A Frightening Reality
From a sustainable antibiotics perspective, 2018 is not wasting time getting to the point. The new year has kicked off with tremendous momentum in the fight against antimicrobial resistance (AMR), with the publication of the AMR Industry Alliance first progress report, which shows actions taken by the life sciences industry to tackle this public health threat one year since the Alliance’s inception.
This report was shortly followed by the world’s first AMR Benchmark from the Access to Medicine Foundation: a detailed analysis of pharma company action against AMR, covering topics such as antimicrobial R&D, responsible manufacturing and appropriate access and stewardship. The World Health Organization also published its first Global Antimicrobial Resistance Surveillance System (GLASS) report on resistant pathogens, and Nordea investment bank followed up with its second report on the pharma industry’s environmental issues in India and China.
For me personally, as I expect for the many who have made it their mission to find solutions for the superbugs crisis, witnessing all this action is a relief. What I find concerning however, is the pace of actual progress on the ground.
Two things struck me most upon reading the many recent publications. The first is that, though from a variety of angles, all come to the same conclusions on antibiotics resistance:
- AMR continues to spread fast, even the most common bacterial diseases and infections – and potentially most dangerous – show alarmingly high percentages of resistance to the most commonly used antibiotics
- It is a global issue, affecting all countries – bacteria do not know borders
- AMR is caused by human and agricultural misuse and overuse, as well as by environmental pollution from human and animal excretion, hospital waste streams as well as from irresponsible antibiotics production
- On antibiotics production, standards are lacking. Existing regulation is failing to stop polluting companies, since it does not set limits for release of antimicrobial activity in waste streams
- Many pharma companies – generics in particular – need to step up being transparent about their waste treatment, the antimicrobial activity limits they set, and data of actual residual activity presence in their effluents, as well as about the performance of their suppliers on this subject
- Many people, including children, in developing countries lack access to any type of antibiotics, which causes more deaths than AMR in these particular areas. While excessive use of antibiotics causes AMR and needs to be stopped, improving access to antibiotics, while still effective is equally important.
This alignment in messaging currently happening around the globe gives me hope. I am also excited and encouraged to see that more companies, governments, scientists, NGO’s, public – private partnerships and individuals are getting involved and driving awareness and action to curb antimicrobial resistance.
More needs to be done to connect the dots
The second thing that struck me is that no matter how promising and encouraging our progress is, we are not yet winning against AMR. If we don’t move at a faster pace, we WILL go back to the pre-antibiotic era, in which the most common of diseases and treatment and surgery will again lead to many deaths and a steep rise in healthcare costs. A frightening reality. The WHO’s report on AMR published in September 2017, already said AMR is spreading faster than new medicines can and will be introduced into clinical practice. Meaning we are close to a public health crisis if we fail to keep our existing antibiotics effective. As I said before, for now they’re all we have.
To keep existing antibiotics effective, we need to connect the dots by adding up the many observations on the issue of AMR with solutions we know are there. In my opinion, we need to start by drastically increasing and intensifying collaboration; both within our industry as in public-private partnerships and platforms, and act as a single front to stop the misuse and overuse in humans and agriculture.
We must also actively drive the solutions known to us for cleaning up the antibiotics residues that enter our environment. Moreover, on this particular subject, key influencers, being regulators and tender-issuing agencies such as buying consortia and health insurers, form an essential dot. To be able to really make the difference, they must take leadership and responsibility in improving education, create awareness on appropriate use and push for responsible manufacturing. Regulators can do the latter by setting standards in a regulatory framework, while buying consortia and health insurance companies should include environmental criteria in their sourcing decisions.
From DSP’s perspective, as global leader in sustainable antibiotics, we have a responsibility. To people who depend on our medicines, now and in the future, as well as to our planet. It is time all antibiotics manufacturers recognize and act on this responsibility and clean up their production methods and supply chains, like originator pharma companies have started to do. In the absence of formal mechanisms, we can and should already start today. Together we can share good practices, develop higher standards for antimicrobial activity levels in waste and implement these globally. Transparency of supply chains should be regulated and environmental criteria should become part of every sourcing decision for antibiotics.
To make this our reality, many more – and especially generic antibiotics manufacturers – will need to join the battle by allying with collaboration platforms. So far only a few out of the estimated two hundred generic antibiotics manufacturers have joined the existing collaboration platforms, such as the AMR Industry Alliance or PSCI, and only the ten biggest were selected to take part in the Access to Medicines Foundation AMR Benchmark. So far not even half of the global antibiotics manufacturing capacity is represented in these initiatives. This says enough about our need to expand and intensify industry collaboration, and indicates the need to speed up action.
My take on this: yes, we have momentum. Now it’s time to push through. A single company can only do so much. Strength is in numbers, so I welcome you to join me in collaborating, and to fight for our future and that of generations to come.