The role of vaccination in combating antimicrobial resistance: prospects and forecasts for the future
Antimicrobial resistance (AMR) constitutes one of the most significant and urgent threats to Public Health globally, causing over 5 million deaths each year and increasingly undermining the effectiveness of available treatments. Against this backdrop, vaccination stands as a fundamental and strategic preventive tool, averting approximately 515,000 deaths annually and directly reducing the incidence of infections. Through the primary prevention of infectious diseases, vaccination makes a decisive contribution to limiting the spread of resistant microorganisms, reducing the development and propagation of resistance genes, the transmission of pathogens and the consequent recourse to antimicrobials, which are often used inappropriately. For these reasons, vaccination is internationally recognised as one of the ten most effective measures for combating antimicrobial resistance, not only in terms of reducing antibiotic consumption. In this context, the Vaccines Working Group of the Italian Society of Hygiene (S.It.I.), in its paper “Vaccinations Included in the National Immunisation Calendar as a Tool to Tackle Antimicrobial Resistance: Current Evidence for Selected Pathogens in Italy’, summarises the national evidence on the role of vaccination in preventing infections and reducing multidrug resistance, confirming its strategic importance in the fight against AMR.
Antimicrobial resistance is now one of the major emergencies facing Public Health worldwide. The steady increase in infections caused by microorganisms resistant to multiple classes of antimicrobials (Multi-Drug Resistant Organisms, MDROs) has, over time, led to a progressive reduction in available treatment options, resulting in increased complexity of care, morbidity, mortality and associated healthcare costs (World Health Organization. Antimicrobial resistance: global report on surveillance. Geneva: WHO, 2014). Despite this spread of AMR, there has been no parallel development of new antimicrobial molecules, making the phenomenon particularly critical for clinical practice and the sustainability of healthcare systems. In the European Union, it is estimated that the use of second- and third-line antibiotics and prolonged hospital stays result in additional costs exceeding 1.5 billion euros per year.
The impact of AMR is not limited to humans, but also significantly affects the veterinary and agricultural sectors. In fact, over 50 per cent of the antibiotics used globally are intended for veterinary use, thereby promoting the selection and spread of resistant bacteria, both commensal and zoonotic. The transfer of multi-resistant microorganisms to humans can occur through the consumption of food of animal origin, direct contact with animals or via cycles of environmental contamination. With this in mind, the link between human, animal and environmental health is the subject of joint analysis by the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC). Precisely to raise awareness of the prudent use of antibiotics, the ECDC has been promoting the European Antibiotic Awareness Day (EAAD) every 18 November since 2008. In Italy, the recognition of AMR as a public health emergency has led to the adoption of the National Plan to Combat Antimicrobial Resistance (PNCAR) 2022–2025.
In response to this situation, numerous international agencies and organisations have developed structured strategies to combat AMR, identifying as priority actions the adoption of cost-effective technologies, the strengthening of infection prevention and control measures, the ongoing training of healthcare professionals, timely and appropriate diagnosis, and the responsible use of antimicrobials (Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. 2014). In this context, the prevention of infections is a key element, and vaccination is fully recognised as one of the most effective strategies. Indeed, being able to prevent numerous infectious diseases, both directly and indirectly (via herd immunity) vaccines contribute significantly to reducing infections caused by multi-resistant microorganisms. They reduce the overall number of infections, limit the circulation of bacterial strains (including resistant ones) and diminish the need for antibiotic treatment.
In this regard, the impact of vaccination against pneumococcus, meningococcus and Haemophilus influenzae is emblematic: the drastic reduction in cases of meningitis and invasive sepsis has led to a significant decrease in the use of antibiotics, particularly in children, a group in which many febrile infections are of viral origin. According to the World Health Organisation’s report 'Estimating the impact of vaccines in reducing antimicrobial resistance and antibiotic use', widespread use of currently available vaccines could reduce global antibiotic use by approximately 142 million DDDs (Defined Daily Doses) per year, prevent over 100,000 deaths and generate significant savings in terms of hospital costs and productivity losses (World Health Organisation, 2024). Furthermore, a further increase in pneumococcal vaccination coverage could prevent tens of thousands of deaths and millions of DALYs each year. At the same time, the development of new vaccines against highly resistant pathogens, such as Klebsiella pneumoniae, Group A Streptococcus and Mycobacterium tuberculosis, represents a crucial prospect for the future, with the potential to prevent hundreds of thousands of deaths and substantially reduce global antibiotic consumption.
The role of vaccination in the fight against AMR is fully in line with the integrated One Health approach, which recognises the interconnection between human, animal and environmental health. The use of vaccines in veterinary and livestock farming helps to reduce the need for antibiotics on farms, thereby limiting the selection and spread of resistant bacteria and environmental contamination.
In light of the available evidence, the structural integration of vaccine-based prevention into national and international strategies to combat antimicrobial resistance – as also provided for in the National Plan to Combat AMR (PNCAR) – is an essential step. It is within this framework that the paper ‘Vaccinations Included in the National Immunisation Calendar as a Tool to Tackle Antimicrobial Resistance: Current Evidence for Selected Pathogens in Italy’ (Annex 1), prepared by the Vaccines Working Group of the Italian Society of Hygiene (SItI) and published in the journal *Vaccines* (MDPI), which analyses and describes the current and prospective role of vaccination in preventing infections and reducing the use and impact of antimicrobials. The document aims to provide an up-to-date scientific overview of the best available evidence, emphasising the value of prophylactic vaccination as a key intervention in combating AMR and as a structural element of Public Health policies, within a framework of multidisciplinary and integrated prevention.
In light of the above, vaccination is once again proven to be not only a means of individual prevention, but also a strategic tool for Public Health, capable of protecting individuals, reducing the spread of resistant pathogens and ensuring the sustainability of healthcare systems. Integrating vaccination into national and international strategies to combat AMR therefore means translating scientific evidence into concrete policies, thereby strengthening a multidisciplinary approach that recognises the link between human, animal and environmental health, and placing prevention at the heart of any effective action against antimicrobial resistance.
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