Following the publication of the second O’Neill report yesterday, Tackling a global health crisis: Initial steps, Chair of the ABPI’s Antibiotic Network Mark Lloyd Davies considers the steps that need to be taken to ensure antibiotics research is no longer seen as the ‘poor relation’ of the medical research field.
The challenges facing our society from antimicrobial resistance (AMR) are well-known, and prompted David Cameron’s announcement last year of a review, led by internationally renowned economist Jim O’Neill. In his initial report last year, O’Neill predicted that AMR could kill an extra 10 million people a year and cost up to $100 trillion by 20501 if the global spread of ‘superbugs’ is not halted. The rationale for appointing an economist to lead the review, was the recognition that market failure was at the root of the issue. Mr O’Neill’s stark figures were believed to be the first to quantify the potential financial impact of AMR and served to make the case to global policy makers that urgent action is needed. Whatever the solution, O’Neill estimates that tackling the problem is likely to cost the world less than 0.1% of global GDP – a cost that can be spread across ten to fifteen years. Presented in these terms there is an economic benefit to action, besides of course the tremendous impact on humans of failure to act.
The publication of the second O’Neill report yesterday, Tackling a global health crisis: Initial steps, sets out a first set of recommendations. Five specific actions are recommended, but the idea that has attracted the most attention is that of establishing a global “innovation fund” of $2 billion to speed development of much-needed new antibiotics. According to O’Neill, a targeted fund would support the kind of research needed to pave the way for new drugs, alternatives to antibiotics and more accurate diagnostics. Other recommendations in the report include re-examining new doses or combinations of existing drugs, training a new generation of scientists and improving how we track the spread of resistance. There are no ‘quick fixes’ here.
Incentivising research into antibiotics by setting up a targeted fund is a further call upon global policy makers for public action. A lot of innovative thinking is happening in infectious disease research at the moment, thanks in part to companies’ research efforts and in part to public-private partnerships in the US (Biomedical Advanced Research and Development Authority) and Europe (Innovative Medicines Initiative, New Drugs for Bad Bugs). But we urgently need to develop these ideas and scale up research. Often, lack of funding acts as a barrier to enabling innovation to flourish, and the creation of a targeted fund could support the blue-sky science that is needed to pave the way for new drugs.
As the ABPI has pointed out on previous occasions, there is currently little incentive for industry to undertake expensive R&D in this area. As we know, bringing a new antibiotic to market is a risky business, and reimbursement is notoriously poor. Taking into account the high development costs, the wide availability of cheaper generics and the perverse incentive that prescribers have to hold back newer drugs as a ‘last line of defence’ in the face of growing resistance, there is little wonder that historic investment in this area has been light.
Others have begun to ponder how to provide a viable economic model to stimulate antibiotic development, proposing idea such as ‘de-linkage’, where return on investment would be decoupled from unit sales. However, today’s report reserves judgment on these issues to a later date. Mr O’Neill’s review team will investigate market incentives further before making recommendations in this area.
Many practices of modern medicine - from chemotherapy to surgery - are only made possible by antibiotics. Yet antibiotics have long been undervalued. Today’s report represents an important step forward in the global fight to find new ways to tackle the problem of AMR. Concerted action is needed to ensure that antibiotics research stops being perceived as the ‘poor relation’ of the medical research field.
Mark Lloyd Davies
Chair of the ABPI’s Antibiotic Network
1Antimicrobial resistance: Tackling a crisis for the health and wealth of nations, The Review on Antimicrobial Resistance Chaired by Jim O’Neill, December 2014, accessible here.