The World Health Organization (WHO) recently warned that fungal infections are an increasing global threat. Their inaugural report, released earlier this month, lays bare the shocking deficit of tests and treatments for these rare diseases. The WHO’s findings indicate a troubling rise in invasive fungal diseases, particularly among patients undergoing treatments for conditions such as cancer. Since 2019, the group has uncovered 46 cases of invasive fungal diseases. This worrying trend underscores a perilous public health crisis.
The report emphasizes that the rise of invasive fungal diseases is closely linked to improved treatments for other medical conditions. Scientific breakthroughs are allowing the most vulnerable populations, such as cancer patients and organ transplant recipients, to live longer. This greater survival is paired with an increased risk of severe and disabling fungal infections. In fact, the WHO has designated Candida auris as a critical priority pathogen. Moreover, Aspergillus fumigatus poses major public health concerns, causing diseases ranging from allergies to invasive aspergillosis. Alarmingly, the mortality rates for the fungi that the WHO has deemed “critical priority” can go as high as 88 percent.
The Challenge of Resistance
The first focus of the report, and perhaps its biggest worry, is the growing antifungal resistance of fungi to current treatments. As the WHO recently noted, we have very few options, only three primary classes of mold- and yeast-fighting antifungals. In comparison, there are close to a dozen classes of antibiotics to treat bacterial infections. This woeful arsenal doesn’t come close to matching the increasing wave of resistance. The rampant use of antifungals in clinical settings and agriculture only serves to aggravate this increase.
Gerry Wright, a biochemistry professor and Canadian Institute for Advanced Research Fellow, explained what climate change means for fungal pathogens. He told me that this is one of the first times that climate change has impacted a pathogenic organism in this way. Now, it can grow at human body temperature, 37 degrees Celsius, which poses very serious implications.
Resistance is increasing, creating difficult choices for healthcare providers in finding efficacious treatment options. Adding to this burden is the urgent demand on public health infrastructure to find answers that work. Dr. Shapiro was on board with these concerns. He added, “We need to be responsible in how we approach antifungals, in the clinic and on farms.”
Limited Development of New Treatments
In fact, the need for new antifungal treatments has never been greater. The WHO just announced that few if any approvals will be seen over the next ten years. Of the nine antifungal treatments now in clinical development, only three are in Phase 3. This standstill in drug development creates a worrisome prospect for the future treatment of fungal infections.
Wright is optimistic that awareness of this issue is gaining traction among experts, real-world solutions aren’t coming quickly enough. He explained that a small army of passionate people understands this massive challenge. While the latter is a disappointing development, we’ve heard from board members that they are genuinely serious about finding a better solution. You know, we don’t have solutions overnight.” A hopeful future
The consequences of failing to solve this crisis may be catastrophic. In addition, Wright emphasized the danger these fungi are to human health. He explained that they have the potential to cause significant lung infections, such as fungal pneumonia, and cautioned that certain fungi attack the neurological system and can produce life threatening conditions in the spinal cord and brain.
Rising Public Health Concerns
The WHO’s report is a major wake up call on this urgent public health crisis that should not be missed. Fungal diseases such as Candida are increasing, resulting in more severe manifestations of these common infections such as oral and vaginal thrush. These infections are rapidly becoming resistant to treatment. This troubling trend has dangerous implications for marginalized communities. People with potentially immunocompromising conditions, such as cancer or organ transplants, are already more vulnerable.
Wright stressed the individual effect of this problem. He continued, “Each of us have a vulnerable person in our lives that has been touched by cancer. Some of us know people who have had kidney transplants, heart transplants, or those who live with lupus.” Increasing fungal infections are exacting a toll on our society that goes beyond the individual. These life-altering or life-ending infections can strike people from all walks of life.
As understanding of this key connective tissue grows, experts are calling for improved communication. To minimize resistance, they call for collaboration and coordination of antifungal drug use within human health providers and agriculture. Dr. Shapiro pointed out an important caveat. He stressed the need to have some line of communication and accountability on how substances are being utilized on both sides.
