Antimicrobial resistance is the next battle
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The writer is chief executive of GlaxoSmithKline
The Covid-19 pandemic teaches us that the world needs to be better prepared for global health threats. Pharmaceutical companies, including GlaxoSmithKline, are pulling out all the stops to tackle coronavirus through new treatments and vaccines, but we are playing catch-up. We need to start investing ahead of outbreaks.
Antimicrobial resistance, or AMR, is just such a threat, but, unlike Covid-19, AMR is predictable. Scientists already track increasing rates of antibiotic resistance and the World Health Organization and the US Centers for Disease Control and Prevention have identified the bacteria that pose the greatest risks to human health.
We risk returning to a time when a simple cut could have lethal consequences and common surgical procedures might be too risky to perform. The UN estimates that, left unchecked, drug-resistant diseases could cause 10m deaths per year by 2050 with a catastrophic effect on the global economy, costing more than $100tn.
New antibiotics need to be used carefully and held in reserve or used only as a last resort, which leads to low sales. As a result, financial returns, which would underpin new research and development investment, have largely dried up. Recent bankruptcies of several antibiotic biotechs are cases in point. The solution is clear. The world needs commitment from pharma companies and new incentives to attract long-term R&D investment. “Pull” incentives to attract this investment would radically change the underlying economics for large and small companies alike, by creating a predictable market with acceptable returns.
The current pipeline of new antibiotics is insufficient to treat future resistant infections. Of the about 40 clinical-stage antibiotics in development, just six are considered novel by the WHO. GSK’s gepotidacin is one of them. The others are being developed by small companies with limited revenues or funding.
The launch last week of the $1bn AMR Action Fund is an important effort to bridge this gap, to stimulate new innovations and get ahead of the curve of resistant infections. Industry is stepping up, with the WHO, European Investment Bank and Wellcome Trust, to bring two to four novel antibiotics to patients by 2030. In 30 years, no new classes of antibiotics have been launched, so this is an ambitious target.
Yet as well as industry commitment, we need new incentives. Here we have seen little progress. The main obstacle has been political. Few votes are won by prioritising investment against future health risks. Surely, this will change as a result of Covid-19.
The UK has been a pioneer in developing pull incentives. Last year, it launched a pilot to develop and test a subscription model for purchasing new antibiotics. Done right, this could create financial rewards that reflect the value of new antibiotics to society and share the uncertainty of future resistance rates between company and payer. The UK should expand beyond the two antibiotics in the pilot to include other treatments that will launch soon.
We need other countries to lead too. Government support has helped industry accelerate progress for treatments and vaccines for Covid-19 and it will be critical for antibiotics. Progress in the US will be vital. The early discussions in Congress to create subscription-like payments for antibiotics under the Pasteur Act are welcome and should be taken forward. Exploration of other incentives, such as an intellectual property-based extension voucher, or changes to health technology assessment methods for valuing antibiotics, as implemented in Germany, are promising options for Europe.
We can change the momentum on AMR. The new fund will work as a hub, bringing together experts and combining the efforts of all stakeholders. I hope it serves as a catalyst for broader action.