With fungal diseases an increasing public health concern and with common infections growing increasingly resistant to treatment, the World Health Organisation (WHO) has released its first analysis of anti-fungal agents in preclinical and clinical development, warning of a “critical lack of medicines and diagnostic tools" for invasive fungal diseases.
The organisation said there is an ‘urgent need for innovative research and development to tackle the challenge,’ and said that fungal infections disproportionately impact severely ill patients and those with weakened immune systems, including those undergoing chemotherapy, living with HIV, or who have had organ transplants.
The report: Antifungal agents in clinical and preclinical development: Overview and analysis indicates that while commercially available tests exist for fungal priority pathogens, these tests rely on well-equipped laboratories and trained staff, meaning that most people in low-and middle-income countries cannot benefit from them.
“Invasive fungal infections threaten the lives of the most vulnerable, but countries lack the treatments needed to save lives,” said Dr Yukkio Nakatani, WHO Assistant Director-General for Antimicrobial Resistance ad interim. “Not only is the pipeline of new anti-fungal drugs and diagnostics insufficient, there is a void in fungal testing in low-and middle-income countries. This diagnostic gap means that the cause of people’s suffering remains unknown, making it difficult to get them the right treatments.”
The report highlights that in the last 10 years, the US Food and Drug Administration, the European Medicines Agency, and the Chinese National Medical Production Administration have approved four new anti-fungal drugs.
The report also notes that most approved anti-fungal drugs commercially available pose challenges including frequent adverse events, significant drug-drug interaction, limited dosage forms and the need for prolonged treatment courses. There is also a lack of anti-fungals for paediatric use.
The WHO recommends expanding financial incentives for drug discovery and development, funding basic research to help identify new and unexploited targets on fungi for medicines, and investigating treatments that work by enhancing patients’ immune response. “The pre-clinical pipeline remains extremely sparse and insufficient to address the global need to prevent and treat drug resistant fungal infections,” the WHO said.
Fungal pathogens have been of concern for some time, leading the WHO, during 2022 to release its first list of 19 fungal ‘priority pathogens’ representing the greatest threat to public health.
The WHO’s latest report follows a recent study released by the European Environmental Bureau (EEB) which warns that climate change is altering fungal behaviour and distribution, potentially increasing the risk of exposure to mycotoxins, a naturally occurring compound produced by fungi, present in certain foods, feeds and crops, which can be harmful to health.
Along with the direct impact of mycotoxins on human health, the EEA briefing: Mycotoxin Exposure in a Changing European Climate warns that the increased prevalence of fungal infections on plants, due to climate change, could trigger increased use of fungicide.
The UK Health Security Agency has also recently published a list of the pathogen families that could pose the greatest risk to public health, in an effort to focus preparedness and R&D efforts. The list of 24 pathogen families is included in a reference tool to help guide R&D investments and looks at global public health threats as well as those most relevant to the UK.
Further reading
• Vaccines urgently needed for these 17 pathogens, says the World Health Organization
• New testing technology aims to identify plant pathogens faster
• New research finds harmful fungi fusarium mycotoxins present in European wheat
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