Antimicrobial-resistant infections are an increasing global threat, serious enough that in July 2014 the then-UK Prime Minister David Cameron asked Lord Jim O’Neill to lead a major independent Review on Antimicrobial Resistance, to analyse the global challenges posed by antimicrobial resistance (AMR) and to propose international solutions to tackle the problem.
Two years on, the Review has published several reports addressing different aspects of the AMR challenge and set out its final recommendations. These outputs have regularly featured in the news, and the team has engaged broadly with experts and stakeholders internationally, including governments, multilateral bodies like the World Health Organization, academia, industry and healthcare providers. Anthony McDonnell, Head of Economic Research for the Review on AMR, joined us for last month’s Policy Lunchbox event to discuss the Review’s work.
Getting the world worried
To help change behaviour and illustrate the seriousness of AMR, the Review drew on existing evidence showing that drug resistance is already a global problem. Importantly, they also used economic models to predict and outline future global costs if no action was taken. The headline figures from this work – that AMR could cause 10 million deaths a year and a cumulative economic cost of $100 trillion US by 2050 – have been very widely cited.
Quoting statistician George E. P. Box’s “all models are wrong but some are useful”, Anthony acknowledged that these simplified models are imperfect, but important for stimulating interest and debate. In reality, the models likely underestimate the potential impacts of AMR because they used a selection of key infections and ignored many secondary impacts, such as lost productivity from increased sick leave and greater risks associated with routine medical treatments.
Demand and supply problems
To develop workable solutions to tackle AMR, the Review investigated how excessive and unnecessary usage and demand for antimicrobial drugs in human health and agriculture is contributing to the emergence and spread of drug resistance.
Anthony explained that another key part of the problem is the failure of the antimicrobial research and development pipeline to deliver new antibiotics to replace those becoming ineffective. There has been little incentive for pharmaceutical companies to develop antibiotics over recent decades due to their high research and development costs. These drugs can take a decade or more to develop, with little guarantee of a return on the investment.
Demand for a new antibiotic will likely only increase substantially once there is widespread resistance against already existing (cheaper) generic drugs; this is coupled with a logical desire to minimise use of a new antibiotic to keep it as a last line of defence. Therefore the highest demand for a new antibiotic – and the largest revenue its sales will generate – may only come near, or beyond, the end of its patent, meaning the company may struggle to recoup its development costs.
Setting out solutions
The Review recommends 10 areas of global action to tackle the supply and demand underpinning the AMR challenge.
To reduce unnecessary demand for antibiotics and other antimicrobial drugs, key recommendations include: a massive global public awareness campaign to educate both consumers and prescribers; a drive to reduce extensive use of antimicrobials in agriculture; and supporting the development of new rapid diagnostics for infections so that antibiotics are used more effectively.
To improve the pipeline of new antimicrobial drugs, the Review’s recommendations include: a Global Innovation Fund of up to US$2 billion over five years to support early-stage research on antimicrobials and diagnostics; and market incentives to reward research and development of new antimicrobials.
So who will foot the bill? Anthony highlighted that governments will eventually pay for AMR either way. However, US$40 million – the estimated 10-year cost of the Review’s proposals – is much less than the US$100 trillion that AMR could cost the world by 2050. G20 countries allocating just 0.05% of their existing US$7 trillion healthcare spend is one of several funding options proposed by the Review.
As Anthony highlighted, whether it be building flood defences, preventing climate change or tackling Ebola, humanity has a history of acting too slowly. Getting the international community to look beyond the short-term costs will be a key challenge.
Moving from talk to action
Anthony was asked by attendees of the Policy Lunchbox whether we would see tangible actions from the Review’s proposals. He noted that the Review has served its purpose – to propose solutions and promote discussion – and that the baton is now in the hands of policy-makers. However, he was hopeful that some of the Review’s proposals would be taken forward by the international community at the G20 and United Nations summits later this year.
Indeed, some progress has already been made over the course of the Review, such as the UK and China agreeing to each contribute US$50 million to a Global Innovation Fund and the UK Government’s Fleming Fund, which will partly aim to improve surveillance of AMR in low- and middle-income countries. These are, however, initial steps and greater sustained investment and action, driven by international collaboration, will be required to tackle AMR head on.
You can download the Review on AMR’s reports from their website.
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