In This Issue
Medical Mycology is pleased to announce a collection of 14 systematic reviews encompassing 19 fungal pathogens or fungal diseases undertaken by a World Health Organisation (WHO)-commissioned research group. As a Journal of the International Society for Human and Animal Mycology (ISHAM), Medical Mycology commends these reviews to its broad readership of scientists, clinicians, pharmacists, and others with a passion for all aspects of mycology. ISHAM is committed to advocating for increased appreciation of the impact of fungal diseases, not only in humans but in a One Health context.
Development of the WHO Fungal Priority Pathogens List
Invasive fungal diseases are on the increase globally with the morbidity of superficial fungal infections well-known. Further, fungal disease may be, or can become, chronic.1,2 Although estimates of fungal disease and mortality are inexact, data suggest an annual incidence of 6.5 million invasive fungal infections and 3.8 million deaths.1 The under-recognition of, and attendant under-investment into, fungal diseases and their clinical impact including at the public health level has challenged health care planning.2 It is thus encouraging that In 2022, the WHO published the first fungal priority pathogen list (FPPL) (the WHO-FPPL) to increase awareness of fungal disease, identify solutions to address their adverse consequences, and to guide research priorities.3
As a prelude to the WHO-FFPL, in 2020, the Global Initiatives and Research Coordination (IRC) Unit of the WHO Antimicrobial Resistance (AMR) Global Coordination and Partnership Department (GCD) proposed to develop the global FFPL and to review the current development pipeline of fungal treatments to inform/identify public health and research and development gaps. An initial review by the WHO IRC identified significant challenges to meaningfully ranking fungal disease threats because there was no pre-existing prioritization focusing on global public health or research and development for fungal infections. The WHO AMR Division recruited the WHO Technical Advisory Group (TAG) FPPL, after which a ‘Study Group’ was appointed following a global call for expressions of interest and a competitive application process. In December 2020, the consortium comprising the University of Sydney, together with the Australia and New Zealand Mycoses Interest Group (ANZMIG), and Australasian Society for Infectious Diseases, was commissioned.
The approach to prioritizing pathogens3 is modelled on the development of the WHO Bacterial Priority Pathogen List.4 The Study Group was asked to conduct 14 systematic reviews of 19 fungal pathogens/fungal infections according to predefined WHO criteria.2,3 These were existing incidence or prevalence and evidence of change of disease caused by a particular pathogen and its geographic range, mortality, complications and length of stay after treatment, diagnostic and treatment availability, transmissibility and outbreak potential and antifungal resistance concern. Based on the results described in this series of manuscripts and advice of the TAG FPPL, the WHO ranked pathogens. Firstly, each pathogen was assigned a criteria score. Next, in coordination with the WHO AMR secretariat, the Study Group conducted a discrete choice experiment (DCE) based on multi-criteria decision analysis5,6 via a survey of > 300 members of a Global Medical Mycology Expert Respondent Group, to determine the relative importance of each of the 10 criteria. The two sets of scores were combined to determine an overall ranking score. Finally, an additional DCE-based survey was conducted involving a subset of the above expert group, focusing on the perceived public health importance of the pathogens. Results were merged whereby a final pathogen ranking produced three priority groups – critical (Candida auris, Ca. albicans, Cryptococccus neoformans, Aspergillus fumigatus), high (Nakaseomyces glabratus [previously Ca. glabrata], Ca. parapsilosis, Ca. tropicalis, eumycetoma causative agents,Fusarium spp., Mucorales, and Histoplasma spp.), and moderate priority (Pichia kudruavzevii [previously Ca. krusei], Cr. gattii, Scedopsorium spp., Lomentospora prolificans, Pneumocystis jirovecii, Talaromcyes marneffei, Coccidioides spp., and Paracoccidioides spp.).3 All results were confirmed by the WHO.
Key messages
Gleaned from each of the reviews, some key learnings will be similar across pathogens/diseases but also differences identified which reflect the relative gaps in knowledge or access to treatments, or simply the urgent need for more effective antifungal treatments which are currently absent. Medical Mycology and ISHAM encourage its readership in leveraging the recommendations stemming from the reviews for health care planning and partnering with professional bodies. Three areas for action identified are:
Improved surveillance of fungal disease;
Public health interventions and enhanced health infrastructure to secure equitable and affordable access to diagnostic tools including resistance detection;
Targeted support for research and development and innovation to accelerate the implementation of new antifungal drugs.
Contributor Information
Sharon C-A Chen, Editor-in-Chief, Medical Mycology.
Arunaloke Chakrabarti, Immediate Past President, ISHAM.
Oliver A Cornely, Treasurer, ISHAM.
Jacques F Meis, General Secretary, ISHAM.
John R Perfect, President, ISHAM.
Author contributions
Sharon C-A. Chen (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing), Arunaloke Chakrabarti (Conceptualization, Investigation, Project administration, Resources, Supervision, Validation, Visualization, Writing – review & editing), Oliver A. Cornely (Conceptualization, Investigation, Project administration, Resources, Supervision, Validation, Visualization, Writing – review & editing), Jacques F. Meis (Conceptualization, Investigation, Project administration, Resources, Supervision, Validation, Visualization, Writing – review & editing), and John R. Perfect (Conceptualization, Investigation, Project administration, Resources, Supervision, Validation, Visualization, Writing – review & editing).
References
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