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An Earnest Proposal for Tackling AMR

Despite global recognition of the threat posed by antimicrobial resistance (AMR), not nearly enough has been done to bring new antibiotics into development. With some drug makers now leaving the antibiotics market altogether, there is an urgent need for a realignment of incentives in this vital area of public health.

LONDON – Under Article 50 of the Treaty of Lisbon, the United Kingdom will leave the European Union on March 29, 2019. Presuming that it does (but even if it does not), the UK government should continue to lead the charge against antimicrobial resistance (AMR), as it has in the past. Specifically, it is time for the UK to join with pharmaceutical companies in piloting a new model of finance for investment in research and development of new antibiotics.

Over the course of my professional life, one of the most rewarding roles that I ever had was between late 2014 and September 2016, when I chaired an independent Review on AMR under the government of then-Prime Minister David Cameron. We were confronting a serious challenge to global health and prosperity, and our efforts were appreciated around the world. Soon thereafter, the United Nations General Assembly issued a high-level political declaration on AMR, and the topic was placed on the agenda at the G20.

Even more recently, the Health and Social Care Committee of the UK House of Commons published an updated report on AMR, in which it called for more substantive policies to encourage the production of new drugs. And this more or less coincided with the publication of The People’s Prescription: Re-imagining Health Innovation to Deliver Public Value, a report from the UCL Institute for Innovation and Public Purpose (IIPP) that calls on governments to “adopt a mission-oriented approach” to bring more drugs to market.

This added attention is most welcome. As I pointed out at an event for the launch of the IIPP report, the original Review on AMR was emphatic about the need for more financing at the early stages of new drug development. And, as it happens, this is an area where there has been genuine progress, thanks largely to financing from the US Department of Health and Human Services’ Biomedical Advanced Research and Development Authority and the Wellcome Trust. Moreover, government and philanthropic contributions are enticing some private businesses, and thus more AMR researchers, into the field.

Without the initial outlays from the US, the UK, China, and other governments, one doubts that private capital would have ventured into this area. Recent developments show that when the right conditions are put in place, there can indeed be a market for developing new antibiotics. Better yet, we still have other ways to strengthen incentives. There are now a number of academic studies showing that a $1 billion annual prize could bring a host of new antibiotics down the pipeline in the coming years.

Most of the recent academic proposals are in keeping with the model of “market-entry rewards” that we recommended in the original Review. I would add only that such prizes should come with certain conditions regarding the marketing and pricing of new drugs, especially in low-income countries.

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If the amount of money that has been pledged for early-stage funding is sustained over the next five years, the total could reach the $2 billion that we recommended in the Review. Yet, despite this momentum, no government has announced any plans to finance a market-entry reward.

Similarly, while there has been endless talk among pharmaceutical-industry executives about the need to bring new antibiotics through clinical trials and to the market, there has been absolutely no substantive action. Even worse, of the few companies that were already in the antibiotics business, some have actually exited the market since the Review was published; and still more seem to be heading in that direction.

Clearly, now is the time to introduce a market-entry reward. With this proposal in mind, I have been meeting with a number of relevant stakeholders in the UK, including committed MPs such as Kevin Hollinrake and officials at the Department of Health and the Association of the British Pharmaceutical Industry. I can report that all of the key public-sector stakeholders do want market-entry rewards; and I have even detected a slightly more serious attitude among industry leaders.

I can only hope they are being sincere. At a time when capitalism increasingly seems to serve the interests of the few at the expense of the many, they should think about who would bear the blame if we were to start running out of effective antibiotics.

Assuming that everyone is on board, I would propose that instead of expecting the government to put up the whole $1 billion for a market-entry reward – and in order to avoid inviting a revocation of industry-friendly regulations – British pharmaceutical companies should come together to contribute 50%. Imagine how encouraging it would be to see industry leaders standing next to the prime minister to announce the rollout of a jointly financed award for the creation of life-saving antibiotics.

To be sure, as my Review colleagues and I note in Superbugs: An Arms Race Against Bacteria, this proposal amounts to a mild form of “pay or play” capitalism. But it would also be a win-win for global public health.

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