It is hard to imagine how differently we would treat life threatening diseases including cancer, pneumonia and tuberculosis today, or how outcomes from surgery (for example hip and knee replacements) would vary, if Sir Alexander Fleming had not made his legendary discovery in 1928.
But in some ways antibiotics have been a victim of their own success becoming ubiquitous in care settings; not just in modern healthcare systems but across other industries such as agriculture, horticulture and brewing. As with any naturally occurring bacterial resistance, the more we use, the more resistant we become, and we now face the problem of soaring numbers of antibiotic-resistant infections. The issue we face is multi-factorial and global – bugs do not respect borders and defining optimal regimes is far from straightforward.
That is why in the UK, Health Secretary Jeremy Hunt was right to say earlier this year that "there are few public health issues of greater importance"1. Indeed, our Chief Medical Officer Professor Dame Sally Davies has warned that "If we don’t take action, in 20 years’ time we could be back in the 19th century where infections kill us as a result of routine operations"2.
At the ABPI we are looking forward to taking part in discussions, with Dame Sally and others, at the forthcoming Chatham House conference Antimicrobial resistance: Incentivizing change towards a global solution. It is important that we work in partnership to start to address the issues, which operate on number of levels. For example, we need to consider not only responsible stewardship in prescribing, but also to think boldly about innovation – both in terms of the science and in relation to extant commercial and regulatory structures.
From an industry perspective, the idiosyncrasies of the antibiotic market mean that returns on research and development are very difficult to recoup (the risk involved in research is significant and costs of development of a single medicine can stretch to over £1bn spanning 12 years). There remains a fundamental challenge in figuring out how to decouple returns from usage as low prices of antibiotics are not offset by high volumes of usage. I believe a reasonable response requires a mixed approach of both push and pull incentives, and we would welcome the opportunity to engage with the Department of Health (DH) and other stakeholders to further explore potential ideas in more detail It is also useful to note the scientific challenges around the development of antibiotics, and the potential for the UK to play a role in encouraging innovation in this field should be considered within the UK Life Sciences Strategy to ensure the particular challenges posed by research in this field are appropriately reflected.
We appreciate that such a severe problem will undoubtedly require complex and manifold solutions. We warmly welcome all ongoing discussion on the issue from the DH and look forward to the pharmaceutical industry having an ongoing voice in the debate.
ABPI Chief Executive