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6/28/2018 - Posted in  Pharmaceutical Affairs

Superbugs: a slow start for pharma companies

Our expert's opinion

"Lord O’Neill, chief economist of the financial group Goldman Sachs, is a bit worried by the slow start of pharmaceutical companies in the fight against superbugs (which are bacteria that became resistant to antibiotic drugs). This market requires a lot of investment - we are talking $40 billion - over the next 10 years, but it could save 2.500 times that amount by 2050. A long-term vision is truly needed if we want to save a maximum of lives. Numerous pharmaceutical companies said that they were going to act, but right now, almost none of them did. O’Neill is proposing to impose a new tax on other drugs that would gather funds to create a reward for companies that successfully developed new AMR (Antimicrobial Resistance) antibiotics. I think that it is a great idea because on top of helping to launch the fight against superbugs, it will create R&D opportunities in big pharma over the next years."

- Antoine Desprez, Associate Consultant

Lots of talk but little action means we risk losing the arms race against superbugs

Next month will mark the two-year anniversary of the publication of the review into antimicrobial resistance (AMR) that I led for the then Prime Minister, David Cameron.

Leading that review was possibly the most stimulating job I have ever done, not only because of its importance, but also because of the global nature of the antimicrobial resistance threat, and the complexity and diversity of issues the challenge presented.

In our review we outlined a scenario showing that, if we lose the arms race against bacteria, 10 million lives could be lost globally by 2050. Yes, 10 million, on top of the accumulated economic cost of those deaths and lost productivity to the world economy of $100 trillion.

In our final recommendations we proposed 27 specific interventions that would require investment of around $40 billion over a decade across the world to avoid these huge losses.

As one sharp-minded hedge fund friend of mine said when I told him our findings: “You mean $40 billion over 10 years saves $100 trillion over 35?” noting that this was a return on investment of 2,500 per cent. That was a good line, and is how everyone should think about the challenge.

Of course, $40 billion is a huge amount of money but it is actually less than the three leading US pharmaceutical companies spent between 2010 and 2015 when they bought back their own shares.

They did this to improve their performance, believing this was more attractive to shareholders than investing in the search for desperately needed new antibiotics.

Our 27 policy proposals covered 10 separate but related areas, which have become known as the 10 commandments. In speeches I give these days on AMR, I usually preach about these commandments, and the progress - or lack thereof - in each since we published our review.

Reflecting on the findings of the review and on some of the evidence that is reported, the rise of antimicrobial resistance is occurring faster and in more places than we ever dreamt of.

The number of reported incidents of resistance to the so-called last line antibiotic, colistin, is especially concerning.

As far as the 10 commandments are concerned, there are some areas where there has been significant and welcome progress since May 2016. Two of the most encouraging ones are the number of new researchers in the field and the amount of early stage funding that is coming into the space.

Various bodies ranging from the Wellcome Trust, the Biomedical Advanced Research and Development Authority in the US, and Novo, parent company of drug firm Novo-Nordisk, have all announced various financial commitments, alongside the UK and Chinese governments.

Indeed, the amounts announced in the past couple of years, if sustained, are equal to the money we suggested was necessary over a five-year period to fight AMR. On top of this, new AMR research centres appear to be popping up all over the place.  

A number of UK universities, including Manchester, Sheffield, Surrey, and no doubt many others, have begun researching AMR, adding to the existing work of Liverpool, Southampton and the London School of Hygiene and Tropical Medicine.

Sadly despite endless talk and broad acceptance of our recommendation of so-called market entry rewards - where a lump sum would be given to the successful producer of a new antibiotic developed under clear conditions - no government or pharma company has actually done anything other than talk.

In January 2015 there were more than 70 signatories to what became known as the Davos Declaration when pharmaceutical companies pledged to combat AMR through a variety of actions. But since then, no major pharmaceutical company has taken any fresh action.

At each of the G20 meetings since our review was launched, and at the United Nations high level meeting on AMR in 2016, governments have discussed the threat of antibiotic resistance, particularly the importance of greater surveillance and raising public awareness.

But no major government has launched any new initiatives or programmes. There has been a lot of talk, but no action.

It is disappointing to see that the UK government’s global and national efforts to fight AMR seem to have faded, alongside the rightly much-lauded leadership it showed on the issue when our review was launched. The government should put this part of “global Britain” back at the top of its priorities.

The chief medical officer, Professor Dame Sally Davies, has been a passionate and committed flagbearer in the fight against AMR but we need the PM and senior cabinet ministers to start banging the drum again.

The UK government’s global and national efforts to fight AMR seem to have faded
Lord O'Neill
Along with no new specific initiatives on new drugs, the other two big disappointments remain the absence of any developments on vaccines and diagnostics. There is a lot of evidence that in many countries, including the most developed, overprescription of antibiotics is high.

The government must prioritise the development of diagnostics - what I call Google for doctors - when giving new money to the NHS as they have the potential to save vast amounts of money, reduce hospital visits and cut unnecessary prescriptions.

Without rapid, state-of-the-art diagnostics at the point of care it is difficult for health professionals to resist patient pressure to prescribe antibiotics.

And then there is agriculture. At a recent conference, I was highly critical of the many animal and food industry people present, who spend far too much time and effort lobbying.

They say that misuse of antibiotics in their industry is less of a problem than my review suggested and claim to have made great progress.

The food industry and farmers may be making stronger efforts but they need to do more. In our review we called for a ban of so-called last line antibiotics in agriculture, like colistin.

But no one in the agriculture industry accepts this ban, insisting they need access to such drugs in the event of a crisis.

This isn’t good enough, and certainly doesn’t set the right example to those in the developing world and the United States, where the use of antibiotics in agriculture is much greater.

One idea might be to ask the International Monetary Fund to include health system preparedness as part of its assessment of a country’s economic position.

This would bring AMR prevention into the mainstream of economics and finance - as our original review sought to do - and could be one way of solving this  worrying threat.

Source: The Telegraph


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