The new Antimicrobial Resistance Benchmark report provided a reality check on the progress pharmaceutical companies are making on antimicrobial resistance (AMR). It reports that companies are expanding their efforts against AMR – for example to discourage overselling by sales agents – yet change is not happening at the scale needed. The 2020 AMR Benchmark was launched during an Affiliated Session of the 2020 WEF Annual Meeting. The AMR Benchmark is funded by the Dutch and UK governments.
The session was opened by Bruno Bruins, Minister of Medical Care for the Netherlands, who confirmed that he will use the results of the AMR Benchmark to trigger further action when meeting with pharmaceutical companies. He affirmed that antimicrobial resistance remains a key priority for the Dutch Ministry of Health, which convened international One Health meetings on the topic in 2014 and 2019. The panel discussion was moderated by Professor Dame Sally Davies, UK Special Envoy on AMR and co-convener of the UN Interagency Coordination Group on AMR. The agenda focused on revitalising the infrastructure for developing and deploying antibiotics to reach more patients around the world.
The urgent need to improve access to antibiotics was a recurring theme during the panel discussion. Charlotte Petri Gornitzka, UN Assistant Secretary-General and Deputy Executive Director, Partnerships, UNICEF, made the strongest plea for better access, in particular to child-friendly formulations of antibiotics for children living in low- and middle-income countries. She referred to a recently published UNICEF technical note on the topic, which points out that, in 2016, better access to antibiotics would have prevented many of the 6.3 million deaths among children under five.
Different tools for motivating pharma companies
A central question for the panellists was on the best approaches to motivate pharmaceutical companies to do more to curb drug resistance. In his answer, Alex Harris, Head of Global Policy and Advocacy at Wellcome Trust, highlighted the importance of using both carrots and sticks. He particularly called for "push" incentives to be complemented by new financial “pull” incentives, which would support companies developing novel antibiotics. Several governments are currently piloting such incentives, such as the “Netflix” model being piloted in the UK, which aims to replace a pay-per-pill approach with contractual “subscriptions” to antibiotic supply.
Peter Sands, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria, said that the AMR Benchmark can be a useful tool for all global health stakeholders interested in partnering with the private sector. For example, the Global Fund is the biggest purchaser of antimicrobials in the world and it will look at the results of the AMR Benchmark to explore how company performance could inform procurement decisions.
Speaking on behalf of GSK, one of the last large R&D-based pharmaceutical companies to remain committed to anti-infectives R&D, Thomas Breuer, Chief Medical Officer at GSK Vaccines, confirmed that the company will make its raw surveillance AMR data available to researchers via the AMR Register developed by Wellcome Trust and the Open Data Institute. The 2020 AMR Benchmark reported that GSK has not yet fulfilled a past commitment to data-sharing. Thomas Breuer said that, although it is taking longer than expected, the company remains committed to taking this step.
Re-inventing the antibiotics space
Speaking before the panel discussion, Jayasree K. Iyer, Executive Director of the Access to Medicine Foundation, made the point that the tough market conditions for antibiotics must be replaced through a mix of public and private investment. The aim would be to ensure a healthy ecosystem of pharmaceutical innovation, production and supply: “The 2020 Benchmark shows that pharma companies are stepping up – but we can’t take their commitment for granted and wait for more companies to abandon this vital area of modern medicine.”
In the same week, the need for coordinated and international efforts to curb AMR was underscored in a new Lancet editorial. It drew on key findings from the 2020 AMR Benchmark to set out the scale of the challenge in improving appropriate access to antibiotics, especially in low-income and middle-income countries (LMICs). Other articles on the issues facing the antibiotics market and on the Benchmark findings can be found here.
Announcing an Investor Year of Action on AMR
AMR is a material risk and opportunity for investors in pharmaceutical companies. During the WEF event, Jeremy Coller, CIO and Chairman of Coller Capital, announced the launch of the Investor Year of Action on AMR, a new collaboration between the UK Government, the Access to Medicine Foundation, the FAIRR Initiative and the Principles for Responsible Investment. The aim is to encourage and guide investors to use an “AMR lens” when making decisions and engaging with companies.
In a statement to the press, Matt Hancock MP, UK Secretary of State for Health and Social Care said “The UK has played a central role in working to ensure antimicrobial resistance is contained and controlled by 2040. Mobilising the global finance industry to innovate and find solutions to resolve such a significant problem is key to unlocking the advancements we need. I am incredibly proud to be supporting the first-ever Investor Year of Action on AMR to galvanise global commitments to address AMR.”
Setting out the materiality of AMR
The “AMR lens” was set out in more detail during two webinars hosted by the Access to Medicine Foundation on 28 and 29 January, and joined by more than 100 investors. Taking the Benchmark findings as the starting point, the Foundation’s Investor Engagement Manager, Bowen Gu, worked through the main materiality factors facing the industry in relation to AMR.
For the global economy, the economic costs associated with drug-resistant infections could equal those of the 2008 global financial crisis, according to the World Bank. Specifically for the pharmaceutical sector, AMR poses a risk to profitable therapeutic areas. Oncology, for example, depends on antibiotics to enable safe surgery as well as treatments that compromise the immune system. The Norwegian Cancer Society has warned that many treatment options will disappear entirely due to antibiotic resistance. Slides and audio from the webinar are available on request.
2020 AMR Benchmark –Key Findings in brief
Antibiotics are not being made widely available in low- and middle-income countries through registration filings or supply strategies: only three of the 13 on-patent antibiotics in this analysis are filed for sales registration in more than 10 of the 102 countries where better access is urgently needed; and when it comes to older, but still useful, antibiotics, companies are supplying just 14 of 30 so-called “forgotten” antibiotics to low-income countries.
10 companies are either decoupling bonuses from sales volumes or refraining from deploying sales agents for antimicrobials. This compares with five companies in 2018. One company (Teva) sets a new best practice by not having a sales force to promote any of its antibacterial or antifungal medicines. By decoupling bonuses from sales volumes, or not using sales staff, companies mitigate against overselling antibiotics and driving resistance.
A new standard has also been set when it comes to companies sharing what they know about the spread of resistance, with Pfizer becoming the first to share raw data from a surveillance programme in an open-access online register. Hospitals and governments need to know where resistance is developing so they can adapt treatment guidelines.
Since 2018, a few more clinical-stage antibiotics are supported by plans to ensure better access and good stewardship soon after launch: eight candidates out of 32, compared with two out of 28 in 2018 (25% up from 7%). However, the development of such plans remains patchy. Planning ahead while R&D projects are in clinical development accelerates access and stewardship for successful candidates after launch.
Companies’ environmental risk-management strategies for minimising the impact of their manufacturing processes on resistance are more comprehensive than in 2018. Most companies are now requiring third-party suppliers to meet comparable standards. Releasing manufacturing waste into the environment can contribute to AMR, as bacteria present in water and soil are exposed to antibacterial ingredients, which can trigger the emergence or selection of resistance genes.