WHO publishes detailed list of the most-harmful fungi

The World Health Organization (WHO) published a report today about dangerous fungi that can cause diseases, also known fungi pathogens.

Research for fungal infections that are spreading

The report called for people to pay more attention to fungi that could be toxic. It created a list of 19 fungi that represent the greatest danger to society and the public’s health. The name of the list is the WHO fungal priority pathogens list (FPPL) and it’s the first global initiative to prioritize fungi pathogens. The goal of the FPPL is to include additional research and policies to strengthen the universal response to fungal infections.

WHO mentioned that fungal pathogens are posing a threat to health care and are starting to become resistant to antifungal medications. Most people affected by fungal infections are extremely ill patients and people with underlying medical conditions. The organization also said there has been an increase in fungal diseases during the Covid-19 pandemic and due to global warming.

A rise in fungal infections

During the pandemic, hospitalized patients had an increase in fungal infections, while the fungi became progressively more resistant to medicine. “Emerging from the shadows of the bacterial antimicrobial resistance pandemic, fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide,” said Dr. Hanan Balkhy, WHO Assistant Director-General, Antimicrobial Resistance.

WHO wants to reveal these fungal diseases so that more data can be gathered about the pathogens, allowing researchers to learn more about their antifungal resistance.

Reasons for the report

The two key factors that led WHO to create this list were the rising threat of fungal infections, combined with the emerging resistance. It also wants to provide knowledge to the public so that there can be improvements in understanding fungal infections.

The organization wants the information to be directed at policymakers, public health researchers, healthcare providers, the pharmaceutical industry and research funders who invest in implementing new antifungal agents. However, WHO is also trying to reach out to the public, to let people know how important it is regarding the treatability challenges for fungal infections. It is emphasizing the importance of knowing about the dangerous fungal infections, noting that in 2020, no such prioritization of fungal infection threats existed globally.

Process

The selection of 19 pathogens was based on 10 assessment criteria presented by WHO.

The list was composed in part by the WHO Advisory Group FFPL, along with regional offices. The criteria for the list of pathogens were determined through a discrete choice experiment (DCE) survey. A minimum sample of 300 researchers with a background in public health or medicine were required. WHO recruited participants for the survey from various countries and regional offices, medical mycology (the branch of biology that studies fungi) societies and social media. In total, there were 376 participants from around the world.

In order to determine which fungi were the most dangerous, the WHO used best-worst (BW) scaling in an additional survey. For this portion of the report, there were 49 respondents. Altogether, results from the two surveys were combined to produce a ranking system to guide research and development requirements, along with provide strategies to control and manage the spread of dangerous fungi.

“We need more data and evidence on fungal infections and antifungal resistance to inform and improve response to these priority fungal pathogens” said Dr Haileyesus Getahun, WHO Director, AMR Global Coordination Department.

Approach and findings from the survey

WHO determined four important findings from the approach. First was the importance of public health in determining the priority of the rankings. “Apart from antifungal resistance, disease-burden related criteria (mortality, annual incidence, and morbidity) had the highest weights for relative importance in the survey,” the report said. The second finding was that antifungal resisitnace is a top priority based on survey results, third, is that the systematic reviews showed knowledge gaps on the burden of fungal infections, meaning that all 19 pathogens lacked data on the burden of the disease. Lastly, the fact that fungal pathogens vary significantly by region shows the importance in studying these diseases to understand the variation in their prevalence.

Ranking

The 19 fungal infections were ranked into three categories based on scores from the survey results and discussion amongst WHO FPPL. The three groups listed were the critical group, the high group and the medium group. The importance of the criteria in each group was ranked. The most important factor was antifungal resistance, at 38.5%, and the second most important factor was number of deaths 13.9%. Overall, the fungal species at the top of the list are the ones that are most resistant to antifungal medication, and those causing mortality. The critical group, which ranks highest in causing concern amongst researchers, includes Cryptococcus neoformans, Aspergillus fumigatus, Candida auris and Candida albicans.

The report aims to inform people of the growing threat that fungi may present to the world. WHO wants to encourage more research on fungal infections so that better treatment options can be created to stop the pathogens from spreading.