WHO’s new bacterial priority pathogen list emphasises on public health needs, infection burden of developing countries

The World Health Organization (WHO) on May 17, 2024 released the new Bacterial Priority Pathogen List (BPPL) for 2024. This is the second report on priority pathogens, with the first being published in 2017. 

The WHO BPPL 2024 focuses on the antibiotic-resistant bacteria that present the greatest unmet needs and pose the most significant public health burdens. This list identifies priority pathogens of public health importance to guide research, development, international coordination and strategies to combat antimicrobial resistance (AMR). 

AMR occurs when bacteria, viruses, fungi and parasites evolve to resist the effects of antibiotics, making these drugs ineffective. This has become a major global public health challenge, contributing to an estimated 4.95 million deaths in 2019, with projections to rise in the coming years. The situation has raised the need to regulate the proper use of antibiotics and develop strategies to combat AMR. 

BPPL 2024 is created by using a multi-criteria decision analysis protocol, with advancements in protocol used for BPPL 2017. BPPL 2024 incorporated the data from improved surveillance systems, Rifampicin-resistant tuberculosis (RR-TB) and peer-reviewed estimates of the global burden of infections caused by antibiotics-resistant bacteria 2019. 

“By mapping the global burden of drug-resistant bacteria and assessing their impact on public health, this list is key to guiding investment and grappling with the antibiotics pipeline and access crisis,” said Yukiko Nakatani, WHO Assistant Director-General for Antimicrobial Resistance ad interim in a press release issued by the United Nations health agency. “The threat of antimicrobial resistance has intensified since the first Bacterial Priority Pathogens List was released in 2017, eroding the efficacy of numerous antibiotics and putting many of the gains of modern medicine at risk,” added Nakatani. 

Source: WHO bacterial priority pathogens list, 2024

BPPL 2024 includes 15 families of antibiotic-resistant pathogens and 24 bacterial pathogen-drug combinations, categorised into critical, high and medium priority for R&D and public health measures. 

The earlier list of 2017 had 12 families of bacteria in these three categories. In the updated list, four new bacterial pathogen-drug combinations have been added: Macrolide-resistant Group A Streptococci, penicillin-resistant Group B Streptococci, macrolide-resistant Streptococcus pneumoniae and rifampicin-resistant Mycobacterium tuberculosis. Additionally, five pathogen-antibiotic combinations have been removed.

With increased infection and global burden particularly in low- and middle-income countries (LMIC), the gram-negative bacteria that are resistant to last-resort antibiotics are kept in critical priority pathogens along with rifampicin-resistant Mycobacterium tuberculosis. Pathogens of high priority, such as Salmonella and Shigella, also reported to impose a substantial burden in LMICs. 

Moreover, the list also reflects the inclusion of community pathogens in LMICs and global concern of Pseudomonas aeruginosa and Staphylococcus aureus. Group A and B Streptococci considered in medium-priority pathogens are responsible for a high disease burden, particularly in paediatric and elderly populations.

BPPL 2024 addresses AMR research and development priorities, investment needs and public health actions. It emphasises the need for a comprehensive approach to overcoming both supply and demand side barriers to access.