The UK Government’s plan to address antimicrobial resistance (AMR), announced at the World Economic Forum in Davos, and widely reported in the media shows genuine leadership. While this important intervention builds on the G20 commitment to combat AMR, some areas that could form a crucial part of the solution are worth highlighting.
Through the second half of the last century an antibiotic revolution transformed healthcare and society benefited from the discovery and launch of a number of new mechanism antibiotics which allowed physicians to keep ahead (largely) of AMR. However, in recent decades, no new mechanism antibiotics have been introduced. We have seen improvements to existing antibiotics but in many cases, despite evidence, old and sometimes inappropriate antibiotics continue to be used.
Ironically, this is partly a result of efforts to tackle AMR. Hospitals, under cost pressures and pressure to keep antibiotics in reserve, are reluctant to prescribe these new antibiotics. But new drugs must be used to support a healthy development ecosystem for antibiotics, ultimately for the benefit of patients. Clinicians and healthcare systems need to promote stewardship, but leaving new and innovative drugs on the shelf is not the solution. A lack of adoption of new antibiotics has had a profoundly negative impact on patients and AMR. Reduced investment threatens the industry’s ability to respond to new threats: large pharma has generally abandoned antibiotics and investors are put off by the lack of commercial return. Our hopes lie with academia and the smaller companies, like mine, who continue in the space.
Industry needs to be more creative with research and development, for example in developing clinical trials that better demonstrate the wider societal value of new antibiotics. Governments have their role by maintaining inward investment mechanisms into innovative antibiotic research in academia and smaller companies. At the market facing end, incentives that reward innovative antibiotics are required to ensure a return on the capital invested in R&D.
A healthy funding environment will support innovation. There are reasons for optimism here, as with greater understanding of bacterial genetics, it is possible to produce new mechanism, targeted antibiotics that can improve patient outcomes and provide options to beat AMR. These antibiotics also promote good stewardship by matching the right drug to the right infection, allowing valuable broad-spectrum agents to be kept in reserve for the most difficult cases.
Published in the Financial Times Letters to the Editor 7th February 2019
