Healthcare workers were covered in Personal Protection Equipment (PPE) and wore double N95 masks cutting into the back of their ears. Some nurses and doctors shared their frustrations and grief but, for many, emotions could be seen solely in their eyes. Eyes became the only windows into seeing each other’s emotional spirit, and it was dwindling. The COVID-19 pandemic pushed healthcare workers to the breaking point, contributing to a healthcare provider shortage that is still vastly impacting medical institutions today. Although many people have moved on, choosing to forget COVID-19, its consequences are still reverberating. COVID-19’s impact did not just linearly diminish as the number of cases decreased. Therefore, the world cannot just ignore the statistically significant possibility of a future pandemic. 

The memories of COVID-19 cannot be shoved under the carpet; living in a false safety that this circumstance will not happen again is an extreme collective denial. Rather, it is vital that the world rebuilds with a new approach to protecting the global population from the next possible source of a global pandemic, what has become more commonly referred to as Disease X. 

Disease “X” is the World Health Organization’s (WHO) coined term for an unknown pandemic pathogen. This is a placeholder concept the organization has created for a pathogen that has not yet mutated into a global outbreak but could do so in the near future. Disease X was first introduced in the WHO 2018 Annual Review of diseases prioritized under the Research and Development Blueprint. The Disease X term was needed to discuss the threat of a hypothetical pathogen that is not known or exists yet. It is still largely debated whether COVID-19 (SARS-CoV-2) should be considered the first pathogen given Disease X classification. In fact, experts are also discussing whether COVID-19 is just a small taste of what is to come with a far more fatal Disease X. Ultimately, the Disease X concept is considered a pathogen which will hold the right characteristics and ingredients to create another global pandemic. Recognizing the growing threat, the scientific community has turned its attention to defining which types of pathogens the international community should be urgently monitoring. 

For instance, there is specialized focus on zoonotic diseases as the next possible source of Disease X. It takes what is known as a zoonotic jump for an animal virus to become transferable and infectious in human beings. The Center of Disease Control states that an estimate of  “more than 6 out of every 10 known infectious diseases in people can be spread from animals” whilst “3 out of every 4 new or emerging infectious diseases in people come from animals.” These statistics highlight that, in most cases, zoonotic spillover is an inevitability not an anomaly. 

This is especially the case since the boundaries between species have become increasingly  entangled because of deforestation, industrial agriculture, the wildlife trade and climate change. Environmental pressures and human behavior should not be overlooked when addressing zoonotic disease solutions. Notable origins of diseases from animals include Ebola virus, where bats are the suspected virus reservoir; Creutzfeldt-Jakob disease, the human form of the prion disease Bovine Spongiform Encephalopathy (mad cow disease); Zika virus, which is transmitted by mosquitoes; and Avian influenza (bird flu), which originates in birds. These examples illustrate a disease landscape that could serve as the origin of Disease X and has well-established precedent.

Another potential source of Disease X that needs to be scrutinized is an engineered pandemic pathogen. Carl Jung, an influential Swiss psychiatrist and psychotherapist, warns that the “only real danger that exists is man himself.” Bioterrorism is a threat to humans created by humans. Alongside nuclear weapons, bioterrorism has become a new missile in the self-destruction toolbox. The development of biotechnology has allowed for advancements in many health sectors such as pharmaceuticals and vaccines. However, it has also made engineering pandemic pathogens that can be customized to have high virulence and fatality rates possible. During the cold war, viral agents were stockpiled as militarized weapons in the US and the Soviet Union. Viral bioterrorism puts everyone at risk and, whether the release of a bioengineered Disease X could be intentional or accidental, the impact would be globally devastating. 

All these factors suggest that Disease X is not a question of if it will cause the next global pandemic — it is a question of when.

Given this, organizations like The Coalition for Epidemic Preparedness Innovations (CEPI) have identified 25 different virus families that can serve as the host to the next deadly virus. CEPI hypothesizes that Disease X will come from one of these twenty-five different virus families. CEPI’s “100 Days Mission” aims to achieve the ability to respond to the next Disease X pandemic in just under three months by preparing globally accessible vaccines.  The 100 Day Mission is centered around swift and equitable vaccine deployment that will defend those at highest risk in order to stop the spread of an outbreak. Their research on “the most wanted viruses” provides a library of prototype vaccines to preempt the need for the next crucial vaccine by ideally supplying the world with an expedited prophylactic vaccine to contain the spread of the next pandemic. CEPI’s current diversification into the unknown of the 25 families is reimagining pandemic prevention in research. 

The Coalition for Epidemic Preparedness Innovations was born after the Ebola outbreak highlighted just how ill-equipped state and non-state actors are at containing epidemics. The WHO is often criticized for their inefficient reaction and response to the 2014 Ebola outbreak. The WHO did not have efficient intergovernmental cooperation nor the proper funding needed to execute a cohesive effective response. The Ebola outbreak sheds light on the significant gaps in the global health system, harkening the need for an innovative multifaceted approach to respond to epidemics and pandemics. Ebola should have been the wake-up call. Now, the COVID-19 pandemic is the writing on the wall. 

The COVID-19 Pandemic exposed global governments to a new crisis, a war against a common enemy — a virus. 

Sovereign states have the responsibility to protect and provide for the population in crisis. During the COVID-19 pandemic global health security was threatened. However, instead of nations banding together to contain COVID-19, there was global division and politicization of healthcare. The pandemic introduced two predominating questions: who was responsible for COVID-19 and what international actors were going to contain it? 

There needs to be a new framework to instill global cooperation, one that begins with framing viruses as a shared enemy rather than a localized problem. This reframing shifts responsibility not only to individual nations or institutions, but to collective action by changing the narrative to global commitment and shared responsibility. COVID-19 could have been a moment of unification, but it became a moment of polarization. This was not just seen on a global scale. Personally, many people in my own community that didn’t have immunocompromised family members decided it was not their responsibility to protect people from the spread of the virus. This is why framing the virus as a shared enemy and responsibility could create a stronger collective action against the next pandemic. 

 After World War II, global cooperation created the United Nations to prevent future conflict and another devastating world war. The U.N. served as a preemptive measure to ideally maintain peace and established a permanent institution for conflict resolution. Over time, the U.N. has become a platform for diplomacy and has helped shape postwar international order. In addition, the U.N. launched specialized agencies such as the World Health Organization (WHO), founded in 1948 to address global health issues. The WHO was established from the premise that health is inseparable from peace and security. Ten years after the WHO’s Constitution was created, the Soviet Union (USSR) proposed a WHO-led smallpox eradication program that would become a profound example of global health governance. In 1977, the last confirmed case of smallpox was identified and, by 1980, the WHO declared smallpox eradicated. This success was attributed to a moment of unprecedented global political commitment, even during the height of the Cold War, where the US and the USSR both agreed upon this shared goal of eradication. The program’s strength lay in its measurable objective for complete eradication thus countries systematically reported case detection and worked with the WHO. Nations shared the responsibility by sharing resources. The program had political backing and funding for over a decade. The WHO had a Smallpox Eradication Unit that was led by experts in the field like Donald Henderson, who later founded the Center of Civilian Biodefense Studies at Johns Hopkins. The smallpox eradication campaign can serve as a powerful model for international cooperation. Smallpox remains “the only infectious disease to achieve this distinction.”

The evolution of the WHO and the International Health Regulations (IHR) have made expansive strides in global healthcare. However, the accelerating pace of globalization and the changing global health landscape have revealed critical limitations. The WHO struggled to enforce effective governance during the COVID-19 pandemic. It was unable to coordinate an international response, delayed declaring COVID-19 as an international emergency and was not able to hold nations accountable for disease surveillance and timely reporting. The COVID-19 pandemic revealed domestic political agendas which led to a fragmented response and its politicization fueled skepticism on scientific advice globally. What this highlighted is that the WHO has arrived at a critical inflection point where the future of successful pandemic response must be able to transcend political pressures. 

Although the WHO has had a historical commitment to global health, another moment of international solidarity is needed — one where a global crisis becomes the catalyst for cooperation just as World War II served as the platform for creating the U.N. A virus may not be treated as a world war, yet its global consequences and strains are not unlike the destructive impacts of warfare. There are extensive fatalities, governmental instability, economic implications and a shared sense of fear and crisis. So, why isn’t there an international institution or organization solely dedicated and committed to preventing the next global pandemic? 

In 2015, Bill Gates performed a TED Talk where he outlined that the world is not prepared for a pandemic. Fast forward 10 years to today in 2025 the global health system is still not prepared for a pandemic. 

Bill Gates has now proposed a systematic multifaceted solution to prevent the next global pandemic. This solution is the Global Epidemic Response and Mobilization (GERM) team. 

The GERM team would be a permanent institution and organization that can combat and coordinate rapid responses to new potential infectious outbreaks. Ultimately the GERM team could be seen as another functional unit of global cooperation and governance. Additionally, they would be coordinated with the WHO. The GERM team would become a multinational unit that comprises over 3,000 full time specialists in epidemiology, vaccine development, genetic engineering, data science, computer simulation, emergency medicine, communications and diplomacy. The GERM team would be actively monitoring and researching threatening outbreaks. Disease X would be contained before it becomes a global health threat. Bill Gates states in his TED talk that if COVID-19 was caught in the first 100 days it would have saved over 98% of the lives lost. The first 100 days are crucial to stop the spread of an epidemic and the GERM team would be equipped to do so. 

The GERM team is an exemplary theoretical model solution that can transition into becoming a groundbreaking reality. For the GERM team to come into fruition it needs funding. Governments spent an immense amount of funds during COVID-19. Money was poured into economic relief programs, healthcare infrastructure and other aid response measures. The U.S government spent 4.6 trillion dollars and created the Coronavirus Aid, Relief and Economic Security (CARES) Act during the pandemic. The International Monetary Fund (IMF), a major U.N. financial agency, estimates that COVID-19 has cost the world around 14 trillion dollars. To put the GERM team’s funding into perspective, spending money on the GERM team now would save nations from spending trillions of dollars later. The GERM team will cost the world 1 billion dollars annually to maintain all the resources and on-the-ground manpower. This is a worthy investment for the survivability of our future. To apply Bill Gates’ motto here — “This is the billions we need to spend in order to save millions of lives and trillions of dollars.”

The funding needed for the GERM team would have an expansive impact beyond stopping Disease X. It could provide another opportunity to advance medical tools for efficiency in many different specialties. To prepare to prevent a pandemic there needs to be investment in diagnostic tools, vaccines and deliverance which will subsequently address health disparities and global accessibility. A case study on microneedle patch vaccines exemplifies the reach the GERM team could have on closing the health security gap. 

The GERM team would fund new research in vaccine deliverance such as microneedle patches. Microneedle patch vaccines provide an efficient delivery system to the dermis and epidermis layers of the skin. Research on this deliverance method has shown higher immunogenicity for some vaccines than the traditional intramuscular needle route. Microneedle patch vaccines could revolutionize immunization strategies because it allows fast global vaccine deployment and mass production. More importantly, this vaccine method does not need large infrastructure or manpower to distribute. The vaccine patches do not require refrigeration, making delivering vaccines in remote areas and rural regions easier, thus improving accessibility. As illustrated, the GERM team’s impact on healthcare development could provide more than just pandemic prevention but could also help remedy the gaps in global health security that disproportionately devastate populations that do not have access to proper healthcare infrastructure. New diagnostic tools and therapeutics, disease surveillance, strengthening existing healthcare infrastructure in low-income countries and pathogen genomic data sharing are just a few more examples of how the GERM team’s impact addresses narrowing the health gap. 

In this era of increasing interdependence between nations, international institutions play a critical role in global governance and are vital forums to address global crises. The United Nations, the World Health Organization and the World Trade Organization are international institutions that are fundamental to global stability in governance, economy and health security. Yet the capacity to respond through these institutions has been undercut by political resistance. The Trump administration, for example, has demonstrated a strong aversion towards global multilateral commitments and institutions. Recently, the administration has cut thousands of programs under the United States Agency for International Development (USAID). USAID has long supported global health, education, humanitarian relief and economic development for nations recovering from conflict or disaster. Increased efforts to defund and discredit governmental agencies and organizations such as the WHO have further politized healthcare and weakened international cooperation. The GERM team could have direct funding that could be insulated from shifting political pressures which would bypass bureaucratic delays and geopolitical conflicts. Detailed frameworks for pandemic response are still under development, but the most important promenet is addressing the governance and enforcement gaps by embedding pandemic preparedness into the core agendas of nations. 

The current geopolitical climate has revealed the fragility of global health governance within the hands of today’s leaders. The tension underscores the relevance of Complex Interdependence Theory, founded by Keohane and Nye, which establishes a framework where states are not solely driven by military power or security concerns. Instead, nations are deeply interconnected through shared economies, trade networks, security interests, technological advancements, international institutions, shared health dependencies and environment (Keohane and Nye). States do not operate in isolation. While interdependence is a defining feature of global order, many states perceive it as a liability during global crises, precisely when collective action is most critical. Disease X will not happen in isolation either, it will thread itself through the web of international interdependence. 

 Globalization has fueled more interconnectedness among states, making global cooperation the cornerstone for global stability. A global pandemic is a wicked problem characterized by its complexity. It requires a multifaceted approach that necessitates international cooperation and robust global governance. A single nation is not able to stop a global pandemic alone, yet a single nation’s outbreak can trigger a chain reaction sending the world into crisis. The GERM team is strategically and uniquely positioned to interrupt the chain reaction. However, the question still remains: Who is responsible for Disease X? The answer is everyone — Disease X is our shared global foreign enemy, and it is our collective responsibility to confront it.

The views expressed in opinion pieces do not represent the views of Glimpse from the Globe.

The post Disease X: The Next Global Foreign Enemy — Are We Ready? appeared first on Glimpse from the Globe.

Antibiotics are particularly powerful because the medication targets and restricts bacterial cell functions, either immobilizing their spread or killing them completely. The first antibiotic created was Penicillin, invented by physician and microbiologist, Alexander Flemming, in 1928. 

Dr. Mukherjee, the author of the Pulitzer Prize winner, The Emperor of All Maladies, concludes that, “Penicillin kills the bacterial enzymes that synthesize the cell wall, resulting in bacteria with ‘holes,’ in their walls. Human cells don’t possess these particular kinds of cells, thereby making penicillin a magic bullet”. Penicillin was revolutionary because it was the first time in history that there was a cure for infectious bacterial diseases. The efficacy of this new antibiotic had a monumental impact on World War II by controlling bacterial infections. During war, infectious diseases were often referred to as the “third army” because disease was a primary threat to soldiers. The unsanitary conditions, nutrition, overcrowding and open wounds created an ideal environment for bacterial diseases to thrive. “In World War I the death rate for bacterial pneumonia was 18% and in World War II it was less than 1%.” After World War II penicillin was being manufactured by the billions every month. 

Ever since its introduction, penicillin has become the “magic bullet” in medicine. However, the medical world realized it would not last forever. Alexander Flemming accepted the Nobel prize warning generations to come that the overuse of penicillin will cause bacterial resistance. The magic bullet, antibiotics, would become an old-fashioned bayonet against modern nuclear weapons – resistant bacteria.  

Bacterial infections can become resistant to antibiotics. Essentially, the process begins with antibiotics killing the microbes that are causing the infection. Then, the fraction of those microbes that survive the antibiotic treatment are naturally selected for the genes that make them resistant. As such, the presence of antibiotics increases the propagation of the surviving microbe, creating generations of antibiotic-resistant bacteria. 

The new generation of antibiotic-resistant bacteria essentially outsmarts the drug through the process of evolution. Therefore, the increasing usage of antibiotics generates new strains of antibiotic-resistant bacterial infections. Many bacterial strains have not only become resistant to one antibiotic but have become multidrug-resistant.  

Consequently, the world has moved into an era of pan-resistant infections, where microbes are no longer just multidrug-resistant, they are resistant to all available antibiotics. The drug that once protected and saved millions of lives has become a threat due to its overuse and misuse. 

Antimicrobial resistance (AMR) and Antibiotic resistance (AR) is the global silent pandemic. 

Antimicrobial resistance is a term that captures a broader range of infections caused by other microbes and is used in conjunction to antibiotic resistance. Millions of people die from antimicrobial resistance annually. The World Health Organization (WHO) published in 2019 that AMR contributed to 4.95 million deaths, including 1.27 million deaths where AMR was the direct cause of death. The WHO has declared AMR as “one of the top 10 global public health threats facing humanity.” 

Antibiotics are notoriously inappropriately prescribed. C. Lee Ventola, a highly cited researcher on drug response, has uncovered that “treatment indication, choice of agent, or duration of antibiotic therapy is incorrect in 30% to 50% of cases” in the United States. He also highlights that 30% to 60% of antibiotics prescribed in intensive care units (ICUs) follow suit. 

Antibiotic prescriptions and over-the-counter antibiotics are unregulated in many countries. Antibiotic resistance is largely attributed to the overuse and misuse of antibiotics. Antibiotics have become a convenient catch-all drug that is commonly prescribed for unnecessary treatments. Antibiotics accessibility, economic costs and lack of new advancing antibiotic research in the medical and pharmaceutical sectors contribute to its misuse. 

The antibiotic resistance issue is defined by its complexity and is in need of progressive, multifaceted solutions that will require the cooperation of many international actors. 

The fight against antibiotic resistance needs new global economic incentives for drug development, a reimagined advocacy viewpoint and an approach to stimulate awareness and cooperation. 

Modern medicine has created some of the most revolutionary achievements of mankind. The twentieth century has ushered in futuristic genetic engineering, novel immunotherapies, RNA vaccines and numerous developments in all medical specialties — antibiotic resistance is threatening these achievements.

The WHO states that organ transplantations, chemotherapy and surgeries such as caesarean sections become much more risky and dangerous without effective antibiotics for the prevention and treatment of infections that arise from such procedures.

Re-imagined Awareness Platform 

People from all walks of life are affected by antibiotic resistance but cancer patients are on the frontlines and are one of the most vulnerable populations.

Bacterial infections are the second leading cause of death in cancer patients. Unfortunately, many people are not strangers to the painful treatments and strenuous fights against cancer. Globally, it was estimated by the Worldwide Cancer Research Fund in 2020 that there are 18.1 million cancer patients. Cancer patients endure treatments that kill both cancerous cells and healthy cells, compromising their immune system. Furthermore, much of their care is provided in hospitals, where hospital-acquired infections (HAI’s) are a significant concern. Constant invasive visits that require puncturing skin for IV lines or the use of IV ports, surgery recovery, wound redressing and being present in an environment that treats some of the harshest multi-drug resistant infections makes cancer patients highly susceptible to HAIs. 

Kevin Outterson is the Executive Director at CARB-X, Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, a global nonprofit partnership and his research focuses on global antibacterial innovation. He is also a professor of Health and Disability Law at Boston University. He published a review with other scientists that addressed the issue of HAIs and antibiotic resistance in the Clinical Journal of the American Cancer Society. In a podcast interview with the Union for International Cancer Control, Outterson discussed the increased dangers of AMR to cancer patients. 

“Data shows that while antimicrobial resistant superbugs are a problem for everyone, for people with cancer, the risks are really three times higher that they’ll get a fatal infection from these superbugs,” Outterson said. He highlights that innovative cancer treatments have advanced so far that we can’t have the progress “undermined by the old foe of infection. ”

This point can be extended to how society has come so far in medical science that there is no time to be defeated by pan-resistant superbugs. 

Cancer patient communities have developed many awareness groups that have contributed to the demand for new treatments. Money is being pipelined into research funds and cancer institutes. There is a lot of awareness surrounding the cancer community, which is why there is a demand for new drugs. 

Cancer patient communities and advocacy groups work hard to spread awareness. Every month on the calendar is attributed to the awareness of different cancer types. The assortment of colorful ribbons divides cancers by where it was initially localized. However, that very ribbon no matter what color, symbolizes a plethora of support and unity for cancer patients.

There isn’t the same caliber of support and awareness for antibiotic resistance. The silent pandemic cannot remain quiet. 

AMR poses a threat to cancer treatments and many people are unaware of this. The Union for International Cancer Control is striving to “sensitize” and educate the cancer community to the AMR threat. Cancer patients and supporters could become the global ambassadors for antibiotic resistance advocacy. They have a strong base to instill action and awareness for antibiotic resistance. 

If health advocacy groups could implement AMR awareness in their programs and platforms, the impact would be monumental. Currently, there are some movements to spread awareness such as the global campaign, such as World AMR Awareness Week. However, AMR awareness requires a larger approach because it affects everyone. Imagine if every medical condition organization embedded AMR awareness in its mission. Kevin Outterson comments that not many patients identify as “I’m a survivor from a drug-resistant infection,” however, a wide range of patients would fall under this category. Countless patient groups rely on antibiotics, to unite those groups with the cancer community could change the fate of antibiotic resistance through awareness. 

There needs to be a public outcry, just as the cancer community has fought for preventative measures to ensure others avoid cancer, such as HPV vaccinations, wearing sunscreen and laws surrounding cigarette usage. The mobilization of these patient groups that already have an established platform could make a significant difference in both raising awareness and mobilizing funding for antibiotic research and solutions. 

Antibiotic Resistance Research Pipeline and Economy 

The antibiotic research communities are described by Outterson as looking “over longingly at the pipeline and the money going into cancer, ” Outterson said. Compared to the revolutionary research being done in the cancer industry, the antibiotic industry has fallen short. The predominant cause for this discrepancy is lack of funding. 

The science behind both cancer research and antibiotic research is remarkable. Science is not a limiting factor for research in the antibiotic field, it is that society does not expend money or resources for antibiotic development as if they are valuable. 

Antibiotics are relatively cheap in comparison to cancer treatments as common antibiotics are mass-produced. However, the WHO states that, “just 27 new antibiotics for the most threatening infections are in the clinical trial stage of drug development. In contrast, there were more than 1,300 cancer drug trials in 2020.” To further extend this alarming condition, the WHO only recognized two antibiotics to be effective for surviving antimicrobial-resistant bacteria. 

The underlying issue is that there is not enough research going into the solution for antibiotic resistance. Internationally, there was only one antibiotic, “cefiderocol, that was approved to treat the superbugs on WHO’s most critical list.” The recently published urgent threat multi-resistant bacteria and fungi include Carbapenem-resistant Acinetobacter, Candida auris, Clostridioides difficile, Carbapenem-resistant Enterobacteriaceae and Drug-resistant Neisseria gonorrhoeae. Carbapenem-resistant Acinetobacter, which cause pneumonia, bloodstream infections, urinary tract infections and wound infections, especially in patients receiving care in intensive care units. It is also one of the many resistant strains cancer patients are susceptible to. The Carbapenem-resistant Acinetobacter carries “mobile genetic material” that can produce enzymes that inhibit the effect of antibiotics.

There are limited incentives to produce new innovative antibiotic drugs to combat these threats. The cancer research industry has fantastic reimbursement through selling cancer treatment drugs. The economic model for pharmaceutical companies is to invest upfront and reap the rewards from sales once approved. This model is not applicable for antibiotics and it stems from its market nature. Negative externalities arise as the production of new antibiotics results in a cost to a third party. Antibiotics may help a group of patients but then create resistant bacteria for the rest of the population.

It is an unusual market condition because companies invest time and money to produce antibiotics that are then used sparingly to reduce antibiotic resistance. 

Antimicrobial resistance escalates when there is an increased use of antibiotics; it creates a cycle of developing smarter microbial infections. That is atypical for the general medicines used today. For example, anticoagulants, antihistamines and antiepileptics will not lose their efficacy over time and only affect the individual patient prescribed. 

According to Doctor Venkatasubramanian Ramasubramanian, president of the Clinical Infectious Diseases Society of India,  “with a new antibiotic, we say, ‘don’t use it,’ or ‘use it sparingly so it lasts longer… It is not an attractive proposition for anyone in the industry,” Ramasubramanian said. 

Antibiotics need to be conserved to prevent the evolution of more antibiotic resistant bacteria. This is why newly developed antibiotics are typically used sparingly for five to fifteen years to ensure its efficacy. 

The flipside to this situation is that companies “developing one new antibiotic can take up to two decades and usually costs $568 million to $700,” according to Pharmaceutical Research and Manufacturers of America’s, Medicines in Development for Antimicrobial Resistance 2021 report. After all, the resources and money is put into approving a new antibiotic drug; it is then not used for as long as possible until necessary. Therefore, a large majority of antibiotic companies have gone bankrupt or abandoned the antibiotic field. Big Pharmaceutical companies are fleeing, such as Melinta Therapeutics, a large antibiotic developer warned the regulators they were running short of funds. Achaogen, a biotech company, went bankrupt after dedicating 15 years to develop a new antibiotic that was then added to the WHOs list of essential new medications. This market exit is a terrible trend as antibiotic resistance becomes more exacerbated.

Antibiotic resistance is a massive global financial burden worldwide and the highest burden is for low-resource countries. The United Kingdom’s AMR policy paper mentions that the World Bank predicts that “28 million people will be forced into extreme poverty by 2050 unless AMR is contained.” The World Bank also highlighted that there will be a global cumulative cost of $100 trillion by 2050 if the issue of antibiotic resistance remains under the radar for most people. 

There is a need for new global initiatives to stimulate more money into researching not only new antibiotics, but innovative solutions targeting antimicrobial resistance. 

The United Kingdom has pioneered an incentive payment model that could be emulated globally. In 2019, the United Kingdom’s Department of Health and Social Care launched an AMR project titled “UK 5-year action plan for antimicrobial resistance 2019-2024” that aims to contain AMR in the UK by 2024. 

The UK is the first country to create a subscription-based payment model for antimicrobial pharmaceutical companies where the government pays a fixed fee upfront to companies developing new antibiotic drugs. Since this model makes profits independent of prescription volume, it could dis-incentivise part of the reasons for antibiotics overuse . 

In 2022, Shiongi, a Japanese discovery-based pharmaceutical company signed an agreement with the National Health Service to begin a “subscription payment model for reimbursement of cefiderocol in England,” and Shionogi commented the company welcomed the “introduction of pull incentives to help bring urgently needed new antibiotics to market.” Although the UK’s initiatives have been attracting international pharmaceutical companies, they recognize that their actions to combat AMR need to be coupled with a global response where countries implement this model or their own variation of incentives into their domestic markets.

In the United States, the Pioneering Antimicrobial Subscriptions To End Upsurging Resistance (PASTEUR) Act introduced in 2023 follows a similar suit where companies would be paid contractually. The PASTEUR Act begins to address the broken marketplace for developing antibiotics and would authorize the Department of Health and Human Services to “enter into subscription contracts for critical-need antimicrobial drugs, providing $6 billion in appropriations for activities under the bill”. 

The PASTEUR Act is being debated, and if passed, it would fund vital antimicrobial stewardship programs as well. The UK serves as a role model for the rest of the world by taking a step in the right direction to solving the interdisciplinary issue of antimicrobial resistance. 

COVID 19’s Impact on Antimicrobial Resistance 

In the CDC’s 2022 Special Report on COVID-19’s impact on antimicrobial resistance, they state that Antimicrobial resistance was the “greatest public health concern prior to the COVID-19 pandemic, and it remains so.” The CDC also released that antimicrobial resistance is a leading cause of death globally. 

COVID-19 taught the world that viruses are a threat to human vitality, and preventative measures were crucial to combat the contagious spread of COVID-19 as it continued to mutate and create new strains. Even countries with strong healthcare infrastructures suffered from the fatal virus. 

The pandemic overshadowed the antimicrobial resistance pandemic. During COVID-19, patients upon admittance to the hospital would be prescribed antibiotics. This was an overuse of antibiotics when patients frequently did not have bacterial infections. This was due to the fact that healthcare professionals did not have any cure for COVID-19 and had to be greatly cautious. Patients that had weakened immune systems from COVID-19 were more susceptible to bacterial infections. In the US, “from March 2020 to October 2020, almost 80% of patients hospitalized with COVID-19 received an antibiotic.” 

COVID-19 should serve as a lesson that the international community must invest in the preparedness to fight the next pandemic. Antimicrobial-resistant will have severe, long-term consequences and it is our “silent” pandemic. The best way to fight this pandemic is to be preventative. This is why funding in antimicrobial resistance research is crucial and should be at the forefront for the scientific community. For example, there is a need for specialized laboratory tests to efficiently identify bacterial infections and new effective stewardship programs for infection prevention measures. 

The COVID-19 pandemic created a race to find curative measures against the virus. The novel vaccine restored the world. However, it is important to note that antibiotics are a “shared resource” drug, one person’s use of antibiotics impacts the efficacy of the drug. This is why global cooperation is so important to combat AMR. The WHO created the Global Antimicrobial Resistance and Use Surveillance System (GLASS) to inform, collect data and connect global actors on solution strategies. This is a representation of global cooperative measures that are needed. 

Vaccine development is at the forefront of antibiotic resistance research fields and serves as a new hope to decrease antibiotic use. Drug-resistant S. pneumoniae is the only bacterial pathogen that has an effective vaccine, pneumococcal conjugate vaccines (PCVs) listed in the CDC’s special report. This vaccine “prevented more than 30,000 cases of invasive pneumococcal disease and 3,000 deaths from 2010 to 2013 alone.” Vaccines such as this help safeguard antibiotics from overuse that creates resistance. 

COVID-19 required an international response, and collective action was taken to combat it. COVID-19 taught the world that we are not immune to viruses or infections. The virus evolved into new strains which required global action to combat its rapid evolution into more contagious strains, such as Omicron.

 The CDC’s 2022 report stated that much of the progress was lost in regard to antimicrobial resistance in the US due to the impacts of COVID-19. They stated that the “pandemic pushed healthcare facilities, health departments, and communities near their breaking points in 2020, making it very hard to maintain the progress in combating antimicrobial resistance.” Now that the COVID-19 pandemic is more controlled, the world must face and focus on the pandemic of antimicrobial resistance here and on the horizon. 

Valeria Gigante, a member of the WHO’s antimicrobial resistance division states that people who die from antibiotic resistance outnumber the deaths from HIV, tuberculosis and malaria combined. There has been great mobilization for all three and similar mobilization occurred during COVID-19. 

It is time to see the same call for action for antibiotic resistance because we live in an age with an upsurge of pandemics and superbugs. 

We are no longer strangers to superbugs; we must reimagine a world where our priority is to combat antibiotic-resistant microbes because if we don’t they will always be evolving one step ahead of us. 

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In order for governments to combat the blood shortage crisis, they are challenged by the voluntary condition of blood donation, due to civilians’ hold on body autonomy. Yet, according to the Lockian social contract, the government has the right to limit personal autonomy for the greater benefit of the public good. 

In terms of our world today, we have all entered different social contracts provided by the legitimate sovereign states we reside in. Everyone has given up some of their personal liberties and agency to the greater benefits of governance. Globally, many countries have common good laws such as driving restrictions, voting laws, property protections, and other laws that help sustain order. During the pandemic, governments limited some of our personal liberties, for example imposing a mask-wearing policy, for the greater good of everyone’s health. 

Blood donations have always been crucial to the healthcare system. It is a necessity to have access to this life-saving resource. During the pandemic in 2022, the American Red Cross declared a national blood shortage. There was a pivotal moment to unite when the government declared the pandemic a state of emergency comparable to the state of war. Healthcare professionals then faced the ethical dilemma of how to best allocate the supply of donated blood. It required physicians to assess which patient receives a life saving blood transfusion. 

A patient describes her trepidation during this crisis, “It’s very scary, especially if you don’t know if the blood is coming…this is something that you need to live”. The United States Red Cross exemplifies the reality of the shortage in this statement, saying they need “approximately 12,500 blood and nearly 3,000 platelet donations every day,” to fulfill the demand. The necessity of blood donation is constant. In the  U.S. someone needs blood or platelets every two seconds and with one donation three lives can be saved. 

As the philosopher Jean-Jacques Rousseau describes, the general will of the people becomes more important than individual interest once we have entered a social contract. In this current state of blood shortage crisis, the general will of the people must be a priority; a governmental system that would call upon civilians to donate blood is an urgent necessity. In the United States, this system does not exist. Consequently, the government’s responsibility is to intervene and aid its population to access the proper healthcare—safe blood donations. 

The United States provides many policies and rules for the greater benefit of its civilians. However, historically when the United States is faced with a healthcare issue that revolves around access and body autonomy then there is divisive sentiment. Nevertheless, when the U.S government imposes new rules, its civilians have the choice to either submit or rise into protest. 

In 2020, many Americans proudly claimed that COVID-19 was a hoax and that they will not be forced by the government to wear a mask. The bumptious “don’t tread on me” slogan reigned again in the United States. This negative sentiment of government interference surrounding personal liberties is the exact opposite of why individuals enter the social contract. According to Locke, individuals have an obligation to obey the governing body created to have their natural rights protected in order to maintain a state of civil society. The social contract theory embodies the consent of the people for the government to protect their basic rights and promote a common good for all. Security and healthcare can be considered urgent priorities for civilian protection and welfare. 

Regardless of the degree of control a government has over its people, the question is asked, why do people rebel when the government imposes rules to protect them? The essence of this answer is people like to believe they still are a sovereign entity, but forget they have given up autonomy in order to enjoy the luxuries of security and order. The population would benefit from the privileges of possessing enough blood. Enough blood would give every patient in need of a transfusion an opportunity to survive, from cancer patients, to kidney disease patients, sickle cell anemia patients, and emergency department patients with severe trauma injuries. 

In a time of high stress and need, why can’t citizens be called upon to serve their country? To serve their community that has entered the same social contract as themselves?

In these situations, can a government impose a blood donation draft, where citizens are motivated to sign up for the commitment to saving lives? To call upon citizens to save lives through blood donation just as they can be called upon for war? 

This paternalistic control for the general will of society tests the social contract theory. This might be an idealistic desire but getting to a point where the government has the right to tell you to donate your blood to your neighbor, is not without the scope of realism. Donating blood could be a compulsory task for every human being that met the safety requirements needed to donate blood, through compelling and cogent policies. 

The United State government ensures its military strength, security, and size, by allocating an immense amount of money to the military budget and encouraging men to join their ranks. The United States Selective Service System requires men to sign up for the selective service within 30 days of their 18th birthday in an event where a draft is needed. Although it is not compulsory, the USA Selective Service governmental website states that “A man who fails to register with the Selective Service may be ineligible for opportunities that may be important to his future. He must register to be eligible for state-based student financial aid in many states, most federal employment, some state employment…” and the list continues. Failure to register also has consequences; it is considered a “felony punishable by a fine of up to $250,000 and/or five years imprisonment”. In the United States, 40 states require Selective Service registration in order to receive a driver’s license and in eight states, men are not allowed to enroll in state universities without registering for Selective Service. The government does not force men to enlist into the Selective Service, but they are compelled by the benefits and avoidance of unfavorable outcomes. 

The unfavorable selective service policies ensure men sign up, therefore the government can provide security in a situation of war. Security is a governmental public good. 

The Selective Service’s effective and persuasive policies can be emulated to encourage blood donation. 

Blood shortage is a state of emergency like war, so the government should use its paternalistic jurisdiction to encourage civilian blood donations. Fundamentally, the government can combat the national blood shortage with a blood donation selective service draft. 

Most of the European Nation’s healthcare is free, where governments embody a greater social contract that controls the healthcare system benefiting the public good. In Europe, there are only four countries — Germany, Austria, Hungary, and the Czech Republic — that have private and public sector collection centers to combat the blood and plasma shortage. In these countries, plasma donors receive a “flat-fee” compensation. There have been new discussions regarding the efficacy of compensating volunteers that donate their blood or plasma. European policymakers are wrangling with ethical monetary compensation laws to fulfill the plasma-derived medicinal products demand for 300,000 people. These important debates highlight the government’s paternalistic jurisdiction that can be compared to imposing a blood donation draft system. The four countries that compensate volunteers were able to acquire, “58% of the plasma drawn in the EU needed to make medicines.”  However, compensating volunteers is not necessarily the simple fix to the shortage of donations. 

There are unintended consequences that can occur as a result of paying plasma donors. Regular blood donors who come on their own will end up donating plasma instead of blood causing another issue and shortage. Bernardo Rodrigues, an advocacy officer at the European Blood Alliance, believes, “You should not have a financial incentive to go out and donate.” He represents establishments in Europe that are not-for-profit blood donations and these institutions bolster plasma and blood collection through more holistic means such as opening new centers and educating the public about donation. 

One vital component of programs like these is calling upon existing donors to ask for their donations. Many citizens also commit themselves to an on-call list, if their blood is desperately needed. This is like a donation draft as they call up citizens who have registered to be a donor. Yes, they do have the agency to refuse or donate, however, the premise of a draft is established as a governmental system. 

New governmental policies that encourage blood donation, such as a blood donation selective service, is a necessary limitation of personal liberties to benefit the greater public good of healthcare. Human beings have entered social contracts to have their well-being protected, and governments are failing if they can not fulfill their responsibility to the people.

Theoretically, mankind could progress in medical advances if society could restrain the constant need for autonomy and submit to the hierarchical domestic order. At the end of the day, we do not have full body autonomy. The government limits our ability to put illicit drugs in our system by criminalizing substances: the government tells women whether they can terminate their child or not and the Selective Service sacrifices a man’s body in the case of war. 

Nevertheless, the social contract is supposed to limit our personal liberties for the amelioration of the human condition. Can this materialize for the benefit of increased blood supply? This dichotomy between the limitations of personal liberties and self-determination is a parallel between the general good and libertarianism. What balance can exist between these juxtapositions, the double-edged sword of a social contract? 

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When former U.S. President Ronald Reagan left office in 1989, his farewell address was proud and triumphant. His view of the United States was that of a ‘city on a hill,’ a metaphor coined by the famous colonial Puritan Governor John Winthrop. In his address, Reagan echoed Winthrop and called the United States a “tall proud city built on rocks stronger than oceans, windswept, God blessed, and teeming with people of all kinds living in harmony and peace.”

American leaders have emphasized their nation’s exceptionalism throughout the years, and it has become a central part of the American identity. For decades, the United States has felt the obligation to lead the world to progress and freedom. American foreign policy has historically reflected this concept of exceptionalism, resulting in mixed international reactions. In the 1958 novel The Ugly American, authors William Lederer and Eugene Burdick write about the brash and disrespectful behavior of culturally ignorant diplomats in East Asia who exacerbated geopolitical tensions during the tense Cold War era. The term has come to represent the idea that Amereicans are rude and entitled when engaging with or visiting foreign countries. This begs the question: in 2020, how “ugly” is the United States to the rest of the world?

The failure of American leadership amid the COVID-19 pandemic has exacerbated concerns over the United States’ position on the global stage. The world’s perceptions of the United States and its leadership have plummeted to points as low as, or lower than, they were during the controversial Iraq War. This year, in the face of the ongoing coronavirus global public health challenge, U.S. leadership has fallen short. Similar to its approach to the Iraq war, the United States continues to lie to the world and play by its own rules in an delusional attempt to exist above global standards. 

This delusion has risen to absurd levels. Despite President Donald Trump’s own government telling him that the virus was deadly, he told the public that “one day — it’s like a miracle — it will disappear.” This statement was made in February, and even then it was clear that his assessment was wildly incorrect. However the damage in early 2020 was nowhere near current levels. According to data published by The New York Times, the United States reported three new deaths on March 1. By the end of April, days reporting over 2,000 deaths were not uncommon, and as of October 11, the daily toll consistently hovers around 500. 

As of publication, more than 214,000 people have died in the United States.

Despite these staggering numbers, Trump gave a speech to several thousand unmasked fans at a rally in Swanton, Ohio in September and maintained that “It affects virtually nobody.” This was just a day before the United States surpassed the grim milestone of 200,000 deaths. Repeatedly ignoring mask protocols both personally and publicly at massive rallies since the beginning of the pandemic, and ignoring successful models of mitigation in order to stubbornly deny science, has not proven to be an effective way to tackle the problem. And on October 1, the President and First Lady were both diagnosed with COVID-19 shortly after Hope Hicks, one of the President’s closest aides, was confirmed positive. Now, there are as many as 34 cases amongst White House aides, including Press Secretary Kayleigh McEnany and former New Jersey governor Chris Christie. 

Trump still has not recommended that the general public wear a mask, and instead, casts doubt and claims that masks could possibly harm one’s health. A president who actively lies to his own country, puts thousands of lives in danger by spreading misinformation, and in turn, refuses to adequately supply citizens with resources to fight the virus is failing his duty. This lack of leadership and the proliferation of faulty policy is what makes the United States so “ugly” right now. During a pandemic, there should be a global responsibility to keep others safe. Just one person can start a new wave of the virus and the cracks in the American political system are quickly turning into virus-ridden chasms. 

The world has taken notice. In a September Pew Research poll of 13 nations across continents, nearly 15% of respondents thought positively of the United States’ coronavirus response, 16% were confident in Trump, and 34% viewed the United States positively overall. These numbers are overwhelmingly low. Overall, Trump is less trusted than the leaders of Germany, France and the United Kingdom. Unbelievably, that same poll of shows he is even trusted slightly less than Vladimir Putin, corrupt authoritarian extraordinaire, and Xi Jinping, who faces global scrutiny as he commits genocide against China’s Muslim minorities.

And now, Trump is dealing with the coronavirus’ impact on his health, with the well being of  White House officials in jeopardy. After being released from the hospital, the President took to Twitter, tweeting: “Don’t be afraid of Covid.” Just days after being diagnosed, he made his way back to the White House, signed autographs for fans, climbed up the stairs, took his mask off, and stepped inside — all despite not being declared non-contagious until October 10. Then, only 11 days after his diagnosis, a maskless President Trump held a rally of thousands in Florida, where he expressed his desire to kiss everyone in attendance.

The country with the highest number of COVID cases and COVID-related deaths, with the world cringing at its callousness, now has its president telling citizens not to worry. This is all while President Trump claims experimental drug cocktails that the average citizen has no access to have cured him. 

The world is laughing. 

While plenty of countries took the diplomatic route with routine well-wishes for Trump after revealing his COVID-19 diagnosis, others were smug in their response. Polish Foreign Minister Radosław Sikorski warned Trump not to ingest bleach in light of the President’s earlier, allegedly sarcastic, recommendation that bleach could help treat coronavirus. Germany, which has some of the lowest approval ratings in Europe for Trump and the United States, had the term schadenfreude — used to describe the feeling of joy that comes with another’s suffering — trending on Twitter. 

Washington D.C., once a ‘City on a Hill,’ is becoming sick and weak. The United States is no longer exceptional. One of the most important countries in the world has 75% of new COVID-19 cases and 69% of all related deaths since July 1 among 83 countries categorized as “high-income” by the World Bank. Americans only make up 27% of the “high-income” countries’ population. 

The world has also just watched an embarrassing lack of decorum in the first 2020 U.S. Presidential debate, with some snarky commentary from international media and governments. The Russian state news channel opined that “the candidates behaved like their voters — brawls on the streets of American cities have not let down for several months. America is divided and inflamed.” While Russian state television may have its biases on U.S. politics, their scathing assessment is echoed by many.

The world’s mightiest modern empire has become a source of global schadenfreude,  culminating in an “ugly” lack of responsibility and accountability for the spread of COVID-19.

But the damage is not irreversible. In 2008, former U.S. President, then-Illinois Senator, Barack Obama and his campaign of “hope” for the American people seemed to inspire hope globally, with confidence levels in U.S. leadership and politics taking a drastic turn from the previous Bush administration. However, the humiliating 2020 presidential debate and current anxiety around global health progress moving in the opposite direction does not exactly project ‘hope’ to the world. 

It may be time for the world to learn its lesson. Perhaps countries should look elsewhere for leadership. Perhaps the global community has no need for a hegemon in a globalized and interconnected world. Either way, the United States has lost its respect. Will it be able to gain it back this time, or will things get “uglier?”

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