The fragile antibiotic market has reached a tipping point

At the Access to Medicine Foundation, we have been analysing how pharmaceutical companies tackle access to medicine for more than a decade. This 2020 Antimicrobial Resistance Benchmark has evaluated for the second time how the most important players in the antibiotic market are addressing the rise of resistance and the global need for appropriate access to antibiotics. Although we can see progress — it’s hanging by a thread.

We have reached a tipping point where large and prominent drugmakers have retreated from the antibiotics field and smaller innovative biotech companies have gone bankrupt due to the poor financial rewards on offer. Antibiotics are taken for short courses and the most precious products are reserved for emergencies. Only a handful of large research-based companies remain broadly engaged in developing new antibiotics, down from more than 20 in the 1980s. Losing any more big suppliers and innovators will make it extremely hard to ramp up effective drug discovery and development operations, while the tough economics of the market discourage investment in new manufacturing capacity. 

This disinvestment and industry consolidation has created an increasingly fragile manufacturing and supply chain. While the top 30 companies have more than 200 sites for producing antibiotics globally, just four companies – GSK, Novartis (through its generics arm, Sandoz), Teva and Mylan – account for more than half of them. Each year, more than 90 billion packs of medicines are used worldwide to treat infections. 

Antimicrobial resistance is not a future problem
The impact of drug resistance is already being felt today. Antibiotic resistance causes more than 500,000 deaths each year, including more than 200,000 infant deaths. In India, for example, resistance exceeds 70% for many widespread bacteria. Most at risk are patients living in the poorest countries, where medicine choices are limited. 

This second Benchmark provides a reality check
Fixing the problem does not require a scientific miracle. It demands a very human solution – albeit one that is easier said than done. The tough market conditions must be replaced through a mix of public and private investment to ensure a healthy ecosystem of pharmaceutical innovation, production and supply. 

We see good practice in multiple areas in 2020. More companies are stepping up – with promising ideas for tackling the toughest pathogens, and improvements in tracking resistance and safeguarding the effectiveness of existing products. We can’t take their commitment for granted and wait for more companies to abandon this vital area of modern medicine. It is not too late to prevent irreparable damage to the global supply of antibiotic medicines and vaccines.

Jayasree K. Iyer Executive Director Access to Medicine Foundation