A call to an­timi­cro­bial arms

Financial Mirror (Cyprus) - - FRONT PAGE - By Jim O’Neill

In De­cem­ber, I re­ported the first find­ings of the Re­view on An­timi­cro­bial Re­sis­tance, which I chair. The news wasn’t good: Re­sis­tant in­fec­tions al­ready claim more than 700,000 lives a year. Un­less ac­tion is taken, an­timi­cro­bial re­sis­tance will kill ten mil­lion peo­ple a year by 2050 – more than the num­ber of peo­ple who cur­rently die from can­cer. It will also have a cu­mu­la­tive cost of at least $100 trln, more than 1.5 times to­day’s an­nual global GDP.

We are not do­ing nearly enough to com­bat this dan­ger. The world ur­gently needs new drugs to re­place the an­tibi­otics, anti-malar­ial regimes, anti-retro­vi­ral AIDS and HIV med­i­ca­tions, and tu­ber­cu­lo­sis treat­ments that are los­ing ef­fec­tive­ness. But we do not in­vest enough in re­search and devel­op­ment. It is crit­i­cal that we find new sources of fund­ing to sup­port the aca­demic re­searchers and small com­pa­nies whose dis­cov­er­ies foun­da­tions for to­mor­row’s medicines.

That is why I am call­ing on in­ter­na­tional donors – phil­an­thropic and gov­ern­men­tal alike – to work with the Re­view on An­timi­cro­bial Re­sis­tance to cre­ate a new fund to sup­port R&D in this im­por­tant area. The fund will pro­vide grants for blue-sky science and act as a non-profit in­cu­ba­tor for promis­ing dis­cov­er­ies. Over the com­ing months, the Re­view will be work­ing out the de­tails of how such a fund could op­er­ate ef­fec­tively.

The prob­lem is straight­for­ward: As valu­able as sci­en­tific break­throughs may be, it takes a lot of work to turn them into mar­ketable drugs. And, be­cause an­tibi­otics gen­er­ally pro­duce low – and some­times even neg­a­tive – re­turns on in­vest­ment for the phar­ma­ceu­ti­cal mak­ers that de­velop them, many com­pa­nies and ven­ture cap­i­tal funds steer clear. The Re­view is study­ing ways to align fi­nan­cial in­cen­tives for



the de­vel­op­ing new an­timi­cro­bial drugs more closely with th­ese medicines’ true so­cial value.

But time is of the essence. New drugs take decades to dis­cover and de­velop. Even if we were to fix ev­ery prob­lem in the devel­op­ment pipe­line to­day, it would be at least an­other ten years be­fore the first new an­tibi­otics be­came com­mer­cially avail­able. In the com­ing months, the Re­view will make rec­om­men­da­tions re­gard­ing mar­ket in­cen­tives for de­vel­op­ing new an­tibi­otics and search­ing for po­ten­tial al­ter­na­tives – such as vac­cines – to the use of th­ese drugs in agri­cul­ture. The Re­view will also high­light in­no­va­tive ap­proaches to ad­dress­ing re­sis­tance.

In its most re­cent pa­per, the Re­view has iden­ti­fied spe­cific mea­sures that could pro­vide a start­ing point for the fight against an­timi­cro­bial re­sis­tance. The first is the cre­ation of the in­no­va­tion fund to sup­port early re­search. In ad­di­tion to pro­vid­ing money for ef­forts to de­velop new drugs, the fund should en­cour­age re­search into di­ag­nos­tic tools, sur­veil­lance meth­ods, tech­niques to slow the devel­op­ment of re­sis­tance, and so­cial and eco­nomic stud­ies of con­sumer be­hav­ior. This kind of ba­sic re­search is where med­i­cal in­no­va­tion starts, and the sums in­volved need not be huge to make a sig­nif­i­cant dif­fer­ence.

We should also in­vest more in the peo­ple who will solve the prob­lem. Ev­i­dence seems to show that young sci­en­tists and doc­tors are re­luc­tant to en­ter fields re­lated to an­timi­cro­bial re­sis­tance.

We need to nur­ture the next gen­er­a­tion of aca­demics, sci­en­tists, hos­pi­tal work­ers, and phar­ma­ceu­ti­cal tech­ni­cians.

Gov­ern­ments, for their part, should work closely with com­pa­nies that pro­duce di­ag­nos­tic tools and sur­veil­lance tech­niques, and sup­port use­ful tech­nolo­gies as they are de­vel­oped. It is es­sen­tial that coun­tries work to­gether to gain a bet­ter un­der­stand­ing of how an­timi­cro­bials are used around the world.

And, fi­nally, we need to de­velop new treat­ments that use al­ter­na­tive doses and com­bi­na­tions of ex­ist­ing drugs. Like­wise, we should re­con­sider po­ten­tial med­i­ca­tions that never made it to mar­ket be­cause of side ef­fects that could now be ren­dered safe.

In the com­ing months, I will travel to In­dia and China to dis­cuss an­timi­cro­bial re­sis­tance with se­nior pol­i­cy­mak­ers and com­pa­nies. Both of th­ese coun­tries are par­tic­u­larly vul­ner­a­ble.

By 2050, an­timi­cro­bial re­sis­tance could im­pose a cu­mu­la­tive eco­nomic cost of $20 trln on China – equiv­a­lent to about two years of its cur­rent GDP. Even more wor­ry­ingly, by then China could be los­ing one mil­lion peo­ple per year to re­sis­tant bac­te­ria and mi­crobes. In In­dia, the death toll could reach two mil­lion a year.

It is statis­tics like th­ese that have led me to con­clude that the fight against an­timi­cro­bial re­sis­tance must be placed high on the G-20’s agenda. It is my hope that China, when it as­sumes lead­er­ship of the G-20 in 2016, will play a con­struc­tive role in this re­gard.

A so­lu­tion to an­timi­cro­bial re­sis­tance need not be ex­pen­sive. It is likely to cost the world much less than 0.1% of global GDP. Weighed against the al­ter­na­tive – $100 trln in lost pro­duc­tion by 2050 and ten mil­lion lives lost ev­ery year – it is clearly one of the wis­est in­vest­ments we can make.

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