Following 19 months of consultation and eight interim papers, the new report entrusted by the UK Government sets out recommendations to tackle antimicrobial resistance (AMR) in a global way. The report recommends the following specific steps to reduce demand.
By Dr. Horrys Friaça, Agricultural Health and Food Safety Specialist, IICA, horrys.friaca@iica.int
Following 19 months of consultation and eight interim papers, the new report entrusted by the UK Government and chaired by Dr. Jim O’Neil (Economist – known for coining the term BRIC for the rapidly developing countries Brazil, Russia, India, and China) sets out recommendations to tackle antimicrobial resistance (AMR) in a global way.
According to the report, to stop the global rise of drug-resistant infections, there is a supply and demand problem that needs to be fixed. The supply of new medicines is insufficient to keep up with the increase in drug resistance. At the same time, the demand for these medicines is very badly managed with huge quantities of antimicrobials wasted globally on patients and animals who do not need to be treated by them.
The report recommends the following specific steps to reduce demand:
1. A massive global public awareness campaign
Based on estimates, the report considered it could cost between 40 and 100 million USD a year. It could be met by a mix of existing public health programs in high income countries, support for programs in low and middle income countries and corporate sponsorship for major events.
2. Improve hygiene and prevent the spread of infection
All countries need to act. Some in the developing world will need to focus on improving the basics first, by expanding access to clean water and sanitation. For other countries the focus will be to reduce infections in health and care settings, such as limiting superbugs in hospitals.
3. Reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environment
The report proposes 10-year targets to reduce unnecessary antibiotic use in agriculture, introduced in 2018 with milestones to support progress consistent with countries’ economic development. For this to succeed, governments must support and speed up current efforts, including those of the World Organization for Animal Health (OIE) and others, to measure antibiotic use and farming practices. Restrictions on certain types of highly critical antibiotics should also be applied. Too many antibiotics that are now last-line drugs for humans are being used in agriculture; action should be taken on this urgently by an international panel. Additionally, food producers should become more transparent on the antibiotics used in livestock, to enable consumers to make more informed purchase decisions.
4. Improve global surveillance of drug resistance and antimicrobial consumption in humans and animals
With oversight from the WHO, governments must build on these efforts to collect data about the consumption of antimicrobials, the levels of resistance, and the underlying biological reasons for resistance, supporting countries that need it most in doing so.
5. Promote new, rapid diagnostics to cut unnecessary use of antibiotics
Rich countries must lead the way to change this: they should make it mandatory that by 2020 the prescription of antibiotics will need to be informed by data and testing technology wherever available and effective in informing the doctor’s judgement to prescribe. This will spur investment by giving diagnostics developers the assurance that effective tests will be used. The proposed Global Innovation Fund for AMR would support early-stage research in this area.
6. Promote development and use of vaccines and alternatives
According to the report that could be achieved by: 1) Use existing vaccines and alternatives more widely in humans and animals; 2) Renew impetus for early-stage research; and 3) Sustain a viable market for vaccines and alternatives.
7. Improve the numbers, payment and recognition of people working in infectious disease
Infectious disease doctors are the lowest paid of 25 medical fields analyzed in the United States. It is no surprise that there are not currently enough candidates to fill hospital training vacancies. Improved funding to improve career paths and rewards in these fields is needed.
The report also suggested the following actions to increase the supply of effective antimicrobial drugs to defeat infections that have become resistant to existing medicines:
8. Establishing a Global Innovation Fund for early-stage and non-commercial research
To support early-stage research, the report proposed a Global Innovation Fund endowed with up to 2 billion USD over five years.
9. Better incentives to promote investment for new drugs and improving existing ones
It was proposed a system of market entry rewards of around one billion USD per drug for effective treatments, whether they are based on new or old drugs that work against resistant pathogens in areas of most urgent need.
Governments could afford to cover the cost of addressing AMR by allocating resources from existing health and economic development budgets. Most of the recommended incentives should be structured as ‘payments for success’ so they do not require upfront public investment into projects that may not deliver improvements. In this respect, one funding option that could be particularly effective to shift supply-side resources towards AMR research is an antibiotic investment charge, which would be imposed widely on the pharmaceutical sector and applied on a ‘pay or play’ basis, meaning companies could either pay the charge or invest in research and development (R&D) that is deemed useful for AMR. The money from companies who pay the charge would be used to improve the commercial market for the successful products such as news drugs, vaccines or diagnostics. This would push many more companies to invest in AMR, matching their short‑term financial incentives better with the fact that the industry as a whole depends on effective antibiotics to sustain a range of areas from oncology to joint surgery.
10. Build a global coalition for real action – via the G20 and the UN
Thanks to the courage and determination of a few leaders in this area, the problem of AMR will be discussed at the United Nations General Assembly later this year and continues to rise up the agenda for the G7 and G20 groups of countries. Leaders in these global forums must now rise to the occasion and agree on practical solutions.
What global action on AMR would cost?
According to the report, the cost of taking global action on AMR is up to 40 billion USD over a 10-year period. Within this, it would cost about 16 billion USD to overhaul the antibiotics R&D pipeline using new market incentives such as market entry rewards. These costs are modelled on achieving 15 new antibiotics a decade, of which at least four would be breakthrough products targeting the bacterial species of greatest concern. The report also recommended setting up an AMR Global Innovation Fund endowed with two billion USD over five years. So in total, it was estimated that the world can avert the worst of AMR by investing three to four billion USD a year to take global action. It is a very small fraction of what the G20 countries spend on healthcare today: about 0.05 percent. This is also tiny in comparison to the cost of inaction. The report estimates that by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug resistant infections if countries do not find proactive solutions now to slow down the rise of drug resistance.
*The opinion expressed in this newsletter are those of the author and they do not reflect the position of the Institute on the topics presented.
*This post appears in the IICA Delegation in the USA Newsletter – May- June 2016
