[Ip-health] FT Editorial: Pull together to prevent a superbug apocalypse

Thiru Balasubramaniam thiru at keionline.org
Sat May 21 01:51:30 PDT 2016


Pull together to prevent a superbug apocalypse

Drug companies need market incentives to generate new antibiotics

Jim O’Neill, UK Treasury minister and former Goldman Sachs economist, has
focused the world’s attention on drug-resistant superbugs as one of this
century’s greatest global health threats. The final report of his Review on
Antimicrobial Resistance, commissioned by the UK government, combines
actions to cut excessive antibiotic consumption, which stimulates the
evolution of drug-resistant microbes, with incentives to develop new drugs.

Although the report’s 10-point plan is full of excellent proposals, early
comments have targeted one of its most eye-catching and least
well-thought-out ideas: a “play or pay” scheme. Pharmaceutical companies
would either pay a levy into a pooled global fund to support antibiotic
research and development or demonstrate that they are investing an
equivalent amount or more in R&D.

70% of the antibiotics in the US defined as medically important for humans
are sold for agricultural use

While the global pharma industry bears some responsibility for the current
crisis — most companies cut back hard on antibiotic development because
they foresaw a poor potential return on these new drugs — the best way to
refill the pipeline is through offering better incentives at all stages,
from early research through clinical trials to regulatory approval. Because
new antibiotics would be prescribed sparingly to avoid resistance emerging,
the normal rules of drug marketing would not apply; instead of income from
sales companies would receive a “market entry reward” of up to $1.3bn for
each qualifying drug.

“Play or pay” is potentially divisive and threatens to alienate the
industry whose wholehearted co-operation will be essential if the world is
indeed to defeat superbugs. Another argument against the idea is that
companies might start token antibiotic R&D programmes to avoid the levy,
without a strong commitment.

The costs of taking global action against antimicrobial resistance,
estimated by Lord O’Neill at up to $4bn a year over the next decade, will
have to come from somewhere. Although we are generally wary of imposing new
taxes, there is a good argument for imposing one on antibiotics used in
agriculture and human medicine, most of which are cheap off-patent
compounds; an antibiotics tax could not only raise money but also reduce
demand for these overused products by making them more expensive.

But the main financial contribution will have to come from the public purse
— and as Lord O’Neill points out, this will be small compared with the
cumulative economic cost to the world of $100tn by 2050 if no action is
taken against drug-resistant microbes.

Almost as important as generating new antibiotics is cutting demand for
existing ones. Science will be important here too, for improving diagnosis.
If family doctors can tell through a quick test whether a patient’s sore
throat, for example, is caused by bacteria susceptible to drug treatment,
they can avoid unnecessary prescribing of antibiotics for viral infections
“just in case”.

The review is also right to urge restraint on farmers who use antibiotics
on a vast scale to prevent infection or promote growth rather than to treat
sick animals. One of the most shocking figures in the report is that in the
US, 70 per cent of the antibiotics defined as medically important for
humans are sold for agricultural use.

Action along the lines recommended by Lord O’Neill is urgent and should not
be deflected by arguments over a “play or pay” levy. Antibiotic resistance
must be high on the agenda at key global meetings this year, particularly
the G20 chaired by China in September. Few other issues are as important
for human health and welfare.

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