Drug resistance and superbugs: How to stop the spread

The rapid and unanticipated global spread of COVID-19 taught the world many lessons about the need to prepare earlier for global health threats. We appreciate more today that the health of the world is interconnected, and that public-private collaboration is needed to address the spread of disease, otherwise all individual efforts will be put at risk.

This week’s World Antimicrobial Resistance Awareness Week highlights the real and growing danger of Antimicrobial resistance (AMR). Bacteria in all parts of the world are becoming increasingly resistant to many of the antibiotics used today in healthcare systems and in rearing animals, which also find their way into the environment. Addressing the spread of AMR calls for an integrated, ‘One Health’ approach with multistakeholder input.

Some governments, including the Dutch and British, along with organizations like the Wellcome Trust, have been early leaders in addressing the spread of drug resistance, making strategic investments into combating the issue at the global level. But further collaboration between a broader variety of actors including the private sector, could really stop the next big global health disaster in its tracks.

As Hugo de Jonge, Minister of Health, Welfare and Sport and Deputy Prime Minister of the Netherlands, has said, ''The Netherlands recognizes the vital importance of including antimicrobial resistance in health security efforts. We are a proud supporter of the Access to Medicine Foundation and its role in encouraging pharmaceutical companies to step up. By working collaboratively across multiple sectors, we can stop the next big global health threat in its tracks.”

For the last five years, the Access to Medicine Foundation has tracked how the biggest companies in the antibiotic market have tackled the rise of resistance and the global need for appropriate access to antibiotics.

Our third Antimicrobial Resistance Benchmark finds promising progress in some areas. This includes a significant increase in early planning to make new medicines available in low- and middle-income countries (LMICs). And when it comes to R&D, Big Pharma’s engagement appears to have stabilized after years of retrenchment, although the pipeline of new products remains thin, and progress is heavily reliant on small biotechnology firms with precarious finances.

That is the good news. The bad news is that there is still a widespread industry failure to get established antibiotics to people in resource-poor settings, where the risk of drug-resistant infections is greatest.

Just a third of the products we examined had any kind of access strategy in place – such as price adjustments to make medicines more affordable or licensing agreements to boost supply. This lack of appropriate access forces doctors to use suboptimal or no treatments, giving pathogens an opportunity to infect more people and develop resistance, thereby stoking global patterns of increasing resistance.

What’s more, open and transparent surveillance of resistance to medicines is slow to improve, with still only one company, Pfizer, openly sharing the raw data of its surveillance programmes to advance global research efforts to track the spread of AMR.

Companies like Pfizer, which has made the most progress in battling AMR since the last Benchmark report, show what is possible. Generic medicine manufacturers have also contributed significantly more than in the past, including several large Indian players such as Aurobindo and Cipla that have stayed focused on AMR despite the ravages of COVID-19 in their home country, putting pressure on their staff and demanding production to meet the surging demand of many health products.

What is needed now is a greater sense of urgency and collaboration from all players, along with the critical inclusion of AMR in health security initiatives. The world must take note of the lessons learned from COVID-19.

The unacceptable inequity in global access to COVID-19 vaccines, which left the world’s poorest at the back of the queue, must not be repeated when it comes to defeating antibiotic resistance. Working together to support appropriate access in LMICs is necessary to ensure important and efficacious medicines and vaccines reach those in need, ultimately helping to prevent the global spread of AMR.

Antimicrobial resistance is not a future problem. It is here now, with an estimated 750,000 people dying each year from drug-resistant infections. At the same time, 5.7 million people also die annually from treatable infections because of a lack of access to medicines. The combination of more superbugs and inadequate treatment is becoming a lethal cocktail that threatens to unleash spiralling levels of drug resistance.

We know what needs to be done to counter this threat. There are tried and tested tools to increase the local availability of vital antibiotics in poorer nations. These include wider product registration, tiered pricing, voluntary licensing agreements, technology transfers and public-private partnerships. Active engagement and new forms of collaboration between multi-sectoral partners, including governments and industry, to develop new products faster and to make existing ones available more broadly can effectively tackle this next global health threat.

Back in January 2016, More than 80 companies came together to sign the Davos Declaration on AMR, committing to develop better ways to prevent dependable and sustainable supplies of antibiotics and urging governments to work with them. Since then, the AMR Benchmark programme has seen notable progress from industry in the right direction – but the tentative steps taken so far must now become more ambitious to protect us all.

More about the Access to Medicine Foundation’s work can be found here.