The AMR Benchmark tracks what pharmaceutical companies are doing to bring antimicrobial resistance under control. It evaluates 30 companies, including those with the largest R&D divisions, the largest market presence, and specific expertise in developing critically needed medicines and vaccines. In 2018, GSK and Johnson & Johnson lead among the large research-based pharmaceutical companies, while Mylan leads the generic medicine manufacturers and Entasis leads in the biotechnology group. The Benchmark finds room for all companies to improve, as well as evidence of good practice.
Figure 1: Antimicrobial Resistance Benchmark – company performances
The radials compare how close companies are to achieving 100% of their maximum potential score. 13 companies achieve over 50%.
Three groups of companies are evaluated: large research-based companies, generic medicine manufacturers and biopharmaceutical companies. Two companies lead the large research-based pharmaceutical companies: GSK, which has the largest antimicrobial pipeline for priority pathogens, and Johnson & Johnson, which has a focus on tuberculosis. Mylan, Cipla and Fresenius Kabi lead the generic medicine manufacturers. Mylan and Cipla are active in stewardship and are the only two in this group to report having equitable pricing approaches. Of the 12 biopharmaceutical companies, the strongest performance comes from Entasis, particularly when it comes to planning ahead for access and stewardship of clinical-stage candidates.
Large research-based pharmaceutical companies
GSK and Johnson & Johnson lead, followed closely by Novartis, Pfizer and Sanofi. GSK leads all research areas, with the largest antimicrobial pipeline (55 projects) for resistant pathogens. Johnson & Johnson also delivers a strong performance, with a focus on antibiotic stewardship for tuberculosis.
Pfizer, Novartis and Sanofi are close behind the leaders. Pfizer has a pipeline of seven projects and is involved in a number of educational and surveillance programmes, sharing data. Sanofi performs strongly in R&D. Novartis also performs well, especially in Manufacturing & Production and Appropriate Access & Stewardship.
Shionogi and Merck & Co., Inc. follow. Shionogi is transparent on its activities in combating AMR, and has uncoupled the remuneration of its sales staff from the volume of antibiotic sales. Merck & Co., Inc. has 16 antimicrobial R&D projects in its pipeline, and is involved in multiple AMR-related educational activities for healthcare professionals.
Roche has a low performance in this group. It has been historically active in antimicrobials, concentrating in only a few markets. It is now taking steps to re-enter the field of AMR.
Figure 6. Comparing scores: large research-based pharmaceutical companies
Generic medicine manufacturers
Mylan, Cipla and Fresenius Kabi lead the 10 generic medicine manufacturers in scope. All three are active in stewardship. Mylan and Cipla are the only two companies in this group to report equitable pricing approaches. Fresenius Kabi performs well for its environmental risk-management strategy.
Aurobindo and Teva performed equally well in the Manufacturing & Production Research Area. Macleods has filed two of its newest antibiotics for registration in several low- and middle-income countries. Lupin and Aspen performed moderately in Manufacturing & Production. Neither Aspen, Aurobindo, Lupin, Macleods nor Teva reports any information regarding stewardship, despite producing antimicrobials for the market.
Dr. Reddy’s and Sun Pharma disclose limited information about their AMR responses.
Disclosure among generic medicine manufacturers is generally lower than among the other two groups of companies.
Figure 8. Comparing scores: generic medicine manufacturers
The biopharmaceutical companies in scope are all developing important antimicrobial candidates. Of the 12 biopharmaceutical companies included, the strongest performance comes from Entasis, particularly when it comes to planning ahead for access and stewardship of clinical-stage candidates.
Entasis is followed by Polyphor, Summit and Tetraphase and then MGB Biopharma, Nabriva, and The Medicines Company.
Entasis, Nabriva and Wockhardt have the largest pipelines targeting resistant pathogens. Together with Tetraphase, Entasis also stands out for ensuring access or stewardship initiatives are in place for antibiotic candidates in late-stage clinical development. However, only Tetraphase has developed a concrete access and stewardship provision for one of its late-stage products.
Only five out of the 12 companies assessed explicitly include an access and/or stewardship commitment or plan for products in their clinical pipeline.
Figure 10. Comparing scores: biopharmaceutical companies
There are important products being developed. Yet, there are too few to replace the antimicrobials now losing effectiveness. The pipeline needs to be further strengthened. Once candidates reach late-stages of clinical development, they must be supported by concrete plans to ensure they will be accessible yet used responsibly when they reach the market.
For products already on the market, the Benchmark finds some examples of companies addressing both access and stewardship. All companies should look at how they can expand these practices, particularly for antibiotics that fall into the WHO Essential Medicines List under the ‘Access’, ‘Watch’ and ‘Reserve’ categories. Such products must take priority as companies review their strategies for improving access and for stewardship.
Governments and other funders must act to ensure the antimicrobial market can offer sufficient commercial incentive to keep pharmaceutical companies active in this space: for example by acting on commitments to develop additional and robust market-shaping mechanisms that support access objectives, stewardship, global supply and quality. Governments and NGOs can forge partnerships with pharmaceutical companies to ensure antimicrobial supplies are sufficient to meet demand, with reliable supply chains, and support pharmaceutical companies in managing the access and stewardship of antimicrobials.
The goal of the Antimicrobial Resistance Benchmark is to guide and incentivise pharmaceutical companies to adopt and implement effective actions for tackling the problem of AMR. It highlights where good ideas for limiting AMR are being implemented and where action is still required.
To fairly compare the companies in scope, the Benchmark has evaluated companies only in metrics that are relevant to their businesses and has compared their performances in three groups: large research-based pharmaceutical companies, generic medicine manufacturers and biopharmaceutical companies.
To read more about the metrics and analytical framework for making the 2018 AMR Benchmark, see this link.