Most companies support global efforts to track the spread of resistance

Pharma companies often have unique knowledge of resistance trends, which are particularly valuable where their data cover countries without national surveillance efforts.

Date

18 November 2021

  • AMR surveillance widely supported by pharma companies around the world

  • Benchmark compares efforts by eight pharma companies to monitor resistance

In order to control the spread of resistance, it is important to know where cases are occurring and where infection rates are rising. By monitoring resistance to treatment in patient populations around the world, the resistant strains can be identified and their subsequent spread can be addressed. 

Efforts to collect data on the emergence and spread resistance are termed ‘AMR surveillance’. To date, AMR surveillance has primarily been the responsibility of governments.

However, pharmaceutical companies also have an important contribution to make.
Companies often have unique knowledge of resistance trends, which are particularly valuable where their data cover countries without national surveillance efforts.

In 2020, the Benchmark reported an increase in the number of surveillance programmes being run by the pharmaceutical companies in its scope. It also reported that the majority of these programmes share their results publicly. 

In 2021, the Benchmark again compares the surveillance programmes of the eight large research-based companies in scope, and reports on whether they are active in the surveillance of bacterial or fungal pathogens and/or infections anywhere in the world and whether these results are shared publicly.

As in 2020, the 2021 Benchmark examines the stewardship activities of generic medicine manufacturers. However, these companies are not officially scored in this area, as they have thus far had a limited role in such activities.

This figure shows the extent to which the programmes identified by the Benchmark cover the surveillance of priority pathogens.*

Most companies are engaged in AMR surveillance programmes 

As in the 2020 Benchmark, most companies are engaged in surveillance to some extent. Out of the eight large research-based companies, Otsuka remains the only company not involved. Three generic medicine manufacturers, namely Abbott, Cipla and Viatris, report that they are engaged in surveillance. There are 19 programmes in which at least one company is engaged. Most of the programmes cover at least one priority pathogen.

Which programmes stand out?

Programme: ATLAS

Company: Pfizer

Pathogens: 13 priority pathogens

Countries: 81

Scope: Resistance against Pfizer’s antibacterial & antifungal medicines

Data-sharing: Raw data is publicly available

Pfizer expanded its ATLAS programme to include more priority pathogens and more countries through the Surveillance Partnership to Improve Data for Action on Antimicrobial Resistance (SPIDAAR), a new collaboration with the governments of Ghana, Kenya, Malawi and Uganda. Raw data (from 2018) is available for download on the AMR Register, which is an open-access data platform. Aggregated results (of antibacterial and antifungal resistance data) are shared on the ATLAS website, which is also an open-access data platform, as well as through open-access journal articles. Priority pathogens identified by WHO and/or the CDC are known for leading to resistant infections and deaths. According to the CDC, more than 3.1 million infections caused by priority pathogens occur in the US each year, and more than 49,000 people die as a result.1 Out of all surveillance programmes from companies in scope, ATLAS and CANWARD both cover the most priority pathogens, however ATLAS has a broader geographic scope than CANWARD.

Programme: SENTRY

Companies: Cipla; Pfizer; Shionogi

Pathogens: 11 priority pathogens

Countries: 57

Scope: Changes in resistance patterns over time, worldwide

Data-sharing: Aggregated results are publicly available

SENTRY is a multinational programme managed by JMI laboratories and supported by several companies in scope. This programme is one of three which cover Candida spp., a fungal pathogen which is estimated to have caused more than 34,000 hospitalisations and 1,700 deaths in the US in 2017.2 The managing partner, JMI laboratories, publicly shares aggregated results on the SENTRY website, as well as through open-access journal articles.

Programme: SMART

Company: MSD

Pathogens: 8 priority pathogens

Countries: 63

Scope: Respiratory, complicated intra-abdominal and urinary tract infections, and bloodstream isolates

Data-sharing: Aggregated results are publicly available

One of the priority pathogens covered by SMART is S. pneumoniae, which causes pneumococcal disease, ranging from ear and sinus infections to pneumonia and bloodstream infections. S. pneumoniae is estimated to have caused 900,000 infections and 3,600 deaths in the US in 2014.2 MSD shares the aggregates results in open-access journal articles, as well as on the online SMART database, which is restricted and cannot be accessed without registration

Programme: CANWARD

Companies: Abbott; MSD; Pfizer

Pathogens: 13 priority pathogens

Countries: Canada

Scope: Pathogens isolated in Canadian hospitals

Data-sharing: Aggregated results are publicly shared

CANWARD is a national programme focused on 13 priority pathogens. In Canada, it was estimated that resistant infections contributed to 14,000 deaths in 2018.3 The managing partner, the Canadian Antimicrobial Resistance Alliance, shares aggregated results of the CANWARD programme on an open-access data platform, as well as through open-access journal articles.

The table shows all 19 AMR surveillance programmes in which pharmaceutical companies in scope are active, as well as which of the priority pathogens* are covered by each programme. Enterobacteriaceae, P. aeruginosa, S. aureus and S. pneumoniae are the priority pathogens most commonly under surveillance. The longest-running programme has been active since 1992, while two new programmes have started since the 2020 Benchmark. The geographic range varies widely, from 1 to 81 countries.

Geographic coverage of surveillance is variable in Central Asia and Africa
Each surveillance programme covers a different geographic scope and range of pathogens. 

There are many stakeholders around the world working to build as complete a picture as possible of where resistance is emerging, such as the WHO’s Global Antimicrobial Resistance and Use Surveillance System (GLASS). Companies can fund external programmes run by established institutions, and they can also run their own surveillance programmes.

The first map below shows all countries covered by at least one of the 19 company programmes. The two other maps below demonstrate, for two high-risk pathogens Candida spp. and S. aureus, how company data can provide information and where gaps remain in global surveillance.

Countries with at least one surveillance programme: The map shows which countries are covered by at least one of the AMR surveillance programmes that the companies are supporting. There are 19 programmes running, with ten companies involved. High-income countries are consistently covered by surveillance programmes, as are upper-middle income countries such as Brazil, China and India. Coverage in low- and lower-middle income countries in Central Asia and Africa, however, is more variable. For example, Iran is not covered despite having high rates of antimicrobial consumption as well as resistance against pathogens including E. coli and K. pneumoniae.4,5
Coverage of programmes tracking resistance to Candida spp: looking only at surveillance of Candida spp, there are three programmes that gather data on resistance to this pathogen, with five companies supporting. Candida spp. is a common cause of candidiasis. Notably, the entire continent of Africa is not covered by any surveillance programme across any of the companies in scope, despite increasing resistance rates of Candida spp. in Sub-Saharan Africa.1
Coverage of programmes tracking resistance to S. aureus: Looking only at surveillance of S. aureus, there are ten programmes that gather data on resistance to this pathogen, with six companies supporting. S. aureus is a common cause of skin and soft tissue infections. In contrast to programmes covering Candida spp., S. aureus is covered in a few countries in Africa, but significant gaps remain.

Sharing consumption data is important in overall surveillance activities

Tracking and monitoring data on how antimicrobials are being consumed plays an important role in reducing their misuse. Pharmaceutical companies can provide data to estimate consumption through their imports, sales, donations and production records, and this can enhance national surveillance of antimicrobial consumption.

Who is sharing consumption data?

  • GSK periodically shares consumption data on colistin and/or other antibacterial medicines with the Pharmaceuticals and Medical Devices Agency in Japan. 

  • Johnson & Johnson and Otsuka share some consumption data on their MDR-TB medicines bedaquiline (Sirturo) and delamanid (Deltyba), respectively, with national and international health organisations. 

  • Fresenius Kabi shares consumption data with national governments or other public health authorities, as appropriate. For example, it shares sales data on meropenem in Latin American countries.

* Bacteria and fungi identified as priority R&D targets for limiting AMR, by the WHO and/or the US Centers for Disease Control and Prevention (CDC). See Appendix V in the full report.

1. Africa CWJ, Abrantes PM dos S. Candida antifungal drug resistance in sub-Saharan African populations: A systematic review. F1000Research. 2017;5.doi:10.12688/f1000research.10327.1

2. Centers for Disease Control and Prevention. Biggest Threats and Data.; 2019. https://www.cdc.gov/drugresistance/biggest-threats.html. Accessed August 5, 2021.

3. The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada. When Antibiotics Fail.; 2019. https://cca-reports.ca/reports/the-potential-socio-economic-impacts-of-antimicrobial-resistance-in-canada/. Accessed September 1, 2021.

4. World Health Organization. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report.; 2014.

5. World Health Organization. National Action Plan of the Islamic Republic of Iran for Combating Antimicrobial Resistance(IRIAMR) 2016 - 2021.; 2016. https://www.who.int/publications/m/item/iran-national-action-plan-of-the-islamic-republic-of-iran-for-combating-antimicrobial-resistance. Accessed August 31, 2021.