A call to antimicrobial arms

Jim O’Neill JAKARTA – In December, I reported the first findings of the Review on Antimicrobial Resistance, which I chair. The news wasn’t good: Resistant infections already claim more than 700,000 lives a year. Unless action is taken, antimicrobial resistance will kill ten million people a year by 2050 – more than the number of people who currently die from cancer. It will also have a cumulative cost of at least $100 trillion, more than 1.5 times today’s annual global GDP. We are not doing nearly enough to combat this danger. The world urgently needs new drugs to replace the antibiotics, anti-malarial regimes, anti-retroviral AIDS and HIV medications, and tuberculosis treatments that are losing effectiveness. But we do not invest enough in research and development. It is critical that we find new sources of funding to support the academic researchers and small companies whose discoveries are laying the foundations for tomorrow’s medicines. That is why I am calling on international donors – philanthropic and governmental alike – to work with the Review on Antimicrobial Resistance to create a new fund to support R&D in this important area. The fund will provide grants for blue-sky science and act as a non-profit incubator for promising discoveries. Over the coming months, the Review will be working out the details of how such a fund could operate effectively. The problem is straightforward: As valuable as scientific breakthroughs may be, it takes a lot of work to turn them into marketable drugs. And, because antibiotics generally produce low – and sometimes even negative – returns on investment for the pharmaceutical makers that develop them, many companies and venture capital funds steer clear. The Review is studying ways to align financial incentives for developing new antimicrobial drugs more closely with these medicines’ true social value. But time is of the essence. New drugs take decades to discover and develop. Even if we were to fix every problem in the development pipeline today, it would be at least another ten years before the first new antibiotics became commercially available. In the coming months, the Review will make recommendations regarding market incentives for developing new antibiotics and searching for potential alternatives – such as vaccines – to the use of these drugs in agriculture. The Review will also highlight innovative approaches to addressing resistance. In its most recent paper, the Review has identified specific measures that could provide a starting point for the fight against antimicrobial resistance. The first is the creation of the innovation fund to support early research. In addition to providing money for efforts to develop new drugs, the fund should encourage research into diagnostic tools, surveillance methods, techniques to slow the development of resistance, and social and economic studies of consumer behavior. This kind of basic research is where medical innovation starts, and the sums involved need not be huge to make a significant difference. We should also invest more in the people who will solve the problem. Evidence seems to show that young scientists and doctors are reluctant to enter fields related to antimicrobial resistance. We need to nurture the next generation of academics, scientists, hospital workers, and pharmaceutical technicians. Governments, for their part, should work closely with companies that produce diagnostic tools and surveillance techniques, and support useful technologies as they are developed. It is essential that countries work together to gain a better understanding of how antimicrobials are used around the world. And, finally, we need to develop new treatments that use alternative doses and combinations of existing drugs. Likewise, we should reconsider potential medications that never made it to market because of side effects that could now be rendered safe. In the coming months, I will travel to India and China to discuss antimicrobial resistance with senior policymakers and companies. Both of these countries are particularly vulnerable. By 2050, antimicrobial resistance could impose a cumulative economic cost of $20 trillion on China – equivalent to about two years of its current GDP. Even more worryingly, by then China could be losing one million people per year to resistant bacteria and microbes. In India, the death toll could reach two million a year. It is statistics like these that have led me to conclude that the fight against antimicrobial resistance must be placed high on the G-20’s agenda. It is my hope that China, when it assumes leadership of the G-20 in 2016, will play a constructive role in this regard. A solution to antimicrobial resistance need not be expensive. It is likely to cost the world much less than 0.1% of global GDP. Weighed against the alternative – $100 trillion in lost production by 2050 and ten million lives lost every year – it is clearly one of the wisest investments we can make. Jim O’Neill is Honorary Professor of Economics at Manchester University. Copyright: Project Syndicate.

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A call to antimicrobial arms