A pharmacy in New Delhi © Pradeep Gaur/Mint via Getty Images

The Financial Times hosted a discussion in December 2020 on progress and policy options to tackle antimicrobial resistance, as part of its special report series on the Future of Antibiotics. The meeting brought together senior representatives from governments, non-profit and international organisations, academia, medical centres, the investment community and the pharmaceutical sector. It was held under the Chatham House rule of non-attribution, but below is a summary of the key discussion points and recommendations:

There have been important advances in recent months towards tackling antibiotic resistance, with new financing programmes, regulations and political declarations. Yet drug resistance continues to rise; there are significant gaps in tracking resistance; and there remains an urgent need to develop new drugs, vaccines, diagnostic tools and stewardship protocols.

Coronavirus has diverted attention from this crisis while intensifying the risk of antimicrobial resistance through treatment of secondary infections and misdiagnosis. Yet the fresh focus on public health during the pandemic has also provided a reminder of the dangers of infectious disease and the need for investment in systems to respond. The meetings of the G20, G7 and COP26 this year provide opportunities for governments to tackle the issue with renewed focus and tangible commitments.

Recent progress

  • To tackle the “broken pipeline” of research of new antibiotics, there has been a growth in “push” funding to support early stage research co-ordinated by organisations including the Global Antibiotic Research and Development Partnership and CarbX, supplemented by later-stage funding for development and testing provided by the AMR Action Fund.

  • There is fresh attention on the need for more “pull” funding to incentivise and reward the development of new medicines successfully launched. The UK’s National Institute for Health and Care Excellence has launched a pilot, as have the Swedish authorities.

  • There are indications that there would be bipartisan support for the proposed Pasteur Act in the US, which would provide substantial upfront funding for new antibiotics that win regulatory approval.

  • New initiatives are exploring the development of antibiotics specifically for animals, to avoid use of drugs useful to humans and to limit the development of resistance.

A Chinese farmer administers antibiotics to pigs © Ryan Woo/Reuters
  • Regulatory measures include a pending EU ban from 2022 on antibiotic use in animals without authorisation from a vet. A new EU action plan includes work on audits to help support member states in the development of national plans.

  • Investors have stepped up scrutiny of the use of antibiotics in the food chain, and are working with companies including the pharmaceutical industry to cut down on antibiotic waste entering the water supply, and improve stewardship of drugs. The G7, G20 and new inter-governmental initiatives such as the World Health Organization’s Global Leaders Group have demonstrated rising interest in the problem.

What is needed

  • New tools to incentivise the development and responsible use of drugs, vaccines for diseases that are treated with antibiotics, and diagnostics.

  • Greater efforts to support more equitable and responsible use of new and existing drugs.

  • More focus on limiting the excessive use of antibiotics in meat production and agriculture

  • More and better communication to raise understanding of the rising dangers of antibiotic resistance and consider the response as investments of global benefit.

  • Keeping up the pressure for progress by enlisting governments, investors, consumers, patients and civil society to develop targets and monitor actions. In particular, lower and middle income countries — led by “regional champions” such as South Africa, Brazil and India — need to be more involved in investment, monitoring, stewardship and access.

Next steps

  • Governments should develop comprehensive national action plans that include detailed targets, are linked to funding commitments and are updated regularly to enable tracking of progress.

  • Public spending on combating drug-resistance should be treated as investment in essential infrastructure to improve pandemic preparedness, global health security and the integration of “one health” spanning human, animal and environmental wellbeing. Bodies such as the OECD should explore how this can be reported in national accounts. The IMF should include scrutiny in its Article IV country reviews of national health systems, their capacity to tackle antibiotic resistance and the associated financial risks.

  • Investors should step up scrutiny of governments and companies to consider the ethical and economic risks of antibiotic resistance and the nature of the response.

  • Regulators should require more detailed labelling of foods to declare any antibiotic content; explore the introduction of import bans on any that are not certified as antibiotic-free; and increase transparency in the supply chain for restaurants.

  • Tougher international guidance should be introduced to limit the use of antimicrobial pesticides in agriculture.

An Indian farmer sprays crops with insecticide © Nardinder Nanu/AFP via Getty Images
  • Health systems should share experiences and approaches to better assess the cost effectiveness and broader benefits of antibiotics to public health as well as to individual patients.

  • Medical systems should explore emerging models for funding new antibiotics that de-link payment to drug companies from volumes of usage. Potential approaches include upfront prizes and subscription or insurance models that provide an annual payment to manufacturers.

  • Lower and middle-income countries should work together to pool resources for the procurement of new antibiotics for coupled with stewardship measures to control use.

  • The EU and multilateral organisations should set standards for and mechanisms to support more equitable access in different countries to off-patent antibiotics and diagnostics in order to offer broader access to the most effective treatments and limit the spread of resistance.

  • Leading international medical regulators should harmonise clinical trials to permit more effective, quicker and cheaper testing of novel antibiotics in lower-income countries.

  • Funders should explore enhanced financial incentives for new research and development, including through a European equivalent of the US’s Biomedical Advanced Research and Development Authority.

Letter in response to this article:

Covid response requires ‘minister for pandemics’ / From Professor Philip Howard and Dr David Jenkins, British Society for Antimicrobial Chemotherapy

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