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Will the mRNA vaccine platform be the panacea for the development of vaccines against antimicrobial resistant (AMR) pathogens?

Antimicrobial resistance (AMR) has emerged as a major global public health catastrophe [1]. Annual global deaths from AMR pathogen infections have been estimated to be ~700,000 and could reach 10 million by 2050, exceeding those due to cancer [2]. In addition, AMR could result in up to 24 million people into extreme poverty by 2030 if no action is taken [3]. The COVID-19 pandemic further exacerbates the AMR crisis because of the increased use of antibiotics for secondary bacterial infections and the delayed global action against AMR [4]. As such, AMR has been recognized as a ‘silent’ or ‘the next’ pandemic by medical professions and public health experts [5]. New and distinct classes of antimicrobials are urgently needed to develop for patients infected with AMR pathogens. Unfortunately, there have been few recent successes in developing new antibiotics with improved potency and safety. More importantly, these new antibiotics will also be subject to the same selective pressures responsible for the emergence of current AMR pathogens. To avoid resistance development, substantial efforts have been invested in developing alternatives to antimicrobials, such as bacteriophages, nanodelivery systems, antibodies, vaccines, probiotics, microbiota, and CRISPR, etc. [6]. Among them, vaccines are one of the most attractive and cost-effective strategies against infections without the induction of drug resistance [7]. However, the development of vaccines against AMR pathogens (AMR vaccines) has encountered scientific and logistic challenges due to the opportunistic nature of many AMR infections, overall low incidence of AMR cases, and the often immunocompromised hosts (e.g. elderly, hospitalized). This, coupled with the lengthy (usually 10–20 years) and expensive discovery-to-market process of vaccine development, has limited the financial incentive for vaccine industries to pursue such a strategy [8]. Therefore, no licensed vaccines are currently available for most of the AMR pathogens of high priority. A few that have advanced into clinical trials (such as vaccines for Clostridium difficile, Pseudomonas. aeruginosa, and Staphylococcus aureus) have generally shown disappointing results [7]. Thus, innovative approaches are needed for the development of vaccines as an alternative to combat AMR. 2. COVID-19 responses and the rising of mRNA vaccine platform