AMR and vaccines: Can universal coverage avert a post-antibiotic era?

Antimicrobial resistance (AMR) is a growing global health crisis. As of November 2025, experts warned that, if antimicrobial resistance is not addressed, it could lead to 10 million deaths annually by 2050.

Historically, the role of vaccines in reducing AMR has not been fully recognised, with the focus primarily on their use for preventing infectious diseases. But, according to GAVI, drug-resistant bacterial infections cause an estimated 1.27 million deaths per year globally. Indeed, the Wellcome Trust notes that vaccination is a critical – but underused – strategy in the global response to AMR, reducing the need for antibiotics and helping to slow the emergence and spread of resistant pathogens.

To find out more about this potential, pharmaphorum spoke with Dr Neil Murray, CEO of ReNewVax, about how a recent breakthrough could redefine pneumococcal prevention and antimicrobial resistance strategies.

Q. Antimicrobial resistance (AMR) is one of the deadliest health challenges of our time. What would a “post antibiotic era” look like?

Dr Neil Murray: Antibiotics are ubiquitous in modern healthcare practice, offering protection against everything from strep throat to UTIs, skin infections, and pneumonia. They are essential for preventing infection during surgery or for supporting those with weakened immune systems. And so, the prospect of AMR rendering them useless is frightening. In a post-antibiotic era, routine surgeries would become much more dangerous for patients and simple infections would potentially become life-threatening.

Q. How do pneumococcal bacteria contribute to that risk – and is there an increase in serotypes that are resistant to antibiotics?

Streptococcus pneumoniae (or pneumococcus) is responsible for a range of infectious conditions – from mild, non-invasive infections, such as ear or sinus infections; to severe, invasive disease, such as pneumonia, meningitis or sepsis. Data shows that S. pneumoniae is the third leading cause of death globally from bacterial infection. Critically, it is also the fourth leading cause of death associated with antimicrobial resistance, with the prevalence of AMR-strains of pneumococcus increasingly common.

A recent study (by Mohanty et al, 2023) tracked the growth in resistance among children in US hospitals and found that 56.8% of S.pneumoniae isolates were resistant to at least one class of antibiotics. Worryingly, the study also identified big increases in resistance of S.pneumoniae isolates, from 2011 to 2020. Resistance to at least two drug classes increased at 1.8% per year, and resistance to macrolides at 5.0% per year, highlighting the rapid progress of AMR.

Q. There are a number of vaccines that already protect against pneumococcal serotypes that cause the vast majority of pneumococcal disease. Why do you think the world needs a ‘universal’ pneumococcal vaccine that protects against all known serotypes?

One of the issues with existing pneumococcal vaccines is that they only provide protection against around 20% of the known pneumococcal serotypes. Although there are higher valency vaccines in development, they still only cover around 30% of serotypes. Today, these serotypes are the most clinically relevant – in terms of causing disease.

However, whilst these vaccines are effective against those serotypes that they target, this limited coverage results in ‘serotype replacement’ over time, whereby, as one serotype is controlled by immunisation, another non-vaccine serotype becomes clinically relevant. Increasingly, these arising non-vaccine serotypes have some level of antibiotic resistance, making treatment of the disease that they cause more difficult and more dangerous for patients.

The only way to overcome this problem is through development of a universal vaccine, which provides coverage against all pneumococcal serotypes.

Q. How exactly would a universal pneumococcal vaccine help combat the development of AMR? For instance, would it help cut antibiotic usage? Are there other mechanisms at play?

A universal vaccine would work to help combat the development of AMR in several ways. Firstly, it would protect the individual from getting infected. Prevention of primary infection removes the potential for development of complications that may lead to secondary infection, which could require antibiotics.

Secondly, widespread use of effective vaccines supports the development of herd immunity, which reduces community transmission. This also contributes to the overall goal of decreasing the number of infections – whether caused by resistant or susceptible pathogens. Decreasing infection numbers results in decreased antibiotic use, which directly suppresses the evolution of resistance. In turn, this leads to decreased risk to individuals and more effective antibiotics, which can be used for longer.

This is why the World Health Organization (WHO) has called for vaccines to play a more prominent role in reducing antibiotic use and preventing AMR, as part of their Immunization Agenda 2030 framework.

Q. ReNewVax is using a “genomics driven, reverse vaccinology approach”. What does this entail, how does it differ from traditional vaccine development approaches, and why do you think it is a superior approach, especially for creating a universal vaccine against pneumococcal bacteria?

Usually, vaccine antigens are selected based on a hypothesis-driven approach, where a likely antigen target is first chosen and studies then undertaken to evaluate whether the hypothesis is correct. This is a risky approach, as the hypothesis isn’t proven until clinical studies have demonstrated it.

By contrast, ReNewVax’s agnostic, data-driven approach uses genomics and bioinformatics to screen for antigens that are specifically identified because of their potential for use in human vaccines. This de-risks the discovery and development process. In the case of RVX-001, our pneumococcal vaccine candidate, it delivers antigens that have been specifically chosen because of their coverage against all serotypes.

Q. What innovations in vaccine design and manufacturing are needed to make pneumococcal vaccination affordable and accessible globally?

The historically high cost of pneumococcal conjugate vaccines (PCVs) has limited their use largely to high-income countries. Low- and middle-income countries simply cannot afford to conduct mass immunisation programmes with these products.

Existing pneumococcal vaccines cost more than $250/dose – largely due to the high cost of manufacturing PCV vaccines, such as Capvaxive and Prevnar-20. ReNewVax’s RVX-001, by contrast, consisting as it does of just three protein antigens, can be much more cost effective to produce, due to its simplified manufacturing.

A lower cost, universal vaccine provides the potential to expand use into poorer economies, improve global health, and more effectively limit the development of AMR.

Q. Beyond scientific advances, what policy and funding changes are needed to ensure vaccines play their full role in averting a post antibiotic era?

Current efforts in addressing AMR are focused, understandably, on creating new classes of antibiotics. But not enough is being done to support areas such as vaccine development and diagnostics – both of which can help preserve the antibiotics that we have today.

Similarly, human health policy needs to adopt a cohesive approach to immunisation, both nationally and internationally. A piecemeal approach at the whim of national governments will simply accelerate AMR.

Policy must also focus on communication to ensure that the public truly understands the looming apocalypse of AMR. Within that sphere, much more needs to be done to overcome vaccine scepticism, with evidence-led campaigns promoting vaccine use.

It is simply not possible, nor practical to immunise everyone against every pathogen. Vaccines, however, as recognised by bodies such as the WHO and the Wellcome Trust, still have a profound role to play in the fight against AMR.

References

• Mohanty S, Feemster K, Yu KC, Watts JA, Gupta V. 2023. “Trends in Streptococcus pneumoniae Antimicrobial Resistance in US Children: A Multicenter Evaluation.” Open Forum Infect Dis. 7;10(3):ofad098. doi: 10.1093/ofid/ofad098. PMID: 36968964; PMCID: PMC10034583.

About the interviewee

Dr Neil Murray is CEO of ReNewVax. A seasoned pharmaceutical industry chief executive, with experience of therapeutic development, business growth, and general management, Dr Murray’s role draws upon his extensive experience in the application of platform technologies in drug research and development; overall drug development strategy, planning, and management; portfolio development; and corporate and business development across multiple therapeutic modalities and markets. Dr Murray was previously the founding CEO of Redx Pharma, leading the company through its rapid growth and listing on the London Stock Exchange. Having gained a PhD in Synthetic Organic Chemistry from the University of Dundee in 1987, his career has included senior positions with high profile companies in the industry, including Glaxo-Wellcome, Vernalis (formerly Vanguard Medica), Solutia Inc, and Sigma-Aldrich Inc. He is also a founding director of Impact Data Metrics, an economic development data insights business.