Fighting Microbes with Money

ThinkstockPhotos-488724343Antimicrobial resistance (AMR) is a serious problem. In 2014, the Prime Minister described it as having the potential to cast us back “into the dark ages of medicine”. This month, the Government added AMR to the National Risk Register of Civil Emergencies, threatening that around 80,000 people could die if there was a widespread outbreak of a resistant microbe. Thankfully, the first quarter of 2015 has seen a series of announcements pledging money and resources to fight the global health security risk posed by AMR. The Society’s Policy Officer, Dr Paul Richards, has broken down who announced what and when.

Hidden away in the UK 2015 Budget was the Government’s announcement of a £195 million ‘Fleming Fund’ that will see them working with the Wellcome Trust and other global organisations to improve surveillance networks in low- and middle-income countries. Although the details of the fund are yet to be announced, this figure represents a substantial sum, particularly given that the Medical Research Council have estimated that the UK’s spending on AMR research between 2007 and 2014 totalled £275 million.

The UK research councils have already committed £28.5 million to support AMR research, while the Government’s current initiatives, which include AMR surveillance, infection control and prescribing practices, were described in the UK 5 Year AMR Action Plan. It’s not just the UK committing funds; in January, it was announced that President Obama’s 2016 Budget proposal would seek to double the US Federal Government’s investment on tackling AMR to nearly $1.2 billion.

In February, the European Commission’s ‘Horizon 2020’ funding programme opened calls for the €1 million ‘Horizon Prize for Better Use of Antibiotics’, which has set the challenge of developing a cheap and easy-to-use diagnostic test to distinguish between upper respiratory-tract infections that require antibiotics and those that do not. Similarly, the Longitude Prize was launched in 2014, with a £10 million prize pot available to those developing a point-of-care diagnostic tool that can differentiate between bacterial and viral infections.

Money Talks

Direct funding is not the only way that money is being used to fight AMR: economics are also being used to incentivise both policy makers and businesses to take action. Most recent policy reports or news stories are set against a backdrop of the societal and economic costs of inaction.

It is not surprising then that last July, the UK Prime Minister commissioned renowned economist Jim O’Neill – rather than an eminent policy professional or academic – to chair an independent Review on Antimicrobial Resistance. The review is strongly focused on addressing the international economic issues surrounding AMR, such as the costs of inaction and the funding and market incentives needed to jump-start action from academia and industry.

While emphasising the health security threat posed by AMR, the Prime Minister’s announcement of the review noted that Britain could lead the way in antimicrobial development with its “world-class pharmaceutical sector – which employs thousands of highly-skilled experts and is a key part of the country’s economy”. It appears that economic gain from potential growth in AMR has acted as an additional incentive for the Government to engage with this issue.

The Review’s first report, published in December 2014, employed economic modelling to highlight AMR as a “crisis for the future health and wealth of nations”. Focusing on just six of the most common resistant infections, the report estimated that by 2050 AMR could account for 10 million extra deaths per year, and could lead to a cumulative cost of $100 trillion through lost productivity and increased health care costs. Those headline figures certainly grabbed the attention of international media.

January saw the publication of the Review’s second report, which detailed under-investment in financial and human capital as a key barrier to tackling AMR. For example, the report highlighted that between 2010 and 2014, US National Institute for Health spending on AMR was $1.7 billion, over 15 and a half times less than that spent on cancer over the same period. The report highlighted such funding disparities as a barrier to scientists and clinicians entering and sustaining a career working on AMR and infectious diseases, and urged international investment in this area. Another headline recommendation was the establishment of an international ‘blue sky’ innovation fund to tackle under-investment in the fundamental and mid-stage research that is needed to drive the development of new antimicrobials and diagnostics.

It is welcome to see high-profile flagging of the need for a strong academic, public health and small industry research base if we are to tackle AMR. Indeed, when the Review surveyed companies and organisations involved in antimicrobial development, early stage grant funding ranked slightly higher than higher market prices as the top solution that would likely lead to better research outcomes. The need for a strong AMR research community is certainly something the Society for General Microbiology recognises and is something we are working with other learned societies to support.

Market Failure

Launching the Review on AMR last July, the UK Prime Minister said, “There is a market failure; the pharmaceutical industry hasn’t been developing new classes of antibiotics, so we need to create incentives”. It is clear that this is the case based on the Review’s survey of companies and organisations involved in antimicrobial development, which found that 80% of 40 companies who responded rated economics as the biggest barrier to investment; this is despite 70% of those respondents who had invested in antibiotics in the 1990s having made a profit.

The problems with the antimicrobials market were neatly summed up at the Chatham House debate I attended in February. Dr Nick Cammack, GlaxoSmithKline’s Senior Vice-President and Head of Medicines Development for Diseases of the Developing World, noted that, confusingly, disinterest in the antimicrobial market arose in part due to its very success, as competition and market fragmentation resulted in less returns on investments. Dr Cammack also emphasised the unique scientific challenges associated with antimicrobial development, which lead to an extremely protracted development pipeline. Professor Kevin Outterson, from the Centre of Global Health Security, highlighted the paradoxical problem policy makers face in that they need to bring about reductions in antimicrobial use, while at the same time incentivising pharmaceutical companies to enter what will be a shrinking market. It will be interesting to see how O’Neill’s Review on AMR tackles this challenge in its next report, which will outline actions to incentivise the antimicrobials market.

It is worth noting, however, that the rise of AMR on the policy agenda could act as an incentive in itself. Pharmaceutical giant Merck completed its $9.5 billion acquisition of Cubist in January, which was driven by interest in Cubist’s antibiotics portfolio. Could we be on a cusp of an antimicrobials ‘gold rush’?

Going Global

We live in an increasingly globalised world and AMR certainly does not respect international borders, so any hope of stemming its rise depends on a coordinated international response. The UK and Swedish governments were instrumental in pushing for the development of a WHO global action plan on AMR last year, which has been drafted and will be submitted to the World Health Assembly in May.

Although world leaders will hopefully adopt the action plan, the big question remains: ‘who will pay?’ Speaking at the Chatham House event, both Dr Manica Balasegaram from Médecins Sans Frontières and Dame Sally Davies, the UK Chief Medical Officer, noted the recent response to Ebola and highlighted that international funding to support the WHO is often not forthcoming.

While high-income countries are well placed to tackle AMR, they will need to provide additional sustainable infrastructure and capital – above what they have already dedicated nationally. Many low- and middle-income countries lack the health infrastructures to fund and support basic infection control, let alone public AMR surveillance and education programmes. The announcement of the UK Government’s Fleming Fund is welcome in this respect, but is likely only a small proportion of the financial support that will be required for an effective global response. It will also be interesting to see if the international community heeds the recommendations being made by the O’Neill Review on AMR to improve the research base and incentivise the antimicrobials market.

Paul Richards

The Society for General Microbiology recently launched the Small World Initiative, which will get school pupils, university students and the public involved in sampling soil for antimicrobials. We hope to at least highlight the challenges faced by both researchers and pharmaceutical companies in developing viable antibiotics.

Image Credit: PeterHermesFurian/Thinkstock
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The 2015 Annual Conference in tweets

This year, the Society for General Microbiology Annual Conference took place from 30 March – 2 April at the International Convention Centre (ICC) in Birmingham. Feedback from attendees and the sheer number of tweets (over 3,000) that used our conference hashtag #sgmbham during the event showed what a success it was. We’ve picked out a few of our favourite tweets below so you can get an idea of what happened over those four fantastic days.

We always welcome first timers to our conferences…

As well as those who have been there, done that, and come back again.

Some people learnt new things.

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Zoo animals need ‘good’ bacteria, just like us

Carpenters work with wood, artists with paint, but what if the main material in your job was monkey poo? That’s the reality for Dr Suparna Mitra who presented her research on the gut microbiome of zoo animals earlier this week at the Annual Conference. This work could eventually lead to better health and welfare of captive animals.

It’s not just monkeys that are the subject of this fascinating study. Working in collaboration with Banham Zoo, the team, led by Dr Lindsay Hall from the University of East Anglia and Institute of Food Research, have been looking for ‘good’ bacteria in the guts of around 60 species of mammals, birds, reptiles and insects.

We know that humans get health benefits from having good gut bacteria, but there hasn’t been a comprehensive study to find out if the same could be true for zoo animals,” Suparna explained. “Our work is in the early stages but it looks very likely that the within the zoo community – including monkeys, lemurs and exotic birds – animals do have some of the same good bacteria as humans.” Continue reading

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Towards a universal coronavirus vaccine: science fact or science-fiction?

8413670095_703d97c772_zNew research being presented today at the Annual Conference describes how the blood serum of people who have recovered from the SARS (serious acute respiratory syndrome) coronavirus can neutralise the MERS (Middle East respiratory syndrome) coronavirus, which was recently discovered in Saudi Arabia. Keith Grehan from the University of Kent’s Viral Pseudotype Unit has been researching the possibility of a vaccine that protects against multiple coronaviruses, which may ultimately prevent, or help control, future outbreaks of SARS, MERS, or whatever the next emerging coronavirus might be.

Coronaviruses cause many diseases, including SARS, MERS and even the common cold. Unlike colds, SARS and MERS are serious respiratory diseases; SARS caused an outbreak of severe pneumonia in China in 2002 in which almost one in ten of the 8098 reported cases were fatal.

MERS emerged in the Middle East in 2012 and while the outbreak continues, the rate of serious disease has been low. This could be because, having learned lessons from SARS, the public health response has been effective; it could be that MERS simply isn’t as infectious as SARS; or MERS may be very infectious but without causing disease in all cases. Continue reading

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Get into the groove: Tackling antimicrobial resistance with synthetic genes

4368294723_8a7a405804_b“Biotechnology is set to be the next industrial revolution, and I didn’t want to miss it!” That’s what Chemical Engineer, Emilio Cortes-Sanchez said when asked why he turned to microbiology in his search for new antimicrobial treatments. Emilio’s work was presented earlier this week at the Society’s Annual Conference.

Antimicrobial resistance (AMR) is a growing problem, worldwide. According to a recent review commissioned by the UK government, AMR could cost millions of lives in the coming years if we don’t take action.

Around 60-70% of all known antibiotics are produced by a family of bacteria called actinomycetes. Some of these molecules are too toxic to use in humans but are providing the inspiration for chemists and microbiologists working in collaboration at Strathclyde University, who are searching for new antimicrobial therapies. Continue reading

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Reservoirs of resistance

4561258496_c2320133f3_bWhen we think about the spread of antibiotic resistance, many of us think of a clinical setting, with its associated hospital-acquired infections, or inappropriate use of drugs. Yesterday at the conference, David Graham, Professor of Environmental Engineering at Newcastle University, described his research looking for other reservoirs of resistance.

David began studying the transmission of and spread of resistance genes in the early 2000s. Initially, he and his colleagues were interested in the use of antibiotics in US agriculture, but in order to understand other drivers of resistance, his group needed to find places in the world that didn’t use the drugs in the same way as the US, which led them to the Almendares River in Cuba.

Although antibiotics are used sparingly in Cuba compared with the US, Graham’s group were still able to identify numerous genes in the river related to antibiotic resistance. The results of this work showed a high correlation between the presence of antibiotic resistance genes and sources of industrial pollution, with increased levels of resistance found near solid waste landfills and pharmaceutical factories.

This work suggested that human activity plays an important role in the broader dispersal and development of resistance, but what role do humans themselves play? To try and answer this question, David travelled to India to take samples from the Ganges, one of the world’s great rivers, which stretches over 1,500 miles from its source in the Himalayas to the Bay of Bengal in Bangladesh. Continue reading

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Diabetics face a brighter future thanks to microbiome research

ThinkstockPhotos-177334698New approaches to the management of debilitating diabetic foot ulcers may be on the horizon, thanks to new microbiome research. Today at the Society for General Microbiology Annual Conference, Eleanor Townsend from the University of the West of Scotland is outlining the first comprehensive analysis of the range of bacteria found in the diabetic foot ulcer microbiome.

Diabetes is on the rise, affecting at least 3.2 million people in the UK. Along with the immediate problem of managing blood sugar, there are several very serious complications that can occur.

Severe skin ulcers are one of the worst problems faced by patients with diabetes. These chronic open wounds are typically on the foot or lower leg, can be extremely difficult to treat, easily become infected and can get so severe that it is necessary to amputate the affected limb.

Researcher Eleanor Townsend explained, “In the worst cases, the dead tissue [in these ulcers] goes all the way down to the bone. It’s a huge challenge for diabetes clinics to manage such intractable wounds and they require a three pronged attack: antimicrobial treatment; removal of dead, damaged, and infected tissue; and high-tech dressings.” Continue reading

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