The development of antibiotics in the 1920s changed the face of medicine by allowing people to be treated for infections and have medical procedures that could previously have been life threatening become “routine”. The benefits of antibiotics are felt globally, and therefore, the risk of widespread antimicrobial resistance (AMR) to antibiotics is a global threat.
On 24th January 2019 the Secretary of State for Health, Matt Hancock, set out the UK's 20-year vision for tackling AMR at the World Economic Forum in Davos stating that nationally and internationally we must rise to the challenge of AMR as it “is as big a danger to humanity as climate change or warfare”. Below we have set out a brief overview of the key points from Matt Hancock’s speech for this 20-year plan.
UK’s 20-year plan:
The UK intends to take the lead globally by setting out its 20-year plan to tackle AMR. The plan covers three key areas:
i)Prevention: the UK wants to cut resistant infections by 10% in the next 5 years and aims to do this by cutting antibiotic use by a further 15% (by only using them in people who are really ill and dramatically reducing their use within livestock), through immunisation and better infection control.
ii)Innovation: there have not been any new classes of antibiotics since the 1980s meaning there are no new options to combat infections that are resistant to current treatment (a clear example of this issue can be seen in the treatment of gonorrhoea where the only single antibiotic that remains effective is extended-spectrum cephalosporins).
Hancock noted in his speech that an issue for promoting innovation in this sector is that the development of new antibiotics is currently commercially unattractive as the traditional model of revenue linked to volume of use does not work when these products must be conserved and used sparingly. A new model will be required to incentivise innovation and so it was stated that within the next 6 months the NHS will swap to a service based payment system “We’re going to be more of a Spotify subscriber than a vinyl record shopper”. Furthermore, the Government’s plan is to pay pharmaceutical companies upfront to make them feel it is worthwhile investing the estimated £1 billion required to develop a new medicine.
iii)Collaboration: however, this will only work if incentives are provided on a global scale and so combatting AMR requires collaboration across borders now and in future. Hancock also noted that the UN inter-agency co-ordination group will be publishing their draft recommendation on the next steps on tackling AMR shortly.
AMR is an immensely serious issue and the UK Government is endeavouring to be a driving force in combatting it. The Government plans to slow further AMR by encouraging the prevention of disease in the first place and then reducing the use of antibiotics in people and animals. However, the key issue for obtaining new antibiotics seems to be a lack of investment and poor reimbursement. Due to the very nature of AMR there is a drive to use less rather than more of the very effective antimicrobials, which would currently lead to these new products having limited returns (as they are paid on a volume based system). Therefore, the UK Government suggests moving to a different payment structure with upfront investment and a subscription based payment system will undoubtedly be welcomed by those developing and investing in new antibiotics. Although, the fight against AMR cannot be done by one single country and so international efforts will be required.
Interesting developments in the field
Many companies and organisations working in the life sciences sector are engaged with AMR and this was a hot topic of discussion in the BIA’s seminar on “Strategic Technologies in Life Sciences”, also on the 24th January 2019. At the BIA Seminar it was noted that much of “big pharma” has dropped out of this space and so there is a real opportunity for smaller companies. More about this sector and those working in it (e.g. Destiny Pharma, Summit Therapeutics and Matoke) can be found on the BIA’s website.