Phages for Global Health

A 2014 report predicted that by 2050 approximately 10 million people will die each year from antibiotic-resistant infections -- equivalent to >10 times the annualized death rate for coronavirus. Inappropriate use of antibiotics in COVID-19 patients is expected to accelerate antibiotic resistance rates further. Thus, we urgently need antibiotic alternatives, particularly in Africa and Asia, where 90% of the antibiotic-resistant deaths will occur.

Before antibiotics were discovered, bacteriophages (AKA phages) were utilized as antibacterial agents. Phages are viruses that exist in the environment and our bodies, and they can kill antibiotic-resistant bacteria. Phage-based drugs are now regaining popularity in the US and Europe, but few researchers in developing countries know anything about them. We are filling that gap by teaching developing world scientists how to isolate phages, then partnering with them to develop phage products locally. By empowering these scientists, our work could save thousands of lives, if not millions.

We are addressing the antibiotic resistance problem, which has been likened to climate change in terms of the potential global impacts. Misuse of antibiotics in livestock, food crops and people has accelerated development of resistance worldwide. To compound the problem, no new antibiotics have been introduced in over 30 years; all recent antibiotics are simply variations in existing drug classes. In addition, the vast scale of the growing crisis -- at least 10 million deaths expected each year from antibiotic-resistant infections -- is predicted to increase due to the coronavirus pandemic. Reports indicate that up to 50% of patients who have died from COVID-19 had secondary bacterial infections, significantly increasing the use of antibiotics globally. 

Almost 90% of the deaths from antibiotic resistance will occur in developing countries in Africa and Asia and, regrettably, drug companies consider antibiotics too costly to develop for developing world populations. Without new types of drugs to combat infections, the World Health Organization warned in 2014 that a post-antibiotic era -- in which routine infections can once again become life threatening -- is “far from being an apocalyptic fantasy, [but] is instead a very real possibility for the 21st century”.

We work in developing countries to facilitate the application of phages as inexpensive, naturally-occurring antimicrobial agents that can kill antibiotic-resistant bacteria. Phages can be selected to target only specific bacteria while leaving other helpful bacteria and human cells unharmed. Also, phages are well-suited for use in the developing world, since they can be easily isolated from contaminated environments, are inherently quick and inexpensive to manufacture and are safe, having been utilized for the past century in the former Soviet Union. The FDA and USDA have approved a number of phage products in the US, but no phage products are yet available in developing countries, and few scientists there have any knowledge about the potential benefits of phages.

We are bridging this gap through two broad approaches: 

1. Teaching scientists how to develop phage products (through a series of hands-on laboratory workshops in Africa and Asia)

2. Creating international teams of global phage experts and developing world scientists to co-develop phage products (e.g., for poultry meat decontamination, cholera prevention, tuberculosis treatment, etc)

Locally developed phages could be used to manage problem bacteria in agriculture, food and water, and for direct treatment of people, significantly impacting health and economic development in Africa and Asia.

We are reaching two different levels of target populations: first, public health scientists in developing countries and, second, the communities they serve. Our primary goal is to provide scientists with expertise in phage technology to help combat the antibiotic resistance crises in their countries. By partnering with them through trainings and collaborations, we aim to empower these regional experts to develop products that are not only technically effective, but also socially accepted within their local cultural contexts. 

While traditional drug development is a long-term process -- a conventional drug typically costs $1 billion and takes 10 years to develop -- phage product development could potentially happen faster and cost less. For example, we delivered our first two laboratory training workshops in 2017 and 2018 in Uganda and Kenya, respectively, and the 50 scientists who participated in those workshops have already:

- Taught phage biology to more than 700 others through their home institutions

- Initiated 34 phage product development projects

- Won 6 grants totaling to over $818,000

These early impact data indicate that practical aspects of phage biology can be quickly learned, applied, and shared with other scientists, even in resource-limited countries.

For decades in the Soviet Union, governmental institutions stored large collections of phages that could be used to kill many different types of bacteria. When a new bacteria emerged, the phage collection was rapidly screened and effective phages were quickly deployed (often for infected military personnel fighting in new territories). The US-based company Adaptive Phage Therapeutics has recently received FDA approval to test a similar approach, utilizing a pre-characterized phage collection for rapid treatment of antibiotic-resistant infections. Since phages can be isolated using basic laboratory equipment, developing countries could employ phage collections to target new bacterial strains that emerge locally.

Most efforts to address antibiotic resistance focus on prolonging the effectiveness of existing antibiotics or financially motivating new drug innovation through the traditional drug development process. The former approach -- ensuring that antibiotics are only used when medically appropriate -- will just delay the inevitable: all current antibiotics will eventually become ineffective. And the second approach -- incentivizing pharmaceutical companies to make drugs for “third world” diseases -- is considered futile by many global health leaders because of the expense. We believe that phage-based drugs can provide a solution since they could be (1) developed cheaper and faster than conventional drugs, (2) designed to minimize future resistance, and (3) produced with relatively simple equipment that is readily available to developing world scientists. To our knowledge no other organization is specifically working to bring phage technology to developing countries.

We deliver 2-week, hands-on laboratory training workshops through which we teach scientists how to isolate and begin to develop phages as antibacterial products. For each workshop, scientists from a specific region (East Africa, West Africa or Southeast Asia) are selected through a competitive application process, with partner institutions from surrounding countries helping with publicity and selecting appropriate participants. Instructors come from leading institutions in the US and Europe.

HOST INSTITUTIONS FOR LABORATORY TRAINING WORKSHOPS:

Makerere University (Uganda) - 2017

Pwani University (Kenya) - 2018

Kwame Nkrumah University of science and technology (Ghana) - 2019

Muhimbili University of Health and Allied Sciences (Tanzania) - 2020

Asian Institute of Medicine, Science and Technology (Malaysia) - postponed from November 2020 until 2021 due to coronavirus

PARTNER INSTITUTIONS FOR LABORATORY TRAINING WORKSHOPS:

Kampala International University (Uganda)

University of Nairobi (Kenya)

Institute of Primate Research (Kenya)

Technical University of Kenya

Sokoine University of Agriculture (Tanzania)

National Health Laboratory (Tanzania)

University of Rwanda

National Veterinary Research Institute (Nigeria)

University of Lagos (Nigeria)

University of The Gambia

Primate Research Center at Bogor Agricultural University (Indonesia)

Yale University (USA)

University of Leicester (UK)

University of Warwick (UK)

Hopitaux Universitaires de Geneve (Switzerland)

We have also brought together international teams to develop phages for poultry meat contamination, cholera outbreaks, and tuberculosis treatment.

COLLABORATING INSTITUTIONS FOR PHAGE PRODUCT DEVELOPMENT:

Kenya Medical Research Institute

Ministry of Health (Democratic Republic of Congo)

Yale University (USA)

University of Nottingham (UK)

University of Leicester (UK)

University of Alberta (Canada)

Queen Astrid Military Hospital (Belgium)

Our mission is to combat the global antibiotic resistance crisis, which is expected to kill 10 million people each year by 2050 -- roughly 10 times the annualized death rate from coronavirus. Unfortunately, 90% of the deaths from antibiotic-resistant infections will occur in Africa and Asia, so all our work is focused there. We utilize bacteriophages (also known as phages), which are inexpensive, naturally-occurring viruses that can kill antibiotic-resistant bacteria. Phages have been safely used as antibacterial drugs for >100 years -- even before chemical antibiotics were discovered -- and they can be isolated from the environment, food and our bodies using relatively basic equipment, such as that available in developing countries. Given the immensity of the antibiotic resistance crisis, phage technology is regaining popularity in industrialized countries, but few scientists in developing countries know anything about them. Thus, we are teaching developing world scientists how to isolate phages, then partnering with them to develop phage products locally for treatment and prevention applications in people, animals and food. We would use The People's Prize money to further empower those scientists, thereby potentially saving thousands of lives, if not millions, and directly addressing UN SDG 3: good health and well-being.