Does Big Pharma have the answers to antimicrobial resistance?
Antimicrobial resistance (AMR) poses one of the most important global health issues of the 21st century
Mortality associated with antibiotic-resistant infections projected to rise to 10 million people per year by 2050
New innovations are needed to tackle AMR, such as incentivising pharmaceutical companies to develop and research new antimicrobials.
Since the discovery of penicillin in the early 20th century, antibiotics have been marvelled as a “magic bullet”. This panacea was once thought capable of curing all types of bacterial infections. Development of other antimicrobial drugs—such as antifungals and antivirals—provided the arsenal to fight the repertoire of infectious microorganisms.
With the risk of mortality from infection in routine surgery, childbirth, and open wounds decreasing, the world was convinced that the war on infectious diseases had been won. Many pharmaceutical companies shared this belief, subsequently stopping their development of antimicrobials for more profitable and in-demand drugs.
However, antimicrobials are now both overused and misused worldwide; these factors are believed to have led to the development of antimicrobial resistance (AMR). AMR poses one of the most important global health issues of the 21st century. The O’Neill Report, commissioned by the UK Government and Wellcome Trust, projects that the incidence of mortality caused by antibiotic-resistant infections could cost the global economy up to 100 trillion US dollars and push about 28.3 million people into extreme poverty. These statistics must not be ignored if health-care professionals, stakeholders, and governments worldwide are to avert a post-antimicrobial apocalypse.
No new antibiotics have been produced since the 1980s despite the global outcry and need for new antimicrobials. Many pharmaceutical companies, however, are presented with several barriers to developing new antimicrobials: cost of the research and development pipeline, insufficient investment from stakeholders, and non-profitable and commercially unattractive returns from a one-off antimicrobial drug course. These barriers provide a possible explanation as to why pharmaceutical companies might not be inclined to develop new antimicrobials.
The lack of new antimicrobials and the increasing incidence of AMR highlight the impending threat to global public health. So what are the potential solutions to averting such crisis? The UK has taken the lead on the global arena in tackling AMR, laying out their 20-year vision. This plan incorporates three domains: prevention, innovation, and collaboration.
Modern-day medicine has progressed towards prevention-focussed strategies for several non-communicable diseases. In terms of AMR, global initiatives such as Antibiotic Awareness Week have been implemented. Reducing the commercial use of antibiotics in livestock to prevent AMR has also begun, in recognition of new WHO guidelines in relation to the farming and food industries.
The UK government additionally recognises that both innovation and collaboration are essential for tackling AMR. If pharmaceutical companies are to develop new antimicrobials, they must be incentivised to do so. At the 2019 World Economic Forum, UK Health Secretary Matt Hancock described incentives that ranged from upfront payments to pharmaceutical companies to a global prize fund for the development of a novel antimicrobial drug class. Our commissioned project therefore aims to explore strategies to incentivise pharmaceutical companies to research and develop new antimicrobials and diagnostics to tackle AMR.
AMR is a global issue. It is in no doubt that a global strategy—involving prevention, innovation, and collaboration across all government sectors and society—is essential to prevent a dystopian world without antimicrobials.
About the authors
Paul is currently a first-year medical student at King’s College London and has a strong interest in global health issues and creative writing. Twitter: @PaulKTang1
Vanessa is a student at Queen Mary University of London (QMUL) and has a keen interest in global health policy.
Ali is a student doctor at the University of Cambridge. He has a keen interest in global health issues and serves as the recruitment lead for Polygeia.
Enock is a 2018-19 Chevening scholar studying MSc Public Health scholar at London School of Hygiene and Tropical Medicine and Researcher with Polygeia. Twitter: @Enomark1979 Instagram: @Enomark2018
Sabina is a GP with an interest in infectious disease, global health and medical education. She is currently a MSc student at the London School of Hygiene and Tropical Medicine.
Rebecca currently works in the charity sector and is an editor with Polygeia. She has a strong interest in global health policy and infectious diseases.