Antimicrobial research and development needs greater push through policies

Mentioning that antibiotics are the cornerstone of modern medicine has become an integral part of anything I have written or presented since I began working in the area of antimicrobial resistance (AMR) in 2021. But if I am being 100 per cent honest with myself, I grasped the enormity of this just earlier this year, when I left a hospital in Berlin deeply grateful, relieved and hyperaware of the integral role antibiotics had played in my successful surgery for cancer. 

It was a long-overdue moment of true realisation, which brought the privilege of having access to Germany’s modern healthcare facilities into sharp focus.

But I always wonder what would happen if the drugs didn’t work and the medicine cabinet was bare? This is not a thought experiment. This is a real danger for the one in five cancer patients undergoing treatment who are hospitalised with an infection — up to 8.5 per cent of cancer deaths are due to sepsis. 

The World Health Organization (WHO) has been loudly sounding the alarm, making it abundantly clear that we are not developing enough new antibiotics — and other antibacterials — to deal with the growing tide of AMR, especially the most dangerous resistant bacteria causing severe infections like pneumonia, bloodstream infections or meningitis. 

The World Antimicrobial Resistance Awareness Week takes place from November 18-24 every year.

There are thousands of oncology drugs currently in clinical development, compared with just 77 antibacterials. This is despite the fact that patients taking cancer treatments are reliant on working antibiotics to avoid life-threatening infections.

There is a growing body of work outlining the unique challenges facing developers of antibiotics, namely the high cost of research and a low return on investment, with experts and stakeholders alike calling for a change in policy and perspectives that would create a more sustainable innovation ecosystem.

AMR is not a secret. It’s been high on political agendas for a number of years, with commitments for action forthcoming, including across the United Nations, Group of Seven (G7), Group of 20 (G20) and European Union. 

Since the first UN General Assembly (UNGA) declaration on AMR in 2016, which represented a major milestone for political action against AMR, a number of initiatives have been created to help advance this agenda. This includes the creation of public-private partnerships such as CARB-X and GARDP, as well as the organisation I work for — the Global AMR R&D Hub. 

Global AMR R&D Hub was formed in 2018 following a G20 call in 2017 for “ ..a new international R&D Collaboration Hub to maximise impact of existing and new anti-microbial basic and clinical research initiatives as well as product development”. There was a clear recognition that research is a crucial feature of our toolkit to combat AMR globally, but that we need an evidence base to help support decision making, especially with finite funds and many competing global challenges. 

The Hub’s Dynamic Dashboard collects data on public and philanthropic funding for AMR research and development (R&D) across all One Health sectors, as well as information on global incentives to improve the antibacterial R&D ecosystem and market functioning.

So, there have been major international and national programmes and global partnerships established to encourage antibiotic and antibacterial R&D. CARB-X and GARDP are great examples of such partnerships with a focus on the most critical public health needs, helping to bolster those fragile preclinical and clinical pipelines. 

But it’s not enough. It is widely recognised that we need both push and pull — or other innovative — policies working together, to reward R&D, bring products to market, and ensure their equitable access and prudent use. 

The UK’s antibiotic subscription model, which pays for the ability to access the drug, not the volumes used, is one way forward. The United States, Canada and Japan are all considering versions of these financing mechanisms at the moment, but more co-ordinated action is required. 

This year’s World AMR Awareness Week theme, Preventing antimicrobial resistance together, also highlights the need for AMR to be tackled at multiple levels across many different sectors. The development of AMR vaccines and diagnostics continues to be underfunded; these receive three times less funding than therapeutics. We are still failing to connect the dots across the One Health spectrum. 

Although the use of antimicrobials in the animal sector vastly exceeds their use in human health, only about 8 per cent of the recorded R&D funding in our database involves animal health. The environmental and plant health sectors receive a fraction of this. Only 6 per cent of all funding is being invested in cross-sectoral projects – those that involve more than One Health sector – but R&D funding has been increasing, doubling since 2017.

The focus is now on contextualising this data to help policymakers and funders further co-ordinate and prioritise R&D activities to ensure impact.  

The upcoming UNGA high level meeting on AMR in September 2024 provides an opportunity to accelerate action and accountability on AMR and strengthen the R&D ecosystem for it across the One Health spectrum. This includes targeted and aligned action on both push and pull, through sustainable and predictable financing and resources, and the setting and monitoring of R&D targets for the development of those key health technologies (for example, therapeutics, diagnostics and vaccines) that we need to address the most critical public health needs.

It’s a lot, but it’s doable. We just have to keep doing better together.

Lesley Ogilvie is director of the secretariat, Global AMR R&D Hub, Berlin, Germany

Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth