Over the last century, advancements in antibiotics, hygiene, and vaccination have dramatically improved global life expectancy. These interventions have significantly reduced the mortality and morbidity caused by infectious diseases. While antibiotics are used to treat infections, vaccines offer preventive protection – providing long-lasting immunity and safeguarding communities through herd effects. 

Today, these achievements are increasingly threatened by antimicrobial resistance (AMR) – a growing public health crisis projected to cause up to 10 million deaths annually in 2050 (O'Neill, 2016). AMR undermines the effectiveness of antibiotics, complicates treatment options, and imposes a heavy economic burden on healthcare systems. The financial impact is expected to rival that of climate change in 2030, with the cost depending on various factors, including the pathogens involved, resistance mechanisms, infection types, and availability of alternative treatments (Rosini et al., 2020). 

The Growing Role of Vaccines in Combating AMR 

In the fight against AMR, vaccination is gaining renewed attention as a preventive strategy. While vaccines can drive evolutionary changes in pathogens – such as serotype replacement, where immunity against specific serotypes may lead to increased circulation of non-vaccine serotypes (Lipsitch, 1999) – they generally exert less selective pressure for resistance than antibiotics. Instead, vaccines train the immune system to recognize and respond rapidly and effectively to pathogens (Rosini et al., 2020), reducing both drug-sensitive and drug-resistant infections and thereby lowering antibiotic demand. 

Vaccines help curb AMR in several important ways: (1) direct prevention of infections caused by microbes that may be either antibiotic-resistant or antibiotic-susceptible; (2) herd immunity, which protects even the unvaccinated by reducing overall transmission; (3) reduction of secondary bacterial infections, such as bacterial pneumonia following influenza infections, which often require antibiotic treatment (Spika and Rud, 2015). 

The World Health Organization (WHO) formally recognized vaccination as a key strategy in its 2015 Global Action Plan on AMR (World Health Organization, 2015). 87% of national AMR action plans worldwide include vaccination components, with pneumococcal and influenza vaccines most frequently cited (Van Heuvel et al., 2022). 

Evidence of Impact 

The real-world impact of vaccines on AMR is clear and compelling. Introduction of the pneumococcal vaccine (PCV) has led to significant decline in drug-resistant Streptococcus pneumoniae and averted AMR-related deaths, particularly among children under five (Jansen and Anderson, 2018). The Hemophilus influenzae type B (Hib) vaccine has also contributed to reduced overall disease burden and a decrease in the prevalence of certain antibiotic-resistant strains (Adam et al., 2010, Heilmann et al., 2005). 

New vaccine candidates are in development for high-priority AMR pathogens, including Staphylococcus aureus, Clostridium difficile, Neisseria gonorrhoeae, Mycobacterium tuberculosis, and Streptococcus pneumoniae (Spika and Rud, 2015). The WHO’s 2020 action framework, “Leveraging Vaccines to Reduce Antibiotic Use and Prevent AMR” (World Health Organization, 2020), underscores the need to expand vaccine coverage and accelerate innovation targeting these and other resistant pathogens. 

Barriers and Opportunities 

Despite the promise of vaccines, several challenges must be addressed. 

• Vaccine hesitancy continues to limit uptake. Rooted in complex sociocultural and political factors, it requires targeted public engagement and trust-building efforts.
• Limited vaccine availability for many AMR-priority pathogens calls for greater investment in research and development.
• Health equity concerns remain. Communities most burdened by AMR often have the least access to life-saving vaccines (Abdul-Mutakabbir and Simiyu, 2022). 

Nevertheless, the inclusion of vaccination in global AMR stewardship programs presents a valuable opportunity (Sallam et al., 2024). Widening vaccine coverage can decrease unnecessary antibiotic use and slow the spread of resistance. Integrating vaccines with other measures – such as hygiene, sanitation, and infection prevention – strengthens the foundation for long-term infectious disease control (Van Heuvel et al., 2022). 

Vaccines are not a standalone solution, but they are an essential part of a comprehensive response to AMR. By helping protect individuals from infection or by priming the immune system to respond more effectively upon exposure, vaccines reduce the need for antibiotics and help contain the spread of resistance. In an age where antibiotic options are dwindling, prevention is more important than ever.  

Expanding access to existing vaccines and supporting the development of new ones must become a global health priority. From prevention to protection, vaccines hold a critical key to turning the tide against AMR. 

Reference 

ABDUL-MUTAKABBIR, J. C. & SIMIYU, B. 2022. Exploring the intersection of racism, antimicrobial resistance, and vaccine equity. Antimicrobial Stewardship & Healthcare Epidemiology, 2, e134. 

ADAM, H., RICHARDSON, S., JAMIESON, F., RAWTE, P., LOW, D. & FISMAN, D. 2010. Changing epidemiology of invasive Haemophilus influenzae in Ontario, Canada: evidence for herd effects and strain replacement due to Hib vaccination. Vaccine, 28, 4073-4078. 

HEILMANN, K. P., RICE, C. L., MILLER, A. L., MILLER, N. J., BEEKMANN, S. E., PFALLER, M. A., RICHTER, S. S. & DOERN, G. V. 2005. Decreasing prevalence of β-lactamase production among respiratory tract isolates of Haemophilus influenzae in the United States. Antimicrobial agents and chemotherapy, 49, 2561-2564. 

JANSEN, K. U. & ANDERSON, A. S. 2018. The role of vaccines in fighting antimicrobial resistance (AMR). Human vaccines & immunotherapeutics, 14, 2142-2149. 

LIPSITCH, M. 1999. Bacterial vaccines and serotype replacement: lessons from Haemophilus influenzae and prospects for Streptococcus pneumoniae. Emerging infectious diseases, 5, 336. 

O'NEILL, J. 2016. Tackling drug-resistant infections globally: final report and recommendations. 

ROSINI, R., NICCHI, S., PIZZA, M. & RAPPUOLI, R. 2020. Vaccines against antimicrobial resistance. Frontiers in immunology, 11, 1048. 

SALLAM, M., SNYGG, J., ALLAM, D. & KASSEM, R. 2024. From protection to prevention: redefining vaccines in the context of antimicrobial resistance. Cureus, 16. 

SPIKA, J. & RUD, E. 2015. Immunization as a tool to combat antimicrobial resistance. Canada Communicable Disease Report, 41, 7. 

VAN HEUVEL, L., CAINI, S., DÜCKERS, M. L. & PAGET, J. 2022. Assessment of the inclusion of vaccination as an intervention to reduce antimicrobial resistance in AMR national action plans: a global review. Globalization and Health, 18, 85. 

WORLD HEALTH ORGANIZATION 2015. Global Action Plan on Antimicrobial Resistance. Geneva, Switzerland. 

WORLD HEALTH ORGANIZATION 2020. Leveraging Vaccines to Reduce Antibiotic Use and Prevent Antimicrobial Resistance: An Action Framework. Switzerland.