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The view from ESCMID Global 2024: AI, climate change and AMR

9th May 2024

The European Congress of Clinical Microbiology and Infectious Diseases is one of the largest annual global gatherings of experts focused on a single topic. This year it has rebranded, emerging as the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Global congress. Here, Gerry Hughes reports on the key themes and highlights from the congress such as AI, climate change and AMR.

With hundreds of invited speakers, the ESCMID Global 2024 gathering in Barcelona, Spain (27-30 April), welcomed approximately 16,000 delegates for five days of knowledge exchange, collaboration and innovation.

As in previous years, antimicrobial resistance (AMR) was a topic of concern among speakers and delegates alike, with issues such as artificial intelligence (AI) and climate change also high on the congress agenda.

Navigating artificial intelligence: opportunities and pitfalls

  • Deploying AI in infection management

During ESCMID Global, an entire study day was dedicated to exploring the intersection of data science, machine learning and infection management. While AI is not a new concept, several presentations explored the use of large language models (LLMs) in clinical practice, which is showing increasing promise.

Dr Raksha K. Bhat, head of department – central laboratory and consultant microbiologist and infection control officer at St Martha’s Hospital, Bengaluru, India, showcased her work with ChatGPT in the clinical microbiology laboratory.

By evaluating Gram stain reports from over 7,200 retrospective sputum samples, ChatGPT was tasked with providing clinical management recommendations. Measuring five qualitative aspects – including accuracy and clinical relevance – of ChatGPT’s performance against human evaluation of these samples, it achieved an overall assessment score of 3.5 out of 5.

Although promising, there are challenges—such as the need for specific prompts during the training of the model and the absence of guidelines for integrating emerging AI technologies into clinical practice.

Dr Bhat posed a question at the beginning of her ESCMID talk: ‘Should clinical microbiologists pack their bags?’ The results of this study suggest not yet, and that AI is currently best placed to complement, rather than replace, clinical expertise.

  • Bridging evidence and clinical algorithms

The 2024 ESCMID Lifetime Achievement Award winner, Professor Evelina Tacconelli, director of the Infectious Diseases Section at Verona University Hospital, Italy, introduced a brand new innovation in the Value-Dx Clinical Algorithm.

This collaborative effort between clinical, academic and industry stakeholders aims to curb inappropriate antibiotic use for community-acquired lower respiratory tract infections.

Leveraging machine learning and a meta-analysis of point-of-care tests, the algorithm assists clinicians in managing common respiratory infections. Professor Tacconelli envisions a future where this process is automated, seamlessly integrating evidence collation and infection surveillance data.

Her vision aligns with ESCMIDs aspiration for high-quality studies to inform clinical practice, and she anticipates AI reducing the time between study publication and guideline integration in the future.

  • The darker side: AI and misinformation

A presentation from Professor Ilan Schwartz, associate professor of medicine in the department of medicine at Duke University School of Medicine, US, took a sobering turn, highlighting AI’s potential for harm.

Opening his talk on LLMs, he noted that according to the World Economic Forum, misinformation and disinformation are currently the top short-term global risks, ahead of extreme weather events.

In a recent publication on this topic, Jin and others argue that more engagement is required between the medical, scientific and local communities, addressing issues such as trust, stigma and scientific literacy to tackle misinformation and disinformation.

Professor Schwartz highlighted the destructive capabilities of AI as reported recently in the BMJ. In that study, LLMs were successfully prompted to generate health disinformation on two topics: sunscreen as a cause of skin cancer and the alkaline diet as a cancer cure.

He also demonstrated the ease with which he could generate a ‘deep-fake’ video for free and with no training on how to use the software.

ESCMID highlights the climate change-infectious disease interface

  • Ancient pathogens and the thawing permafrost

One perhaps unexpected aspect of climate change is the increasing release of ancient pathogens to the environment. Professor Jean-Michel Claverie, emeritus professor at the School of Medicine of Aix-Marseille University, France, described his research in isolating ancient viruses from Siberian and Russian permafrost.

This frozen soil acts as an ideal preservation medium for infectious pathogens because it lacks light and oxygen. However, as the planet warms, the permafrost thaws, releasing these ancient viruses into the atmosphere.

In 2014 and 2015 Professor Claverie’s team revived a 30,000-year-old virus, leading to media attention about so-called ‘zombie viruses’. A recent publication by this team describes isolation and characterisation of 13 new viruses isolated from seven different ancient Siberian permafrost samples.

Professor Claverie advised that large-scale industrial projects near thawing permafrost areas should have on-site medical surveillance to detect any emerging pathogens. Indigenous populations in these regions should also be involved in monitoring, he said.

  • The spread of zoonotic diseases

In another talk at ESCMID Global on the interplay between land degradation and climate change, Professor Kris Murray, professor of environmental change and health, and co-director of the centre on climate change and planetary health at the London School of Hygiene and Tropical Medicine’s Medical Research Council Unit The Gambia, UK, described how climate change and biodiversity loss impact the spread of zoonotic diseases.

He showed how even small changes in temperature and rainfall can affect disease ecology, altering incubation periods and growth rates. For instance, zoonotic viruses such as dengue are finding increasingly suitable breeding and survival conditions due to climatic shifts.

Land use also plays a significant role. In south-east Asia, people working in agricultural land are more likely to be infected with disease-causing pathogens. Murray welcomed mitigating measures addressing land degradation. However, he warned that impact of these efforts varies substantially, and evidence remains scarce regarding their direct effect on reversing disease spread.

Communications in infectious diseases

In times of global crisis, like the threat of AMR or the Covid-19 pandemic, scientists and healthcare professionals play a crucial role in communicating trusted and relevant information to the public. But translating complex medical and scientific advice into friendly and easy-to-understand content is a challenge.

Professor Siouxsie Wiles, a microbiologist from the Bioluminescent Superbugs Lab at the University of Auckland, New Zealand, took up that challenge.

In her session at ESCMID Global, Professor Wiles discussed innovative ways to engage with the public beyond traditional media responses. One impactful approach of hers was teaming up with illustrators and local communities to produce messaging in graphic interchange formats (GIFs).

Joining forces with cartoonist Toby Morris, they produced GIFs on topics such as flattening the curve and the power of individual actions in infection control. Over 70 graphics, including alternatives to handshakes and explanations of mRNA vaccines, were then created and published online by The Spinoff, a New Zealand news outlet. Dr Wiles also made sure these visuals were accessible to all by sharing them under a Creative Commons license.

However, not all experiences have been positive. Dr Wiles faced abusive messages and even death threats arising from her media presence and contribution to the public debate. She highlighted the SafeScience (WetenschapVeilig) initiative, which was set up in the Netherlands to support researchers facing harassment. This sector-wide initiative allows scientists to log abuse incidents and access supportive resources.

Safeguarding public health: ESCMID and AMR mitigation

During the five-day ESCMID Global congress, a central theme emerged: the urgency to safeguard public health. This was a theme that particularly resonated with one of the keynote speakers, the British economist Lord Jim O’Neill.

Lord O’ Neill chaired the widely cited ‘Review on Antimicrobial Resistance: Tackling drug-resistant infections globally’ in 2016, which made strong recommendations on actions that need to be taken to avoid an AMR-driven public health and financial disaster by 2050.

While he lauded achievements in areas such as reductions in the antimicrobial use in certain agricultural sectors, he warned ESCMID delegates that much is still left to achieve. In particular, he underscored the integration of emerging technologies, such as AI, as a pivotal driver for AMR mitigation.

Recent data from the European Centre for Disease Prevention and Control (ECDC) stresses the magnitude of the challenge at hand. Earlier this month, the ECDC released a report based on a point prevalence survey (PPS) conducted in European acute care hospitals in 2022/23.

The survey revealed that approximately 4.3 million patients experience at least one healthcare-associated infection (HAI) annually. In microbiologically documented HAIs, 32% of microorganisms were resistant to antimicrobials. Furthermore, the prevalence of patients receiving antimicrobials in the EU/EEA sample had risen to 35.5% (with a country range of 20.8% to 56.5%), compared to the previous PPS conducted in 2016/17 (prevalence of 32.9%).

This continued threat of AMR, as highlighted by Lord O’Neill and in the ECDC report, is a stark reminder of the urgent need for action.

The ECDC report was published in the same week that the UK Government released its new policy paper ’Confronting antimicrobial resistance 2024 to 2029’, which sets out its latest five-year national action plan to support its 20-year vision for AMR.

Following ESCMID Global 2024, the infectious diseases community will now look towards the United Nations General Assembly, due to convene this September in New York, which will further address the pressing topic of AMR. Hopes are high for accelerated international action.

Blueprint for future-proof and sustainable health sector unveiled by WHO

9th November 2023

A new operational framework for building climate-resilient, low-carbon and sustainable health systems across the world has been launched by the World Health Organization (WHO).

Published to coincide with the upcoming United Nations Framework Convention on Climate (COP-28), the framework includes a guide for healthcare professionals in addressing climate-related health risks to help safeguard the health of local and global communities.

It is ‘an opportunity for the health sector to lead by example by reducing its own greenhouse gas emissions while continuing to enhance quality of care’, the WHO said.

Greenhouse gas emissions from the health sector are now responsible for almost 5% of the global total. And if the sector were a country, it would be the fifth-largest emitter on the planet.

Dr Tedros Adhanom Ghebreyesus, WHO director-general, commented: ‘Around the world, health systems are vulnerable to the impacts of climate change, but they also contribute to it.

‘We therefore have a dual responsibility to build health systems that can withstand climate-related shocks, while at the same time reducing their carbon footprint. This framework gives countries a roadmap for doing just that.’

Sustainable health actions

Consisting of 10 key components, the framework outlines the various actions health organisations, authorities and programmes can take to better anticipate, prevent, prepare for and manage climate-related health risks and therefore decrease the burden of associated climate-sensitive health outcomes.

Of particular note is the second component, which details the need for countries to have a ‘climate-smart health workforce’ centred on three objectives: health workforce capacity; organisational capacity development; and information, awareness and communication.

Sample measurable outputs and indicators are listed for each objective, including up-to-date training for existing staff, the integration of climate-related curricula for new trainees, contingency plans for acute shocks such as extreme weather events, the sharing of best practice on reducing greenhouse gas emissions, and establishing solid communication between internal and external stakeholders.

With continuing themes of collaboration, additional components outlined in the framework relate to climate-transformative leadership and governance; research to provide an evidence-base for the development of policy and innovations; and a focus on infrastructure, technologies and supply chain, among others.

The WHO concludes that the ‘application of this framework would result in an important contribution to universal health coverage, global health security and specific targets within the UN Sustainable Development Goals’.

European Respiratory Society issues consensus statement on climate change and respiratory health

11th September 2023

Guidance on how global warming can be addressed in clinical practice has been outlined by the European Respiratory Society (ERS) in its latest consensus statement on climate change and respiratory health.

Published in the European Respiratory Journal, the statement describes climate change as ‘an unfolding major planetary and health crisis’, and a major threat to those with common lung conditions.

This, it says, is linked to the frequent and extreme weather events, prolonged aeroallergen seasons and poorer air quality associated with climate change, which can lead directly to a worsening of health and an increased risk of death.

Traditionally, clinicians have been involved in climate change adaptation strategies such as identifying vulnerable groups and providing advice on how they can protect themselves during heatwaves, for example.

However, the ERS says this clinical role has now expanded to focus on both human and planetary health, which includes contributing to the reduction in greenhouse gas emissions.

According to the ERS, subsequent changes to clinical practice could therefore include promoting green prescriptions such as inhalers; focusing efforts on smoking eradication; and encouraging patients, where appropriate, to engage with nature, take active modes of transport and make more sustainable food choices.

Professor Zorana Jovanovic Andersen, chair of the ERS Environment and Health Committee and professor of environmental epidemiology at the University of Copenhagen, who was one of the authors, said: ‘As respiratory doctors and nurses, we need to be aware of these new risks and do all we can to help alleviate patients’ suffering. We also need to explain the risks to our patients so they can protect themselves from adverse effects of climate change.‘

Climate change and lung health

The consensus statement also highlights that climate change will have a disproportionately greater adverse effect on individuals living with respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD).

It outlines some of the health risks of climate change such as a decline in lung function, increases in allergic responses and/or new cases of chronic (asthma, COPD, lung cancer) or infectious (pneumonia, influenza, tuberculosis, Covid-19) respiratory diseases.

It also identifies a higher risk of exacerbations for existing respiratory diseases, increased use of medication, emergency department visits, hospitalisations and death.

The fact that children are more susceptible to the impact of climate change on lung health is also highlighted, including the fact that the prevention of chronic respiratory disease should start as early as possible as many chronic lung diseases in adults have childhood origins.

The burden of global warming

Several previous reviews have provided extensive summaries of the different mechanisms by which climate change affects respiratory health, as well as outlining adaptation strategies. The latest statement provides an overview of all major pathways linking climate change with lung health.

While it summarises all of the available evidence, the authors also recognise some gaps in current knowledge. For instance, there is the need for further research to fully map the burden of climate change on respiratory diseases under different global warming scenarios and to understand underlying biological mechanisms, as well as identifying pathways of adaptation that can be translated into public health policies.

Professor Jovanovic Andersen, added: ‘Climate change affects everyone’s health, but arguably, respiratory patients are among the most vulnerable. These are people who already experience breathing difficulties and they are far more sensitive to our changing climate. Their symptoms will become worse, and for some this will be fatal.

‘Air pollution is already damaging our lungs. Now the effects of climate change are becoming a major threat to respiratory patients.’

Indeed, the deleterious respiratory effects of the particulate matter contained within air pollution, are already known to provide a mechanism through which lung cancer can develop among individuals who have never smoked.