Fungal infections cause major morbidity and mortality in healthcare systems worldwide. According to the Global Action for Fungal Infections (GAFFI), 300 million people worldwide suffer from a serious fungal infection each year, with over 1.5 million of them dying from their infection. Nevertheless, in many places around the world, the prevalence and true burden of these diseases is unknown. Moreover, clinicians find very few treatment options for their patients. As a result, endemic regions and vulnerable populations are affected both by underreporting and the lack of tools for diagnosing and treating such infections.
The core of the issue: diagnosis and treatment
Fungal infections are severely underdiagnosed. This global health concern is affected by various factors. First, lack of access to health services prevents patients from being tested. Secondly, the existing diagnostic tests seem to have a limited sensitivity. And ,finally, insufficient training of health staff causes a lack of clinical suspicion of fungal infections. Such failures in public health and stewardship have a negative impact on fungal disease control: a study of 129 centers in 24 Latin American and Caribbean countries performed in 2019 found that only 9% of the clinics met the European Confederation of Medical Mycology’s minimum standards for performing a correct mycological diagnosis. There is a clear need to improve mycosis diagnostic capabilities.
Regarding treatment, there are currently just a few systemic antifungal drugs available. At the moment, only three major pharmacological classes are accessible for clinical use: triazoles, polyenes, and echinocandins. According to GAFFI, many critical antifungals are not available nor registered in several of the countries where fungal infections are most lethal. In addition, because there is a restricted number of treatment targets, antifungal resistance is a great concern, especially in immunocompromised people. Resistance to a single drug class might severely limit treatment options, while multidrug resistance could end up making fungal infections untreatable.
Steps forward: first WHO-led initiative
As the problem of fungal infections grows bigger, the World Health Organization (WHO) has finally taken steps forward towards its control. The “WHO fungal priority pathogens list“, inspired by the 2017 “WHO bacterial priority pathogens list (WHO BPPL),” was released in October this year. The aforementioned publication prioritizes fungal pathogens that can cause invasive acute and subacute systemic fungal infections and that pose treatment and management issues. All included pathogens are grouped into three priority groups: critical, high, and medium.
The underestimation of the burden of fungal infections reduces resources for fungal disease surveillance, outbreak response, epidemiological investigation, and control. As a result, this document suggests measures and strategies for policymakers, public health experts, and other stakeholders to improve the overall response to the prioritized fungal infections, including the prevention of further antifungal drug resistance. The WHO suggests taking three main actions: (1) strengthening laboratory capacity and surveillance; (2) sustainable investments in research, development, and innovation; and (3) public health interventions.
The release of this list highlights the urgent threat posed by fungal infections. Furthermore, it will enhance the prioritization of training programs, the distribution of competitive research funds, the development of health policies for the prevention, diagnosis, and treatment of these diseases, as well as the promotion of access to treatment in underserved areas. Hopefully, the outcome of such efforts will be the reduction of prevalence and mortality, especially in vulnerable populations.