Partnering to Combat Antimicrobial Resistance
This blog was first published on the author’s LinkedIn page on 1 February 2018.
Last week I had the chance to join in conversations on the current and future burden of antimicrobial resistance (AMR) at the World Economic Forum’s Annual Meeting at Davos. Building on the recognition from the UN, WHO, G7, and G20 that action is needed, I was pleased to see a broad recognition of the growing problem and the need for the public and private sectors to work together with government on creative solutions.
Infection can affect all of us, regardless of our age or where we live. Anti-microbial medicines are losing their effectiveness because pathogens change and find ways to resist the effects of antibiotics. Approximately 700,000 people are currently dying every year from drug resistance. If no solution is found, the impact could be devastating: minor infections and injuries could become life-threatening, while serious infections such as pneumonia could become impossible to treat.
Without intervention, the number of lives lost from AMR by 2050 could reach as high as 10 million per year, topping the number of oncology deaths, and the global cost to economic development could soar to as high as $3 trillion per year if current trends continue. This crisis is real, and it can be devastating.
A critical piece of the problem is that we do not have enough new antibiotics to fight these emerging resistant infections; it has been decades since a truly new innovative class of antibiotics has made it to market. In addition, the current pipeline is severely limited and insufficient to meet the growing public health needs. In a report released by the AMR Alliance, 22 companies currently invest more than $2B annually to develop innovative medicines. This is four times the $500M combined investment by all governments that has been reported by the German sponsored BCG report. But the AMR Alliance Report and last week’s Access to Medicine Foundation’s AMR Benchmark both cite the fragility of the market and need for new incentives, largely due to the difficulties in discovery of antibiotics, the lengthy and complex clinical development requirements, and the unique aspects of the commercial market.
In addition to the need for the development of new antibiotics and rational use of anti-infective drugs, experts agree that vaccines also play a vital role in the arsenal to address AMR. Vaccines are typically administered to prevent infections from happening in the first place, which naturally leads to reducing the use — and misuse — of antibiotics. We must support increased access to existing vaccines and stimulate additional vaccine R&D to help prevent infections that impact AMR.
There are a few strategies that industry, in partnership with governments, can take that I think will help to address this growing problem.
First, we need to take steps to preserve the effectiveness of existing antibiotics through good stewardship practices and surveillance of AMR patterns. Such efforts can help ensure that patients receive the correct antibiotic only if needed and for the right duration, and will also help physicians better understand current resistance patterns.
Pfizer currently sponsors one of the largest AMR surveillance programs in the world – called ATLAS – to inform healthcare practitioners and researchers about resistance trends in their regions and countries, and also support global health authorities in developing antimicrobial stewardship programs. We’ve also just announced a partnership with the Indian Council of Medical Research (ICMR) through which Pfizer has provided a grant of approximately US $1million to create a Centre to Combat Antimicrobial Resistance in New Delhi, to serve as a hub for the design and implementation of a comprehensive program focused on enhancing local surveillance, expanding AMR stewardship and improving advocacy and awareness efforts.
Second, we need to streamline the R&D process through regulatory harmonization and shortened clinical development timelines.
And third, we need new incentives to stimulate new R&D efforts. Because of the unique characteristics of the antibiotics market and the need to hold antibiotics in reserve for use with emerging resistant infections, the current incentives simply don’t work. What we need is a mix of push (e.g., R&D cost sharing, tax credits) and pull (rewards for successful development and approval) R&D incentives to spur new innovation and significantly increase sustainable investment across all stages of research and development.
The thoughtful discussion at Davos should serve as an impetus for further action from both industry and government in addressing this pressing global health issue. Going forward, industry, civil society, patients and governments must come together for a dialog around specific pull incentive proposals that will spur innovation for new medicines, while ensuring appropriate use and access. These conversations have started in the United States, and we look forward to similar dialogs in other countries.