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Portfolio analysis

Access is a leading priority for half of antibiotics on WHO EML

Antimicrobials are losing their effectiveness at an increasing rate. To slow the rise of resistance, antimicrobials must only be used when needed. Yet millions of people cannot reliably access antimicrobials, so strategies are needed that also address access issues. In 2017, the WHO EML categorised antibiotics into three groups – Access, Watch and Reserve. The 2018 Benchmark has compared companies’ antimicrobial medicines against this list to show the balance of priorities between access and stewardship.

The Benchmark has compared companies’ portfolios against Section 6 of the WHO Model List of Essential Medicines (EML). Out of 741 marketed products, 268 correspond to antibiotics on the WHO EML. Most are in the Access group. This includes many that are also in the Watch group, meaning risk of resistance is higher. Access antibiotics should be widely available, affordable and quality assured. Reserve group antibiotics should only be used for the most severe cases when all alternative treatments have failed.

Figure 17. Companies in scope have at least 268 antibiotics on the WHO EML (Section 6).
Access: always on the shelf
Access antibiotics are first- and second-line treatments that should be widely available. Broad strategies are needed to improve access to them in countries where health systems are weak. Key elements include plans for widely registering antibiotics, affordability and strengthening supply chains.
Watch: a balancing act

To manage antibiotics in this group, companies must take a nuanced and weighted approach, developing suitable access plans that are integrated with stewardship practices that limit misuse and overuse and predict emerging resistance trends.

Reserve: the last resort
Antibiotics in the Reserve group are essential treatments against the most resistant pathogens. It is vital that companies engage in stewardship activities that promote the appropriate use of these antibiotics, while rigorously monitoring the growing threat of their resistance.

Changing supply and demand
The WHO EML antibiotic groups will likely influence demand from national governments. This will impact antibiotic supply chains, particularly for Reserve group medicines. Companies, governments and multi- lateral agencies must investigate how supply and demand are aligned as well as mechanisms for securing supply. Companies with many Watch and Reserve antibiotics must put strong governance and stewardship activities in place but governments and payers should maintain sufficient incentives to keep these medicines on the market.

For a full list of references, please see the 2018 AMR Benchmark report.

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