HEQ speaks to the AMR Industry Alliance about the burden and prevention of antimicrobial resistance and the impact of the COVID-19 pandemic.
Antimicrobial resistance (AMR) is an ongoing and growing global threat, exacerbated by the overuse and misuse of clinical drugs and the relative lack of funding for research and treatment.
What are the key aims of the AMR Industry Alliance?
The AMR Industry Alliance was established in 2017 in response to the political declaration on antimicrobial resistance (AMR) at the 2016 high-level meeting of the United Nations General Assembly, which called on governments and other actors to take concerted action to comprehensively address the implications of AMR1.
Today, the AMR Industry Alliance – composed of over 100 biotechnology, diagnostics, generics, and research-based pharmaceutical companies and associations – represents one of the largest private sector coalitions providing sustainable solutions for AMR. The majority of its members signed the industry’s Declaration on Antimicrobial Resistance (2016), also known as the Davos Declaration, and the Industry Roadmap for Progress on Combating Antimicrobial Resistance (2016). Together, these documents set forth commitments and goals to mitigate the drivers of AMR related to manufacturing and the environment, barriers to access to novel and off-patent antibiotics, inappropriate use and stewardship of antibiotics, suboptimal vaccine coverage, and diminished R&D investment due to failures in the antibiotics market2.
By fostering inter-industry collaboration, the AMR Industry Alliance aims to harness the power of the life sciences industry through collective efforts to:
- Promote investment in research and development to meet public health needs with new innovative diagnostics and treatments
- Address barriers to patient access to the most appropriate vaccine, diagnostic, or treatment and ensure that antibiotics are available to all
- Contribute to slowing the emergence of resistance through appropriate use of antibiotics
- Reduce the environmental impact of manufacturing through standard setting3.
The AMR Industry Alliance progress reports offer a unique snapshot of the life sciences industry’s collective efforts and leadership in delivering on their global commitments and action to tackle this rise of AMR through work in the areas of research and science, access, appropriate use, and manufacturing – with commitments updated in 2019 to reflect the evolution of the Alliance4. The AMR Industry Alliance recently developed a new Strategic Plan spanning 2021-2025 and continuously seeks to grow its membership to address the global AMR challenge.
How has the misuse and overuse of antibiotics contributed to the spread of drug-resistant infections?
Drug-resistant infections occur when microorganisms and viruses evolve and adapt to existing anti-infectives. Changes over time mean that these pathogens no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness, and death5. While AMR occurs naturally, inappropriate use of medicines, low-quality medicines, wrong prescriptions, and poor infection prevention and control accelerate this resistance6. As a result, medicines more quickly become ineffective and infections persist in the body, increasing the risk of spread to others. Antimicrobials, and antibiotics in particular, represent a landmark in human accomplishment, but their utility is not limitless. Continued misuse and overuse will eventually render first-line antibiotics ineffective.
What are the primary challenges currently facing the management and treatment of drug-resistant infections? Has the COVID-19 pandemic made things more difficult?
We face a number of challenges in our work to slow the spread of AMR, prevent mortality, and reduce direct and indirect healthcare costs, globally. First, we need to raise public awareness of AMR and promote behaviour change, including through school curricula, healthcare worker education, training, certification, continuing education and development, in both the health and agricultural sectors. Given the multisectoral nature of AMR, we endorse a One Health approach, recognising the intersection among people, animals, plants, and their shared environment, itself a prerequisite to achieving the 2030 Agenda for Sustainable Development7.
Globally, we need stronger surveillance and research mechanisms to track and understand antibiotic use, inform how these medicines are used, and measure the impact of AMR on health outcomes and healthcare systems. Further, more and better data will enable us to better understand how antibiotics are used, determine how resistance develops and spreads, and identify the incidence and prevalence associated with AMR8. We also need to strengthen regulation of antibiotic distribution, quality, and use. Without better oversight, once treatable and commonplace infections will pose a devastating risk to all.
Another challenge is the underuse and lack of affordable diagnostic tools, particularly at the point of care. Appropriately used diagnostics help inform a patient’s treatment course, ensuring that patients receive the right drug at the right time. However, the effective use of diagnostics requires strong healthcare infrastructure (for example, in the form of a functioning laboratory network), widespread availability of diagnostics and medical supplies, and enhanced healthcare worker capacity to use diagnostic technologies.
Finally, as a global society, we must accelerate the research and development of novel antibiotics, supported by commensurate investment and incentives to create innovation. We urgently need processes to facilitate this investment and to ensure good stewardship over the use of new medicines so that we can conserve their effectiveness over the long term8. This includes:
- New economic incentives aimed at supporting private sector investment in research and development at the level needed to create a robust antibiotic pipeline
- Customised assessment and recognition of the full value antibiotics contribute to society, currently under-valued
- Reimbursement schemes to ensure patient access to, and availability of, the most appropriate antibiotic for disease prevention and treatment9
Addressing AMR is a complex and multipronged process, requiring strong multistakeholder collaboration and leadership from governments, the private sector, and other actors. While, collectively, we have made great progress since the Davos Declaration, the COVID-19 pandemic has created both additional challenges and an opportunity in the fight against AMR. From a challenge perspective, the pandemic has diverted funds and attention away from other priorities, including AMR. Furthermore, COVID-19 itself has been a driver of more hospitalisation, more infections, more widespread antibiotic use, and therefore, greater drug resistance.
However, because of the pandemic and its tremendous impact across our healthcare systems, economies, and daily lives, people around the world, including policymakers, now have a very real understanding of what happens when we encounter infectious diseases that we do not have the tools to treat. There has also been a renewed appreciation of what multisectoral collaboration and concerted focus and investment in biotech innovation can achieve.
Has AMR been overlooked in the drive to address the COVID-19 pandemic? Could increased research and funding help to offset a secondary crisis in drug-resistant infection?
As mentioned above, the COVID-19 pandemic has diverted funding, political attention, and the focus of healthcare providers and scientists away from AMR and associated global health challenges even as it increases the risk of AMR. The pandemic has led to a higher level of antibiotic usage and an increase in hospital acquired infections (HAIs). The current COVID-19 pandemic is just one example of how viral infections can lead to use and overuse of antibiotics, as antibiotics are used as treatment in nearly all cases of severe COVID-19, contributing to overall resistance. We have learned during the pandemic that stopping viral infections, such as COVID-19, is part of a holistic solution to help prevent AMR. Further, as a respiratory illness, COVID-19 has increased the rate of HAIs, in turn prompting greater amounts of antibiotic prescriptions.
Yet, while AMR has been an increasing concern over the last few decades, only one new class of antibiotics has been developed since 198410. In comparison, there are currently more than 550 innovative treatments and vaccines for COVID-19 being developed10. Despite growing discourse surrounding the urgent need for new antibiotics, there has been limited action in terms of developing innovative financing mechanisms to support R&D for new medicines. To help address this, a number of the world’s largest pharmaceutical companies helped to launch the AMR Action Fund in July 202011. The Fund will invest $1bn in smaller biotechnology firms, with the aim of bringing two to four new antibiotics to patients by 2030. In addition, countries are experimenting with different funding models to support antibiotic research by establishing incentives that reward companies for successfully developing antibiotics. The upcoming G7 Summit to be held in July 2021 in the United Kingdom represents an opportunity to secure a renewed, coordinated focus on increased investment in research and development and regulatory frameworks aimed at incentivising appropriate use of antibiotics and responsible manufacturing.
How can public policy be updated to alleviate the burden of AMR and reduce the number of associated deaths?
At the AMR Industry Alliance, we know that private sector also has a key role to play here, in particular across our four key focus areas: access, appropriate use, manufacturing, and research and science. However, if we hope to comprehensively tackle AMR across countries, we need public policies that are aligned with the ongoing commitments by the G7 and G20 on AMR, the World Health Organization’s (WHO) global action plan on AMR and standards and guidelines established by intergovernmental bodies, such as the Codex Alimentarius Commission, the Food and Agriculture Organization of the United Nations (FAO), and the World Organization for Animal Health (OIE).
Effective public policy can and should support equitable access to, and appropriate use of, existing and new antibiotics required to preserve the ability to treat serious infections. Addressing AMR requires enabling widespread access to health facilities, healthcare professionals, and diagnostic tools for all who need them. Coupled with education and training, national guidelines and regulations to incentivise appropriate use of antibiotics will help slow the spread of AMR12. Global and national manufacturing standards can also help decrease the presence of antibiotics in the environment and reduce AMR prevalence. Finally, global, regional, and national frameworks are required to establish incentive packages and reforms aimed at attracting sustainable and robust R&D investment into new antibiotics and antimicrobials which recognise the medical and societal value of antibiotics and ensure that these reach patients in need.
1 World Health Organization. (2019). Resolution WHA72.5 Antimicrobial Resistance. Available at www.who.int/health-topics/antimicrobial-resistance.
2 Plackett B. No money for new drugs. Nature 586, S49 (2020)
3 For additional information, see www.amrindustryalliance.org/why-the-amr-industry-alliance/.
4 See the AMR Industry Alliance’s latest Progress Report (2020): www.amrindustryalliance.org/progress-report/.
5 World Health Organization (2020). Key facts. Available at www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance; World Health Organization (2017). Antimicrobial Resistance. Available at: www.who.int/news-room/q-a-detail/antimicrobial-resistance.
6 World Health Organization (2020). Key facts. Available at: www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance; World Health Organization (2017). Antimicrobial Resistance. Available at: www.who.int/news-room/q-a-detail/antimicrobial-resistance.
7 World Health Organization. (2017). One Health. Available at www.who.int/news-room/q-a-detail/one-health; World Health Organization. (2019). Resolution WHA72.5 Antimicrobial Resistance. Available at www.who.int/health-topics/antimicrobial-resistance.
8 For additional information, see www.amrindustryalliance.org/amr-industry-alliance-declaration/; World Health Organization. (2015). Global action plan on antimicrobial resistance, available at www.who.int/health-topics/antimicrobial-resistance.
9 For additional information, see www.ifpma.org/wp-content/uploads/2021/02/IFPMA-Global-Principles-on-Incentivizing-Antibiotic-RD.pdf.
10 For additional information see www.project-syndicate.org/commentary/developing-new-antibiotics-to-tackle-antimicrobial-resistance-by-thomas-cueni-2020-11?barrier=accesspaylog.
11 For additional information about the AMR Action Fund, see https://amractionfund.com/about-us/#page-section-0.
12 In this regard, members of the AMR Industry Alliance developed unified, science-driven, risk-based targets, known as predicted no-effect concentrations (PNECs), to be used in the environmental assessments for factory discharges of antibiotics. For additional information, see the AMR Industry Alliance’s latest Progress Report (2020): www.amrindustryalliance.org/progress-report/.
AMR Industry Alliance