Where Are We in the Fight Against AMR?
In recent years, global awareness about the threat posed by drug-resistant microbes has increased, particularly within global-governance bodies such as the G20 and the United Nations. But awareness alone will not rescue us from "superbugs," which could claim more than ten million lives per year by 2050.
LONDON – To mark the second anniversary of the British government’s Review on Antimicrobial Resistance (AMR), which I had the honor of chairing, two members of the Review team – Anthony McDonnell and Will Hall – and I have published a new book: Superbugs: An Arms Race Against Bacteria. In it, we discuss the Review’s ten recommended interventions – what I call the Ten Commandments – while considering the progress made so far, and the work that still needs to be done.
The first part of the book provides a detailed history of our understanding of bacteria and drug resistance, and points to evidence that drug resistance may now be rising faster than we had assumed. For example, colistin, which is generally regarded as one of the last usable antibiotics in humans after others have failed, is losing its effectiveness, owing to overuse in animal farming, notably in China. And, equally disturbing, reports of drug-resistant strains of gonorrhea are becoming more frequent.
In the Review, we predicted that if current trends continue, ten million people could die every year by 2050, at a loss of some $100 trillion in global economic output since 2015. But now there is reason to fear that the situation could turn out even worse. To ensure that it does not, the second part of the book focuses on solutions, and compiles expert viewpoints from many of those we interviewed for the Review.
On a positive note, there has been progress on two of the three “supply” interventions that we recommended. First, financing for early-stage research and development is growing. Just recently, new joint funding initiatives were launched by the British and Chinese governments, the Wellcome Trust, the United States’ Biomedical Advanced Research and Development Authority (BARDA), and the Danish pharmaceutical company Novo. If this support is sustained, the Review’s recommendation of $2 billion in additional R&D funding over the next five years will be within reach.
Second, the number of researchers working on AMR seems to be growing. In fact, I like to joke that in Northern England, AMR research centers probably now outnumber the cities that have agreed to devolution deals under the government’s northern powerhouse plan. The progress made in these two areas gives me hope that similar advances can be made elsewhere. But further progress will require less talk and more action from government and industry leaders.
That is especially true of the pharmaceutical industry – the target of the third “supply” intervention we proposed. Rather than focusing solely on short-term profit margins, the industry must invest more in R&D and the production of new treatments.
Representatives of the 25 largest pharmaceutical firms, I am told, met on the fringes of the World Economic Forum’s annual meeting in Davos this year to discuss AMR, agreeing to remain engaged on the issue. In other words, they agreed to keep doing nothing. The industry’s failure to back earnest rhetoric with concrete actions is becoming increasingly frustrating. The largest 25 firms could easily persuade key governments to act on the Review’s recommendation for a market-entry reward. With a prize of $1 billion or more for the development of new treatments to combat AMR, far more firms would start to pursue their own R&D.
That points to the need for governments to do more as well. Following the Review, AMR was finally put on the G20’s agenda, both at the 2016 summit in Hangzhou, China, and at last year’s summit in Hamburg, Germany. This year, the G20 summit will take place in Buenos Aires, Argentina, and one can only hope that world leaders will start to act on the statements of the past few years, not least by piloting a market-entry reward.
A market-entry reward is crucial because it would also help to advance two of the Review’s six “demand-reducing” interventions: the development of new vaccines and improved diagnostics. Two years ago, we pressed Western countries to start requiring rapid diagnostic tests as a prerequisite for all antibiotic prescriptions by 2020. Not surprisingly, no government welcomed this idea. But, unless effective diagnostics become more embedded in health-care systems, we will not be able to reduce unnecessary antibiotic usage and ensure effective treatments for patients with a genuine need. So, market-entry rewards should be extended to innovations in diagnostics, too.
There has been some progress on the remaining four Commandments – greater public awareness, improved sanitation, improved surveillance, and dramatically reduced usage of antibiotics in agriculture – but not enough. The World Bank, the World Health Organization, and the International Monetary Fund need to shine a brighter spotlight on countries that are not investing in their health systems. And the United Nations needs to follow through on commitments made at the high-level meeting on AMR in September 2016. That means taking steps to improve surveillance and compliance, and pressing the UN’s 193 member states to implement the “One Health” national action plans agreed to in 2015.
With respect to agriculture, some major Western food producers and distributors have indicated that they may develop their own AMR action plans. To that end, they should all agree to start labeling their meat and fish products with color codes denoting the amount of antibiotics that went into their production; and they should refuse to buy or sell any products that have used colistin.
Overcoming the AMR threat is entirely feasible. But confronting it will require us to turn words into action. By getting out of our comfort zones now, we can avoid far worse discomfort down the road.