in terms of short-term financial returns.

In response to these challenges, efforts are underway involving a range of stakeholders—including public mechanisms and non-profit actors—to fundamentally rethink and redesign how antibiotic development and access are carried out.

Within this broader context, GARDP can be seen as one example that is already demonstrating, in practice, a new approach to antibiotic development. There are many areas where our goals and approaches align, and I believe there is strong potential for collaboration. 

By working together, it may be possible to establish similar mechanisms in Japan, and in doing so, transform how research and development (R&D), and access are structured—ultimately contributing to a more sustainable and resilient healthcare system. In that sense, the potential benefits for Japan could be significant. However, sustaining such systems requires strong public understanding.

Can AMR be addressed by one country alone?

No, it cannot. The spread of drug-resistant bacteria is increasing worldwide, meaning that problems abroad quickly become problems for Japan as well. International collaboration is also essential for R&D. While Japan has strong research capabilities, it may not always be possible to recruit sufficient patient numbers domestically for clinical trials. By bringing together the strengths of different countries, overall progress in R&D can be accelerated. AMR is a challenge that cannot be solved without global cooperation.

What role is Japan expected to play?

Japan has important strengths, including its universal health insurance system, a well-developed infection control infrastructure, and a stable healthcare delivery system. In addition, its R&D capabilities are highly regarded internationally. In recent years, international partners have sometimes said, “We hope Japan will not step back.” Even as global cooperation becomes less stable, Japan has maintained relatively consistent engagement in global health. There are high expectations for its continuity and reliability.

On the other hand, what challenges does Japan face?

The biggest challenge is that a sense of urgency is not yet widely shared among the public. While the risks of COVID-19 and Ebola are easily understood, awareness of the threat posed by AMR has not yet fullyspread. In the United Kingdom, public awareness campaigns and school-based education have been conducted for many years, whereas in Japan, AMR tends to be treated as an issue confined to health experts.

In addition, reflecting our own efforts, activities in R&D, infection prevention, appropriate antibiotic use, expanding access, policy, and international cooperation are not sufficiently interconnected.

Rather than working in silos, it is essential to share common goals and connect these efforts.

This, I believe, is what is most needed in Japan today.

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In this video, we explore how the Global Antibiotic Research and Development Partnership (GARDP) is addressing this urgent global health crisis. Discover our groundbreaking clinical trial aimed at validating the doses of two antibiotics for use in newborns and our mission to develop new treatments for children.

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“My mother went into hospital well and healthy but died a week after giving birth to my sister,” says Mirfin. “While recovering from a C-section, she picked up an infection which was resistant to the available antibiotics in the hospital. It rapidly led to sepsis. I’ve always believed that my mother’s death could have been avoided if they’d had the right antibiotics to treat her infection.”

The tragedy was a turning point for Mirfin, who was 18 at the time. He decided to study to become a clinical pharmacist. Since his home country of Zambia didn’t have a pharmacy school, he got a scholarship for his undergraduate studies in Tanzania. He later specialized in infectious diseases and public health in the United States before going back to Zambia. Mirfin has since become one of the leading global voices on the importance of accessing effective antibiotics and advocating for ways to prevent antimicrobial resistance.

As the co-founder of ReAct Africa, Mirfin and his team have supported many African governments in developing and implementing their national action plans on antimicrobial resistance.

Mirfin is particularly proud of the growing band of young volunteers he has helped to nurture over the years. Through ReAct Africa, young people, mostly students, are taught about AMR and how to bring about change through using antibiotics appropriately, and how to prevent infections. They in turn take the knowledge they’ve learnt deep into the community – from schools and clinics to churches and campuses, often relaying their message through art, poetry and theatre. Students have also formed One Health clubs. The programme has cascaded into a range of African countries, such as Kenya, Tanzania and Liberia.

Many of these young ‘AMR champions’, together with policymakers, healthcare workers and researchers also gather at the annual AMR conferences in Zambia, hosted by ReAct Africa and the South Centre. The conference pulses with excitement and energy as people talk about what they are doing to improve infection prevention and control, prevent misuse of antibiotics and increase access to effective antibiotics.

They also discuss ways to best engage politicians, intergovernmental organizations and the global community to counter AMR in Africa, which is disproportionately affected by AMR.

Mirfin has put AMR firmly on the African agenda and onto the global stage. He has become a sought-after speaker in global conferences and working groups and often writes on gaps in access to antibiotics and diagnostics, AMR as a health security issue and other vital issues. He has also supported the World Bank and Africa CDC and other organisations in their work in Africa and Asia.

For Mirfin, life has turned full circle. “My mother’s death was devastating. But it inspired me to commit to this field. Antibiotic resistance causes so much illness and death. It drains money from families as people become too ill to work. It also leaves people feeling desperate as they often can’t afford some of the third or fourth generation antibiotics that could work, if they are available at all. People often resign themselves to die,” says Mirfin.

This is an untenable situation, which needs change, and constant attention, especially in Sub-Saharan Africa, which is particularly hard-hit by drug-resistant infections. While more funding and commitment is needed, Mirfin is not giving up the fight.

“We’ve been strong advocates, not just at a country or regional level, but globally. We have worked with intergovernmental organisations and the Africa CDC on stemming AMR. Our young people – as the doctors, nurses and pharmacists of tomorrow – are playing their part. We have been the voice of the Global South, and we want to get even stronger.”

Mirfin’s mother would have been proud. He has honoured her memory through his dedication towards a better outcome for this generation and those to come.

This story was made in collaboration with ReAct Africa. 

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The escalation of the Israeli attacks in Lebanon since 17 September 2024 has meant that home is no longer safe for Yusra. And she is not alone. As of mid-October 2024, the Government of Lebanon estimates that over 1.2 million people have fled their homes, including over 800,000 internally displaced people.

In Yusra’s case, that has meant travelling to Saudi Arabia to stay with her daughter, Nour Shamas, an infectious diseases clinical pharmacist and specialist in antimicrobial stewardship.

As in previous trips, Yusra travels with her back-up antibiotics on hand and prays that she’ll be able to get medical care if necessary. She’s had these acute needs since 2018, when she got a life-threatening drug-resistant infection following emergency surgery on her back. Yusra recovered after months of treatment, but now she is particularly susceptible to serious recurrent drug-resistant urinary tract infections.

Increasingly the global community is recognizing the link between conflict and antimicrobial resistance (AMR). In Yusra’s case, conflict makes it extremely difficult and costly to access urgently needed medical care, including diagnostics and antibiotics. She worries that emergency medical care in a foreign country without access to her private health insurance or regular doctor could cripple her financially and put her life at risk.

More generally, displaced people in conflict settings may move into temporary, crowded shelters without access to clean water, facilitating the spread of infections. Conflict often interrupts routine medical care like flu shots and childhood vaccinations, facilitating the spread of certain bacteria and viruses. In war zones, traumatic injuries received and/or treated in non-sterile conditions can become contaminated with bacteria and then spread as people move and as soldiers return home. Studies further suggest that bacteria evolve to develop resistance when exposed to the toxic heavy metals used in modern warfare.

Coincidently, Yusra’s daughter Nour has been a leader in implementing antimicrobial stewardship programmes. Such programmes are designed to foster appropriate use of antimicrobials and diagnostics for optimal care that minimizes the spread of drug resistance. Yet Nour and her mother know that well-designed stewardship programmes are only one key part of the solution. Far beyond the hospital walls, conflict is contributing to the AMR crisis.

*Name has been changed for privacy.

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If the treatment is too light or ineffective, the infection could actually grow stronger and spread; if the treatment is too strong, the patient’s recovery could be delayed and accompanied by harsh side effects. Doctors thus seek out just the right amount of antibiotics to kill the harmful bacteria while minimizing side effects and optimizing patient outcomes.  

That is where Professor Nusrat Shafiq comes in.  

About ten years ago, Nusrat was charged with improving antibiotic stewardship at the Postgraduate Institute of Medical Education and Research in Chandigarh, a public hospital in Northern India that receives millions of patients every month, and one of the premier health institutes in the country. At the time, the Global Action Plan on AMR had not yet been rolled out, and there was much lower general awareness of AMR than there is today. 

She started by taking a closer look at patients entering the intensive care unit. “Patients were coming or being referred with all kinds of antibiotic prescriptions,” said Nusrat.  

Soon Nusrat and her colleagues realized that overprescription and inappropriate prescription was a widespread problem caused by multiple factors. Various prescribing practices were being used within each department, and available diagnostic facilities were not being optimally utilized.  

With institutional support, Nusrat and her team began working on improving the rational use of antibiotics—so that the right patients would get the right antibiotics at the right time for the right duration. They believed that they could obtain as good or better patient outcomes, as well as generate savings for hospitals and patients and help to preserve the efficacy of antibiotic treatments. 

To begin, Nusrat and her colleagues zeroed in on surgical prophylaxis, the pre-surgery prescription of antibiotics to prevent infections. Supported by data that showed that patients could fare at least as well with a shorter antibiotic treatment prior to surgery, they went about engaging with surgeons who were accustomed to giving their patients a cocktail of antibiotics.  

Nusrat recalls one surgeon in particular who agreed to follow the single-shot protocol, but with a condition: “He said, ‘Okay, we can implement the protocol you recommend for my patients, but you have to follow them for six months and show me that the recommended treatment does not adversely affect their outcomes.’ We were able to show that. Subsequently we took this story from department to department, and our work kept on getting bigger.”  

Nusrat and her team learned along the way. They tapped into momentum that was being generated at the national level with the drafting of the National Action Plan on AMR. They witnessed improved cleanliness, hygiene and infection control in hospitals thanks to the Kayakalp initiative, which was launched by the Indian government in 2015. They also noticed increased reporting on AMR in the media, and they themselves started to speak on the radio about the threat of AMR and the importance of rational use of antibiotics.  

In this context, a new culture around antibiotic stewardship began to take shape. And now after 10 years of efforts, Nusrat’s team have seen noticeable improvements:   

• The culture of de-escalation has increased, so doctors who start patients on broad-spectrum antibiotics are more willing to move to limited-scope treatments once the pathogen has been identified 
• Double anaerobic cover—so two antibiotics that cover organisms that do not require oxygen for survival—have gone from basically universal use to use in 1-2% of cases 
• Certain last-resort antibiotics are being used later in the treatment process, rather than up front 
• A new approach to developing guidelines for infection management, including involving stakeholders and taking into consideration available resources, has been increasingly adopted by healthcare systems 
• Diagnostic facilities are being better utilized to optimize antibiotic use 

And the work continues. “The more success we have, the easier it is. The good stories travel across departments and beyond to other institutes and community healthcare settings,” says Nusrat.  

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For Bhakti Chavan, this was not a hypothetical question but a reality. At 23 years old and living in Mumbai, India, Bhakti was diagnosed with extensively drug-resistant tuberculosis (XDR TB). TB is caused by Mycobacterium tuberculosis, which like other bacteria as well as viruses, fungi and parasites, can develop defenses over time, rendering antimicrobial medicines less and less effective.

In the case of Bhakti, none of the first- or second-line treatments would work. Instead, she would have to get daily injections of novel antibiotics and take 7-8 combinations of antibiotics as pills over several months. Bhakti suffered from horrible side effects ranging from nausea to blurred vision and depression, and she was nearly completely isolated from her friends.

“It’s physical, financial, social,” she said.

After eight months of intensive treatment, Bhakti stopped receiving injections but continued taking antibiotics in the form of pills. In July 2019, Bhakti finally finished her treatment, nearly two full years after it began.

“In my case, I was very fortunate to get a timely diagnosis and have access to novel medicines provided by Médicins Sans Frontières (MSF). But there are many patients who are misdiagnosed for years, and they don’t get access to those medicines.”

Her experience instilled her with a passion for advocacy and antimicrobial R&D. She now works for a biotech company, where she contributes to the development of novel therapeutics and diagnostics to combat antimicrobial resistance (AMR). Bhakti is also part of the WHO Task Force of AMR Survivors.

“AMR exists – it’s not a future pandemic. Without any prior history, I got infected with drug-resistant TB. If it can happen to me, it can happen to anybody,” says Bhakti.

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Tori Kinamon was a talented 19-year-old college gymnast in the US when she felt a pain in her left hamstring. Her trainer suspected she’d strained it, while an X-ray didn’t detect anything abnormal. The student health department suggested she go home and rest.

But Tori was worried. Within days the pain was excruciating.

“It was so painful that I couldn’t walk. My leg was red and swollen. I had night sweats, a fever and my blood pressure plummeted.”

Tori phoned her mom. Concerned, she took her straight to hospital. “I think she knew something was terribly wrong,” says Tori. Doctors thought she had cellulitis and put her on broad-spectrum antibiotics. Within 24 hours she wasn’t showing any improvement.

Finally, imaging studies showed a large abscess in her hamstring muscle.

“The bacteria were in my bloodstream and then travelled to my hamstring. They set up shop there and multiplied rapidly to the point where I had an 18-centimetre abscess and an associated infection of the hamstring muscle. It was a very deep and severe infection, probably because it was not intervened upon earlier.”

Tori’s road to recovery was tough. It took a month in hospital and several surgeries to drain the wound and clear away the Methicillin-resistant Staphylococcus aureus (MRSA) infection, which is caused by a type of staph bacteria that has become resistant to many of the antibiotics used to treat ordinary staph infections.

Tori credits an effective antibiotic as being key to her eventual recovery.

“I had a great outcome because we had an extra antibiotic in the stockpile to treat my infection. It worked and I was so fortunate. It convinced me that we need to devote a lot of energy, brain power and funding to antibiotic development, especially with the threat of increasing antimicrobial resistance.

“Antibiotics are no longer a luxury that we can take for granted. It is a community, a national and international problem that we all need to be concerned about, because our lives depend on it. Mine certainly did.”

Tori also realised that antibiotics need to be tailored towards patients and their health conditions.

“It’s important to have the right antibiotic, at the right time, for the right patient because each patient responds differently to antibiotics.”

The experience has propelled Tori to do something positive.

“While in hospital, I made a commitment to myself that I was not going to be a victim of this infection. First and foremost, it meant that I was going to devote myself to research; to find out why MRSA happens, and how to prevent it. I also decided to study medicine.

“It expanded my interest in infectious disease and antimicrobial resistance. It allowed me to make meaning from my suffering. On top of that, I vowed to return to college gymnastics.”

From being unable to walk, Tori worked with a physiotherapist to regain muscle strength. Step by step, she got stronger, and returned to college gymnastics within six months…a huge achievement.

Now a qualified doctor, Tori is passionate about spreading the word about MRSA.

“MRSA infections are becoming more prevalent. As an athlete, you’re sharing surfaces; you have cuts and scrapes. Infections can happen to anyone. There is a lot of victim blame. People say: ‘If you’re clean and you shower after practice, you’re not going to get this’. But I was highly hygienic, and it happened to me.”

Tori believes reducing stigma around bacterial infections and increasing awareness and education amongst healthcare providers and patients is critical.

She has designed a curriculum to educate other college athletes about the warning signs of an MRSA infection.

“It’s important to know that if you have pain out of proportion to your injury, a red, swollen limb or joint, and you don’t feel well, trust yourself, trust your body and seek care,” she suggests.

“I’ve been on all sides of the AMR issue – as a patient, student, researcher and scientist. Ultimately, we’re all susceptible to AMR. It affects us all.”

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