[Ip-health] Nature Reviews Drug Discovery - An Audience with Jim O'Neill

Thiru Balasubramaniam thiru at keionline.org
Tue Aug 2 00:30:11 PDT 2016



Jim O'Neill

Nature Reviews Drug Discovery 15, 526 (2016)
doi:10.1038/nrd.2016.160Published online 29 July 2016

Drug-resistant superbugs could claim 10 million lives a year and cost the
global economy a cumulative US$100 trillion by 2050, found a recent
UK-commissioned report into the risks of antimicrobial resistance (AMR).
The sobering analysis, chaired by former Goldman Sachs chief economist Jim
O'Neill, called for global funders to direct up to $40 billion towards
various efforts to tackle the growing scourge. But although O'Neill
advocates $1 billion market entry rewards to encourage pharmaceutical
companies to develop new therapeutics, he also argues that the industry as
a whole has not been sufficiently engaged in finding creative solutions.
It's time for industry to start thinking differently, he tells Asher

How much thought had you given to AMR before being commissioned by the UK
government to lead the review?

That's easy: none. I'm one of the billions of people who didn't know what
it was. I couldn't even pronounce antimicrobial resistance for a number of
weeks. But it has turned out to be one of the best things I've ever done.

What was your review process?

I made some very strong decisions right at the start. First, although I was
encouraged to form an expert advisory group, I chose not to do that because
I thought it would constrain my and my team's ability to be open minded.
Second, I consciously decided to stay away from the World Health
Organization (WHO) and many experts in the early stages of the process
because it seemed to me that if we were going to make a difference we would
have to think differently from the experts.

My message to my small team of 5.5 people was to try to think ambitiously.
One of our missions was to drag all the key participants out of their
comfort zones, because otherwise there won't be any chance of solving this

What was the biggest surprise?

I was very surprised at how narrow-minded and unambitious the
pharmaceutical world is in thinking about the problem of financial business
models for antibiotics. This is especially true when I reflect back on my
own industry and the chaos that the financial industry was in in the middle
of 2008. A large number of people saw that crash coming, but they just
didn't see the scale and timing of the damage that would ensue. When I look
at AMR, the supposed lack of attractive returns for industry on
antibiotics, and the enormous and seemingly strong price-to-earnings ratios
of pharmaceutical company shares, I see parallels that suggest that
cutting-edge players in the pharmaceutical industry should behave
differently. They don't show a lot of what I love to call 'enlightened self

You recommend a mixture of old and out-of-the-box ideas about how to create
financial incentives to attract industry into AMR research. What was
industry's response?

They welcomed everything in the report, apart from the section that says
they'd have to spend more money.

I think they are being unimaginative. At Davos, Switzerland, this year, 85
companies signed a declaration calling on governments to develop new and
alternative market models for antibiotics. This was a great development. If
someone had said 2 years ago that all these companies would have done this,
I would have said “no chance”. But when it comes to actually changing
anything about their own role they are very reluctant to go down a
different path. I think that industry needs to make a Davos declaration 2
in which they put more on the table in terms of what they are prepared to
spend and do, because otherwise policy-makers might end up doing things
that they really won't like.

A lot of the pharmaceutical world thinks that our 'pay or play' proposal —
in which we suggest that pharmaceutical companies could either pay a fee
into an AMR research fund or invest directly in internal antibiotic R&D
programmes — just came out of my team's head. But policy-makers are
attracted to ideas like this because they look at the pharmaceutical
industry and see a staggering amount of apparent profitability and a
seeming reluctance to pursue genuine research in areas that are difficult
and don't have obvious revenue streams.

How are policy-makers and funders responding to your call to free up $40
billion over 10 years for AMR initiatives?

Ask me again in October. Hopefully on 4–5 September the G20 will publish a
communiqué about how to get and pay for new drugs when they meet formally
in Hangzhou in China. But I won't know whether that will be the case, or
how strong their statement will be, until after that meeting. There could
also be a United Nations agreement on this in September.

But a number of things we proposed are already happening. We called for the
creation of a global innovation fund to support preclinical research into
antimicrobial products, and the recent launch of CARB-X provides evidence
that this is happening (Nat. Rev. Drug Discov., 29 Jul 2016).

Although the UK government commissioned your report, AMR is a global
problem and requires a global response. The European Union (EU)'s
Innovative Medicine Initiative has taken a lead here, coordinating a few
international AMR collaborations (Nat. Rev. Drug Discov. 13, 711–713;
2014). Could the United Kingdom's vote to leave the EU put a damper on this

I was in Brussels recently and was quite worried that some of the meetings
might be cancelled because of the Brexit decision. But, encouragingly, they
were not. This is a global problem, and it affects people whether they are
in the EU or not in the EU, and I think this is still widely appreciated.

But there's no two ways about it: the UK population's vote to leave the EU
has invited a major economic challenge. It will not be helpful.

More information about the Ip-health mailing list