The University of Wisconsin-Madison Global Health Institute convened experts from around the world with UW-Madison faculty for a Jan. 27 webinar examining the growing complexities of infectious disease control.
The discussion, moderated by Daniel Shirley, an infectious diseases professor at the UW-Madison School of Medicine and Public Health, brought together researchers working across human, animal and global health systems to address two converging crises: antimicrobial resistance (AMR) and declining childhood vaccination rates.
Vaccines in Wisconsin
Antimicrobial resistance arises when mutations occur in bacteria or viruses that make antibiotics ineffective. Vaccines play an important role in combating antimicrobial resistance because they reduce the potential for infection outbreaks. Without an infection in the first place, clinicians do not have to treat diseases with antibiotics, potentially creating resistant strains.
According to the World Health Organization, more vaccination could decrease the number of antibiotics prescribed by 22% and decrease the annual cost of treating AMR-related maladies, currently $730 billion, by one third.
But across the United States, cases of preventable diseases such as influenza, hepatitis A and B, meningitis, RSV and rotavirus have risen as the required number of vaccines for children fell from 17 to 11 within the past year. Treating these diseases with antibiotics could increase antimicrobial resistance, which currently contributes to 5 million deaths a year globally.
A vaccination decline has also played out in Wisconsin. In 2013, 88% of Wisconsin two-year-olds had received the measles vaccine. By 2022, that number fell to 82%, with some countries experiencing even sharper declines. Monroe County, for example, dropped from 82% to just 59% from 2013 to 2023.
Panelists linked a decrease in Wisconsin childhood vaccinations to rising mistrust in healthcare providers and public health institutions.
Resistance levels to antibiotics treating preventable diseases are likely underestimated because most data comes from hospitalized patients who have already failed earlier treatments, according to Laurel Legenza, an assistant professor in the UW-Madison School of Nursing.
Hospitals with testing capacity, like UW-Madison, play a key role in detecting resistance and guiding care. But even with strong laboratory resources, managing AMR is difficult.
“At UW, we have quite a bit of information: a lot of culture data, a lot of testing for resistance, a lot of access to antimicrobials — and we still face a big problem,” Shirley said. “There are bacteria… and other organisms that we don’t even have good treatments for.”
Some bacteria lack effective treatments, forcing clinicians to rely on combination therapies. Combination therapies involve joining two or more types of treatments in order to treat one infection or virus, often creating higher costs and more potential side effects for a patient.
Antimicrobial resistance around the world
Panelists said limited laboratory capacity and inconsistent data-keeping hinder effective antimicrobial (AMR) research across the globe.
Erta Kalanxhi, whose research involves tracking antimicrobial resistance in Africa, said a lack of digitized data and AMR testing puts low and middle-income countries, where bacterial infections are most prevalent, at risk.
“The data that is available gives an incomplete picture of [antimicrobial resistance],” Kalanxhi said.
She said only 26% of laboratories use electronic information systems, leaving most AMR data stored on paper and difficult to integrate into meaningful research. Additionally, clinicians in low-income settings often lack access to microbial testing, making it hard to identify infections and gather data.
“Many laboratories [are] lacking electronic information systems,” Kalanxhi said. ”The data is there, but it’s difficult for this data to actually inform policy.”
Though Kalanxhi said the AMR data that does exist indicates high levels of resistance, its inconsistent data quality combined with low rates of AMR testing make linking resistance to patient outcomes nearly impossible.
Her research shows that much antibiotic R&D focuses on adults in high-income countries and early-stage drug development, despite bacterial infections primarily affecting people in low-and middle-income countries, according to François Franceschi, an expert in antimicrobial research.
Franceschi, who works for Swiss-based antibiotics nonprofit Global Antibiotic Research and Development Partnership (GARDP), said making all infections treatable, “requires shifting global investment toward high-burden populations, and ensuring that new antibiotics reach the people who need them the most.”
Across all panelists, a shared message emerged: global health is deeply interconnected. Infectious diseases can have consequences everywhere. Protecting health in Wisconsin and around the world requires coordinated action to strengthen laboratory systems, invest in new antimicrobials, improve data quality and rebuild trust in vaccines.
