Growing antimicrobial resistance has the potential to have tremendous costs to society in future. Here, Anthony McDonnell summarises the proposals of a new paper aimed at dealing with this issue.
Antimicrobial resistance (AMR) is the name given to the phenomenon of microbes such as bacteria, parasites and viruses that evolve to become immune or resistant to the drugs we use to kill them. This is a major problem facing the world in the near future. Already AMR kills at least 700,000 people every year, adds $20 billion in additional medical costs just to the US healthcare system alone, as well as having a large impact on the labour market.
The Review on Antimicrobial Resistance was set up by Prime Minister David Cameron in July 2014 and chaired by the economist Jim O’Neill. Its aim is to give economic and policy recommendations to tackle this problem globally. Our first paper was launched in December and using work commissioned by KPMG and RAND we estimated that if this problem is not dealt with more than 10 million people will die every year by 2050 and 3.5 per cent will be wiped of the world’s GDP, costing us 100 trillion USD over the next 35 years.
On the 14th of May, the Review launched its third paper looking at how to stimulate the drugs pipeline for antibiotics. Whilst only one part of the solution to AMR, better drugs are urgently needed to kill highly resistant bugs, that could otherwise cause havoc to modern medicine.
Our analysis of the antibiotics that have been recently approved and those at various stages of development shows a mismatch between what we know the world needs, given emerging levels of drug resistance, and the size and quality of the pipeline to address this growing challenge.
We estimate that only about 2 per cent of promising molecules in antibiotics succeed in becoming a drug and that there is an average of about 15 years between research on an antibiotic starting and it reaching the market. This is similar to lots of other drugs, but unlike other areas of medicine new antibiotics are usually no better than very cheap generics for patients who do not have a resistant infection. So often it is only when resistance rises to a level where a large number of people are affected that it makes sense for companies to invest in finding a cure. As it can then take 15 years to fine that cure, a large number of people will get sick and die in the intervening period.
An example of where this happened was methicillin resistant staphylococcus aureus (MRSA). MRSA started to appear in the late 1980s and was a major problem in the late 1990s and the early 2000s. It was not until the problem had started to become quite severe that a large amount of money was invested into combatting this superbug. It then took years before this investment materialised into drugs to treat MRSA. We now have a strong and growing arsenal to fight MRSA, but in the intervening years many people died or became extremely ill. Had a good drug been discovered in the early 1980s to fight MRSA, a huge amount of human suffering would have been avoided. However at the time it was not possible to predict that this would be an area of great clinical need in the future, so the investments weren’t made. We want to change the system so that companies who create useful drugs are guaranteed not to lose money, in order to stimulate investment in this area.
It is for this reason we have proposed that people who come up with new antibiotics, be they from pharma or elsewhere, should get a lump sum payment from a single global buyer (whether that be some new or existing body). This organisation would be able to either buy-out the rights to the drug completely and sell it at cost price, something which we estimate could cost $2-3 billion a drug (based on the return we think is necessary to get people to invest); or provide a guarantee that if a producer comes up with a good drug, they will not lose money at a probable cost of about $1-1.3 billion a drug (based on the average costs we’ve seen for R&D). This system would come with some guarantee that the company would conserve the drug. As well as securing investment, the advantage of this system is that it could help stop the overuse of antibiotics by removing companies’ incentive to sell them in large volumes, which would significantly reduce the build-up of resistance.
Further to this we have proposed setting up an industry-supported innovation fund to provide much-needed new money for early stage, ‘blue sky’ research, which is often too high risk for companies to take on. The long-term decline of antibiotic discovery initiatives has led to waning interest – and reduced funding – in the area within academia, and thus journal articles on new molecules can get very low citations, and academics often do not want to write about it. We also want the public sector to work more closely during clinical trials, which are the most expensive part of the R&D process, as they can provide infrastructure and patients that can be very expensive for the industry to replicate. We want companies to be more open about areas of research that have failed to deliver to reduce duplication. And we want countries to harmonise their regulation system so that registering drugs in different nations is similar and thus less burdensome.
We believe that these policies will play an important role in creating new drugs and help turn back the tide of resistance. Following on from this we will look at a number of areas, including how to improve the human use of antibiotics with better development and use of rapid diagnostics, reduce the use of antibiotics in animals, improve infection control, as well as assessing alternative therapies such as vaccines.
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Anthony McDonnell is the lead research economist on the Independent review into antimicrobial resistance, chaired by Jim O’Neill. He recently finished a master’s degree in public and economic policy at the London School of Economics, and previously worked as an assistant editor for LSE’s review of books blogs as well as undertaking several different research roles within the LSE.