As bacteria become increasingly resistant to the world’s existing armoury of antibiotics, effective new drugs are desperately needed. But an increasing number of pharmaceutical companies are abandoning the unprofitable quest to develop novel antimicrobials.
The non-profit Access to Medicine Foundation tried to track the activities of pharma and biotech companies in the fight against drug resistance with its AMR Benchmark, the second edition of which will be launched in 2020.
Jayasree K. Iyer, executive director of the foundation, talks to SciDev.Net about the challenges facing drug companies and the case for investing.
What exactly is the AMR Benchmark?
The AMR Benchmark is a tool that we created to evaluate how the pharmaceutical industry is tackling the issue of antimicrobial resistance (AMR). We create metrics to measure how big pharma and biotech companies are doing in terms of responding to the different needs that must be addressed when tackling AMR. And it’s a platform for sharing best practice.
We launched the first edition of the Benchmark in 2018 in Davos. We are now in the data collection phase for the next iteration, which we’re aiming to bring out in 2020.
“As smart people who are trying to safeguard global health we need to curb this today before the problem becomes much bigger,”
Jayasree K. Iyer, executive director, Access to Medicine Foundation
What did the last one tell us about what pharma companies are doing, or not doing?
The last Benchmark was a baseline evaluation of where the industry is today. We worked with companies who have committed to the Davos declaration on AMR and we looked at what they were doing on research and development, manufacturing, and access and stewardship. We learned that almost every company is doing something to address the problem of appropriate access and resistance. But the scale of the interventions were different.
We definitely need more effective antibiotics and vaccines to combat the emergence of resistance… We evaluated companies to see if they were planning ahead on how these products will be made appropriately, to be accessible and to delay the emergence of resistance. The first finding was that among the clinical stage pipeline, there were very few projects that had that level of thinking in place. Out of 28 antibiotics in the late stage of production, only two have both access and stewardship plans [such as education programmes] in place.
How can pharmaceutical companies be persuaded to invest in new antibiotics?
We do need to look at bringing the pharmaceutical industry back into developing new antibiotics and making sure they are produced in a sustainable way. To do that we need a good mix of financial and non-financial incentives – for example making sure companies recognise they are not going to be able to sell products that are used in hospital settings such as cancer products, unless hospitals are also able to provide antibiotics. There’s a very strong investment case that needs to be strengthened.
At the same time companies need to recognise that they need to put patients before profit. They also need to recognise that in order to make the kind of revenues that are necessary to sustain a business in the pharma industry, they need to ensure the production of antibiotics, because we need a safe healthcare zone. In the last few years we’ve seen a lot of companies being squeezed. Years ago, we had Eli Lilly, Bristol-Myers Squibb, AstraZeneca leaving the [antibiotics] market entirely. In the last year, we’ve seen companies like Novartis leaving novel antibiotic development.
Why is this happening?
[Drug companies] recognise that the business case is not strong. Antibiotics are not valued as much as other products in the healthcare system. There’s no market guarantee that antibiotics are going to be purchased in order for them to sustain production.
In many circumstances, antibiotics are priced so low that it’s not an incentive for the pharma industry to produce them anymore… If we don’t start looking at securing the supply and demand of antibiotics in a more sustainable way, we may be forced down the line to pay double, triple, 500 times more when fewer and fewer suppliers are on the market, because they can charge anything they like. To prevent that problem downstream, we need to think hard today about what incentives are in place.
What needs to change?
We definitely need the commitments from companies, but we also need the commitment from governments to buy antibiotics and put forward incentives that de-risk innovation into novel antibiotics. And some of that is in place. But what is lacking are pull incentives that guarantee that there is going to be a paying market for antibiotics.
How can we ensure that the cycle of resistance doesn’t continue with new drugs?
Governments must recognise that people need to use antibiotics effectively, and that means supporting education — of healthcare practitioners and citizens, who need to understand that if you do take an antibiotic, you should finish the course.
A second level would be making sure the guidelines for antibiotic usage and the diagnostics for antibiotics are available, so that healthcare practitioners are able to make the right choices when administering products. The third element is infection control. If you have infection control then the number of infections that a country has to deal with is drastically reduced. And it’s simple things like handwashing, cleanliness and keeping [hygiene] standards in hospitals high.
The last thing would be to recognise that the basic need of a healthcare system is a reliable supply of antibiotics. Today we are facing serious shortages and stock-outs in antibiotics. When a doctor does not have access to the right antibiotics, it leads to resistance, it leads to errors, it leads to delays, to increased hospital costs. It’s happening everywhere in the world and it’s not talked about enough.
There’s been a lot of awareness-raising about AMR, with the crisis likened by some to climate change. How do you see the scale of the threat?
When AMR became important at the political agenda, I initially thought “why?” Why are we bringing this up today? I think the answer comes very simply… Resistance is here. It is happening more often than we realise it. As smart people who are trying to safeguard global health we need to curb this today before the problem becomes much bigger.