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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Why should a surge in sexually transmitted infections (STIs) in Europe be a concern across Africa or for people who don’t consider themselves to be at risk? Because it points to a bigger problem: the ease with which drug-resistant infections are now spreading, and not just in hospitals but within the community too.

The speed and scale at which people travel and interact in our interconnected world is increasingly helping to drive this, allowing drug-resistant pathogens to move rapidly through populations and across the world – including between high-income countries and low- and middle-income countries (LMICs), where the burden is often greatest and surveillance more limited.

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For more than 20 years, EDCTP has demonstrated the impact of Europe–Africa collaboration — supporting clinical research, strengthening scientific capacity and accelerating the development of health innovations that address poverty-related and neglected diseases. Beyond its role as a research funding instrument, EDCTP serves as a strategic platform connecting Europe’s global health, research and innovation agendas.

As global health challenges evolve, continued investment in EDCTP will be essential to ensure Europe and Africa remain at the forefront of discovery, innovation and preparedness for emerging threats.

Read more about the impact of the collaboration between PDPs and EDCTP, and our joint recommendations, in the new report.

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India has enroled its first newborn in a landmark global clinical trial that could reshape how doctors treat one of the biggest killers of infants, neonatal sepsis, at a time when the antibiotics used for decades are rapidly losing their power.

Sepsis in newborns, or neonatal sepsis, is a serious medical condition that occurs when a baby younger than 28 days old has a life-threatening response to an infection.

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