Prof Orla Morrissey wins WHO funding for antifungal stewardship

There is a critical need for a World Health Organisation (WHO) Fungal Priority Pathogen List (PPL) to guide the development of new fungal diagnostics and antifungal agents, as global access to the currently available antifungal agents and effective diagnostics is patchy at best and often unavailable in the areas where the burden of fungal infections is highest.

Professor Orla Morrissey, Department of Infectious Diseases, Central Clinical School, Monash University, in collaboration with researchers from the Australasian Society of Infectious Diseases Mycology Interest Group (ANZMIG) and the University of Sydney, was recently awarded funding from WHO to develop the Fungal PPL and describe the research and development (R&D) antifungal and diagnostic pipeline.

In addition, the currently available antifungal agents result in significant adverse drug reactions due to off-target effects and the requirements for prolonged periods of therapy. Antifungal resistance to many of the currently available classes of antifungal agents (azoles, echinocandins, polyenes) is on the increase.

Prof Morrissey said that antifungal resistance has been shown to further increase the already high mortality rates seen with invasive fungal disease (IFD). "These issues are also compounded by the ever-expanding population of immuno-compromised patients at risk of IFD," she said.

"We are particularly studying deep tissue, or invasive, infections rather than superficial infections of the skin, such as dandruff, and mucous membranes, such as thrush [Candida albicans]. Resistant thrush is a major problem but it is not part of this study. It is likely that this work will be ongoing with the WHO and that a subsequent study will be addressing thrush alone, because it's a huge issue."

The development of WHO Fungal PPL is based on the very successful 2017 WHO PPL for bacteria, which has been instrumental in informing public and private research and investment in new antibiotics.

The same result is expected of the WHO Fungal PPL. Prof Morrissey said that the WHO Fungal PPL list is also likely to be an invaluable tool for raising the issues around antifungal resistance and to informing infection prevention and antifungal stewardship guidelines and policy.

"Because the problem is so pervasive we need to tackle it on several different fronts. So our multi-disciplinary team of researchers includes experts in human and animal health, agriculture, decision-making analysis, patient safety, and social science."

The University of Sydney is administering the funding for the project, which will receive $100,000 over a period of 18 months.