First-ever list of health-threatening fungi by WHO

WHO today released a report detailing the first-ever list of 19 fungi that pose the greatest harm to public health, or "priority pathogens," fungi. The WHO Fungal Priority Pathogens List (FPPL) is the first global attempt to systematically prioritize fungal pathogens, taking into account the unmet needs for research and development (R&D) and the importance that is believed to be associated with public health. To boost the international response to fungi infections and antifungal resistance, the WHO FPPL seeks to direct and motivate more research and policy measures.

There are now only four kinds of antifungal medications available, and there aren't many candidates in the clinical pipeline, making fungus pathogens a serious threat to public health. The majority of fungal diseases lack quick and accurate diagnostics, and those that do exist are not generally accessible or inexpensive globally. Severely unwell patients and those with major underlying immune system-related problems are frequently affected by the invasive forms of these fungi infections. Cancer patients, HIV/AIDS patients, organ transplant recipients, those with chronic respiratory diseases, and people who have had post-primary tuberculosis infection are among the groups most at risk for invasive fungal infections.

New research suggests that as a result of global warming, increased international travel, and increased trade, both the prevalence and geographic range of fungal illnesses are increasing globally. Invasive fungal infections were observed to occur more often among hospitalized patients during the COVID-19 pandemic. The likelihood of more severe infections in the general population is rising as the fungi that cause common illnesses to become more difficult to treat.

According to Dr. Hanan Balkhy, WHO Assistant Director-General for Antibiotic Resistance (AMR), fungal infections are on the rise and becoming a global public health problem as they emerge from the shadows of the pandemic of bacterial antimicrobial resistance. Despite the rising concern, there is a dearth of high-quality information on the distribution of fungal diseases and the trends in antifungal resistance. Because of this, the precise impact of fungal illnesses and antifungal resistance is unknown, which undermines the effectiveness of the response.

The WHO FPPL list is categorized into three priority levels: critical, high, and medium. Each priority category's fungal diseases are ranked mostly based on their public health effect and/or emerging antifungal resistance danger. While WHO recognizes these essential pathogens as a global public health concern, it emphasizes that the FPPL must be carefully defined and contextualized, as some endemic pathogens may be of greater significance in their specific regional or local contexts.

The report's authors emphasize the need for more data to better understand the impact of both disease and antifungal resistance and to guide the response to this emerging threat. The research also recommends extending equitable access to high-quality diagnoses and treatments and emphasizes the urgent need for concerted action to address the impact of antifungal usage on resistance across the One Health spectrum.

To further inform and enhance responses to these priority fungal pathogens, Dr. Haileyesus Getahun, Director of the WHO's AMR Global Coordination Department, stated that more information on fungal infections and antifungal resistance is required. The FPPL paper highlights the approach for legislators, public health experts, and other stakeholders. The measures outlined in the study are all geared toward gathering data and enhancing responses to these priority fungal pathogens, including halting the emergence of antifungal drug resistance. The primary proposed activities are concentrated on boosting public health interventions for prevention and control, maintaining investments in research, development, and innovation, and strengthening laboratory capacity and surveillance.

Dr. Haileyesus Getahun went on to say that countries should take a step-by-step strategy, beginning with boosting their fungal disease laboratory and surveillance capacities and providing fair access to existing quality treatments and diagnostics globally. Inappropriate antifungal use across the One Health spectrum contributes to antifungal resistance. For example, improper antifungal use in agriculture has been associated with an increase in azole-resistant Aspergillus fumigatus infections. The report also encourages WHO to work with the Quadripartite organizations and other partners to address the impact of antifungal usage on resistance throughout the One Health spectrum.