“Antibiotic resistance is a global problem like climate change”

Markus Seeger, what makes antimicrobial resistance (AMR) a global challenge?

Markus Seeger: Not only have we been using the same antibiotics for too long, they have also been administered improperly – in too high doses, for the wrong purposes, or without a prescription. The result is resistance. This is a completely natural process that can only be slowed down, not stopped, and which doesn't respect national borders. The fact that we have significant gaps in antibiotic research and development makes AMR a problem that will dominate this century. AMR is, much like climate change, a creeping, global problem that demands a global response. Countries in the Global South are particularly affected, especially India. At the same time, regulations in these countries are often lacking, for example in relation to the sale of antibiotics.

That sounds alarming. How is AMR comparable to climate change?

Seeger: Both are human-made problems that are developing inexorably. And in both cases, it’s easy to think, “what difference does one contribution make?” But this logic is disastrous. As a small country, Switzerland may have little influence on global statistics. What we do have, however, is expertise, resources, and high standards in research and public health. If we focus our resources and expertise on areas where they can have the greatest impact – for example in countries like India, where AMR is rife – we can truly make a difference. But this global mindset is not yet deeply rooted enough, which I consider a significant missed opportunity.

What do you think are the most important levers when tackling AMR?

Seeger: I see four major problem areas. The first is the misuse of antibiotics. In many countries, these drugs are still available over the counter and are inexpensive. However, even in Switzerland and Europe, where regulations are stricter, antibiotic use remains quite high in certain areas, such as calf fattening and in hospitals. There’s still room for improvement.

Second of all, monitoring is complicated. We often don’t know exactly where antibiotic resistance originates, the routes via which it spreads, and how it ultimately comes to cause infections in patients. Where does transmission occur? Is it in hospitals? Via food? From animals to humans? This is a typical One Health issue. The connection is still not well understood and is very complex to research.

In countries like India, there is also the issue that there is very little monitoring being carried out. In some cases, there is a lack of funding for bacterial genome sequencing. And sometimes, as we learned from our Indian colleagues, genetic data on resistant germs is collected but not shared by state health authorities due to fears about damaging their reputation. But this data exchange is essential to effectively combat AMR.

Ultimately, the gap in research is a significant concern for us. Major pharmaceutical companies have withdrawn from antibiotic research and development over the past decades because they generate less revenue than other drugs. This has caused the innovation ecosystem to collapse. Now we are lacking new active ingredients – right in the midst of this crisis.

In many countries, AMR is not just a future prediction – it’s already reality. How far has the crisis progressed so far?

Seeger: Countries such as Russia, India and parts of Southern Europe have already reached the post-antibiotic era. In these places, there are infections that are resistant to most drugs. The situation is better in Switzerland, but the question is not whether the problem will one day arise, but rather when.

You’re a biochemist. What is your personal contribution to this issue?

Seeger: I’m dedicated to basic research and I study mechanisms of resistance. My research team and I investigate transport mechanisms in bacteria, with the aim of understanding how antibiotics enter or exit cells. This knowledge is essential to the development of new antibiotics. We’re also interested in new diagnostic methods that can be carried out in simple labs, and in precision antibiotics, which are active substances that target specific bacteria. I enjoy working at the interfaces where basic research, applied science and international cooperation meet.

What role does international exchange play in your work – and beyond?

Seeger: An enormous role. In basic research, we regularly exchange ideas with labs all over the world, for example at international conferences. But real change happens when people think beyond the boundaries of their own discipline. That’s exactly what we tried to do at the Indo-Swiss AMR Innovation Dialogue, an event that took place for the second time in May. This time, we were the hosts. We brought together people from India and Switzerland with different backgrounds – those working in research, for the authorities, in industry and as clinicians.

The Indo-Swiss AMR Innovation Dialogue is a new format. How did that come about?

Seeger: The idea came from a funny coincidence – an exchange of ideas on LinkedIn with an Indian researcher who I know from my time in Cambridge (UK). She was working for Swissnex India, advising Swiss companies that want to gain a foothold in India. She put me in touch with Lena Robra at Swissnex India, who is responsible for scientific collaborations between Switzerland and India. From this, the vision of an in-depth bilateral dialogue on AMR emerged. The first meeting took place in Bengaluru in 2023. The second was held recently in Zurich. Swissnex was an invaluable partner when it came to this event; they knew the right people, opened doors and helped with the organization. Without their network, this exchange would not have been possible.

What was special about this exchange compared to other international conferences?

Seeger: Around 50 selected experts attended, half from India and half from Switzerland, covering all areas: research, medical practice, companies, NGOs and state actors. There were short keynote speeches, as well as plenty of time for informal discussions and interactive workshops. As co-organizers, we sensed a great deal of interest, both in this collaboration and in bilateral exchange within the Swiss microbiology community. Our program was very diverse, and included many different players, from universities to start-ups and the pharmaceutical industry. Our aim was to show what’s going on here in Switzerland at various locations, not just at the University of Zurich.

Have the meetings in India and Switzerland already led to new collaborations?

Seeger: Yes, the exchange has definitely intensified. For example, the Institute of Medical Microbiology at UZH and the Christian Medical College (CMC) Vellore in India are collaborating more closely to discover and monitor emerging antibiotic resistance. We’re also expecting new funding calls for bilateral projects soon and are well prepared for these. The foundation of trust created by the AMR Dialogue helps enormously. We know each other, we’ve worked together, and we can get started quickly.

In your opinion, what is required for such multidisciplinary dialogue formats to be successful?

Seeger: First of all: having the courage to start something new. Next, good networks. Swissnex was absolutely crucial for this. Thirdly, working as equal partners. We didn’t travel to India to “provide aid”, but rather to learn together. The Indian partners were very open, self-aware and focused on finding solutions. We didn't exchange any diplomatic pleasantries. Everyone spoke honestly.

What was the most moving moment for you personally at the AMR Dialogue in Zurich?

Seeger: Honestly? It was like organizing a wedding – a lot of effort and a lot of responsibility. But when I saw that all participants were fully focused right up to the last session, I realized that this was more than just a conference. Real connections were made – some almost like friendships. The week-long event brought together people who want to collaborate to make a difference. And that’s what it’s all about.