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Support the Development of the WHO Fungal Priority Pathogens List

Collage of plated mixed culture of Candida glabrata (purple), Candida tropicalis (navy blue), and Candida auris (white, circled in red),

WHO issues RFP to formalize effort for Fungal Priority Pathogens List of Public Health Importance

Recognizing the public health threat of the global increase in burden of disease of fungal infections, coupled with existing treatability and resistance issues (both intrinsic and acquired), WHO is extending its efforts to develop a priority fungal pathogens list of public health importance and identify R&D priorities and gaps.

The World Health Organization is developing the first WHO priority pathogens list of fungal pathogens of public health importance and the subsequent clinical antifungal pipeline analysis to be launched at the end of 2021.

A virtual meeting of the antifungal expert group took place on 7 and 9 of April 2020 to discuss the methodology, pathogen selection and available evidence to begin the prioritization of fungal pathogens of global public health importance for which there is an urgent need for R&D for new treatments.

There was overall consensus that the fungal pathogens initially set out by the WHO secretariat (Candida auris; azole-resistant Candida spp.; azole-resistant Aspergillus fumigatus; Cryptococcus neoformans & gattii; Pneumocystis jirovecii; Mucorales; and potentially Histoplasmosis) were all of global public health importance and should be evaluated based on limitations of treatment options due to resistance and/or existing treatability issues (e.g. Mucorales has limited treatment options and poor outcomes). Experts were in agreement that a longer initial list of fungal pathogens be drawn up which would then be prioritized and shortened.

Other fungal pathogens that were mentioned for consideration include non-fumigatus Aspergillus spp, Fusarium, Coccidioides, Sporothrix, Blastomyces, Chromoblastomycosis, rare pathogens causing Chromablastomycosis and mycetoma (invasive), and even rarer moulds such as Lomentospora, Scedosporium and Talaromyces marneffei. It was suggested that the rare fungal infections that are either poorly treatable or untreatable could be captured in a separate group to highlight the need for compounds with activity against them.

It was agreed that prioritization should consider not only availability of treatment, but also prevention strategies (infection prevention and control/prophylaxis), especially for pathogens with nosocomial relevance (e.g. for C. auris).

There was a general agreement to limit the list to certain pathogens and invasive fungal infections and to consider clinical presentation as a criterion or sub-criterion. It was also suggested that the list be limited to health-care related infections due to challenges in obtaining data outside of that setting, however, no conclusion was reach on this matter.

This week the WHO issued a formal request for proposals (RFP) seeking a qualified contractor to undertake systematic reviews, develop and conduct a multi-criteria decision analysis stakeholder survey, statistical analysis of the results and draft the WHO fungal priority pathogens list and subsequent clinical antifungal pipeline review.

The activity will be coordinated by the WHO’s Global Coordination and Partnership on AMR Impact Initiatives and Research Coordination (IRC) unit and supported by a WHO expert advisory group.

Additional details are available at the United Nations Global Marketplace. The proposal deadline is 28 October 2020.

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