Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime. It may seem an odd thing to link the Antimicrobial Resistance Review to this Chinese (at least according to Google) proverb, but this is really the heart of the issue.
How do we design policy to not only develop new antibiotics, but ensure that the right antibiotic is available where, when and in the amounts needed?
Yesterday the Review on Antimicrobial Resistance published its third paper1. Whereas the first report set out the global public health imperative of AMR, and the second outlined five immediate actions to improve antibiotic use, this paper sets out their thinking on how to achieve a sustainable supply of antimicrobials. In other words, how do we teach the world to fish. As we have set out earlier2, we think this is a very welcome direction for policy development.
The three key actions the AMR Review team propose (at a high level) are:
All three proposals head in the right policy direction for achieving a new deal for antibiotics, although there is still a lot of detail and discussion to be had.
The proposals for lump-sum payments for successful developers and the discussion around de-linking revenue from volume in the market for antibiotics echo proposals we have made recently about creating a sustainable business model for antibiotics. The report seems to tie these lump sum payments to successful development of a new in class, needed antibiotic (defining those criteria will be another challenge). What still remains to be addressed is what happens after development: the critical capabilities and requirements for manufacturing, regulatory approvals and delivery to markets around the world, which ultimately makes it possible to deliver the right antibiotics where they are needed, when they are needed and in the amounts needed.
Our industry has been particularly called on to support the Innovation Fund for early stage AMR research. The proposals for the fund aim to develop scientific understanding, take a fresh look at our current antibiotics and new combinations, and widen the scope for research and development. This sort of collaborative, creative approach to discovery and development sounds very much like the Innovative Medicines Initiative approach established over recent years. It’s a model worth considering.
Whatever else it has achieved, the O’Neill report sets the scene for global partnership to address antimicrobial resistance, and this is something that we should all engage in. We need to work together to find a sustainable solution that can regularly deliver the right antibiotics where they are needed, building both the pipeline as well as making the most of antibiotics available today (and soon to be available)3. We’re looking forward to talk fishing with Jim O’Neill.
Dr Virginia Acha Executive Director Research, Medical & Innovation