Tilting the battle against superbugs in humanity’s favour

The need for new antibiotics has never been greater. Without significant change, antimicrobial resistance (AMR) will cause a devastating rise in deaths from preventable infections over the next two decades, with vulnerable populations living in poorer countries hit the hardest.

Jayasree K. Iyer, CEO, Access to Medicine Foundation

This fourth edition of the AMR Benchmark highlights the scale of the challenge and presents concrete examples of positive actions that can be taken by pharmaceutical companies. It identifies some grounds for hope, including recent regulatory approvals for three antibiotics with innovative characteristics and several promising products in late-stage development. These advances show it is possible to tilt the battle against superbugs in humanity’s favour. Overall, however, the research & development (R&D) pipeline remains worryingly thin, and industry investment has lost momentum.

In evaluating industry performance, our approach focuses on those areas where companies have a clear responsibility in the AMR fight: R&D, Responsible Manufacturing and Appropriate Access & Stewardship. With drug resistance now the biggest single threat to healthcare worldwide, a decisive step up in commitments in all three fields is urgently needed.

It is particularly concerning that the number of pipeline projects from large research-based pharmaceutical companies has shrunk by 35% over the past five years, with just three big players continuing to invest in innovative antimicrobial R&D. Smaller biotech firms have stepped in to fill some of the gaps, but they are constrained by limited access to capital and a lack of global reach.

The scarcity of projects in development makes it vital that medicines which do reach the market are accessible to the people who need them most – especially in low- and middle-income countries, where serious access gaps persist. A handful late-stage clinical development projects targeting drug-resistant urinary tract, intra-abdominal and respiratory infections could save many thousands of lives every year if access plans make them available to people in low- and middle-income countries (LMICs), who face the highest burden of drug resistance.

At present, the availability of antibiotics in low-income countries is often woefully inadequate, especially when it comes to products for children. As a result, patients too often receive suboptimal treatments that are not up to the job, allowing resistance to develop. Against this backdrop, the modest improvement in product registrations seen since the last Benchmark report is encouraging. This could be a springboard to making far better use of lifesaving medicines in future.

There is no time to lose. More than one million people die each year as a direct result of drug-resistant infections, while AMR contributes to over four million deaths in total. By 2050, direct and indirect deaths are projected to rise to nearly two million and more than eight million, respectively.

This report sets out what must be done to minimise the threat by ensuring the sustainable development, supply and appropriate use of antibiotics for the benefit of the entire world. The necessary steps – from strengthening the R&D pipeline to improving product registration and antibiotic stewardship – are well known. What is needed now is more comprehensive action across the board. It is up to all stakeholders to deliver.

Jayasree K. Iyer

CEO, Access to Medicine Foundation