World Antimicrobial Awareness Week: Rethinking health economics to tackle AMR
Toby Cousens, Hospital and Internal Medicines Lead
| Pfizer UK
As ever, World Antimicrobial Awareness week is a good opportunity for us to reflect on the challenge posed by ‘superbugs’ and consider potential solutions. While a whole week might seem like a lot of time to allocate to one healthcare challenge, the scale of the threat posed by Antimicrobial Resistance (AMR) merits it. As we move from pandemic response to pandemic recovery, there is arguably even greater need to consider how we’re tackling AMR and how we can work better together. Toby Cousens, Hospital and Internal Medicines Lead, Pfizer UK, considers the challenge ahead.
This content has been developed and paid for by Pfizer UK
What is AMR?
‘Superbugs’ are bacteria, viruses, fungi and parasites which no longer respond to common medicines like antibiotics, because they’ve developed what’s called Antimicrobial Resistance or ‘AMR’.
The discovery of the first antibiotic, penicillin, revolutionised modern medicine, saving millions if not billions of lives globally. However, the reality of growing resistance is that in the future, effective prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, Caesarean sections, and even routine surgery like hip replacements may become too dangerous to perform if there aren’t effective antimicrobials. It’s frightening to think how many people could be impacted.
While there is much greater awareness of the dangers of AMR now, and a more judicious approach to the prescription of antibiotics, there is much more to be done. The World Health Organization considers AMR one of the top 10 global public health threats facing humanity1. This isn’t a future threat - resistant superbugs are with us now. An estimated 700,000 people die of resistant infections every year, but by 2050 this number could be as high as 10 million people per year.2 Currently superbugs are emerging faster than new antibiotics can reach the market. As such, a strong pipeline of new antibiotics is an essential component to restoring the balance and ensuring that we have new tools in the fight against AMR.
Health economics
The solution to AMR is surely easy then, simply develop new antibiotics? And yet, until very recently, no new classes of antibiotics have been discovered since the 1980s.3
It isn’t just the science that is difficult however, AMR is a unique challenge in that solutions to it necessarily subvert the normal rules of health economics. Developing new medicines takes huge financial investment and the failure rate is high. According to the Welcome Trust, it can take 10-15 years and over $1billion to develop a new antibiotic.3 In the case of antimicrobials, a newly approved treatment will likely be used sparingly to support good stewardship. This creates a challenging dichotomy of needing to preserve public health while making it difficult to recover the high costs associated with development.
Partnership is therefore vital, and this is where policy makers come in.
The power of partnership
To encourage the private sector and investors to continue to invest in the research and development needed to manage the risk of AMR, a policy environment needs to be created that makes the medicines financially viable. The Biopharma CEOs Roundtable’s (BCR) commitment to invest nearly $1 billion through an AMR Action Fund is a welcome example of the kind of collaboration that is needed here, but the public sector also has a role to play.
At Pfizer we are incredibly proud to be included in NHS England’s innovative ‘subscription-style’ reimbursement model pilot for antimicrobials.4 This ground-breaking initiative is a critical step in tackling AMR and unlocking the challenge of developing new antimicrobials, by moving away from
reimbursement based on units sold to instead focus on the value antibiotics bring to wider society.
At the international level, the G7 Ministers’ Statement on Actions to Support Antibiotic Development, has fostered global agreement that policy reforms are critical if a sustainable antibiotic pipeline is to be built. Traditional approaches to antimicrobial valuation do not work and there is a clear need for innovative assessments to understand the true value of a medicine that may be left on a very high shelf until it’s needed.
While medicines development, and specifically new ways of financing investment, are urgently needed, new antibiotics are just one part of the bigger picture. Good stewardship, improved global surveillance and high quality information and education at all levels are crucial, and to do it well we need multiple parties to work collaboratively, pool resources and set global targets.
We also need countries individually to properly invest in AMR to meet the global need. A recent report from the WHO found that fewer than a quarter of countries globally had a funded AMR action plan in place with just 17 making financial provisions.5 This highlights that while progress is positive on some fronts, much more work is needed. The challenge ahead, particularly post-COVID-19, will be to ensure AMR remains high on the agenda.
Lessons from the pandemic
The response to the recent COVID-19 pandemic in the UK gives us all an example of what can be done when there is sufficient focus brought to bear on a health challenge. It also gave us a painful reminder of what it may mean to have no vaccine or medicine to tackle an emerging pathogen. The pandemic should focus minds on why AMR is such a danger and the urgent need for government, industry and society as a whole to work together to find solutions. The difference with AMR is that it’s not visually obvious, for most of us it doesn’t have as immediate an impact as the COVID-19 pandemic has, which makes it more challenging to highlight the dangers ahead, especially if we’re talking about impact over the next two or three decades. However, if we consider AMR as part of wider pandemic preparedness planning, and ensure adequate resource is devoted to stewardship, surveillance and education, we will not lose this opportunity to embed learnings now.
1. World Health Organization, Antimicrobial Resistance, 2021. Available at Antimicrobial resistance (who.int) [last accessed, 16 November 2022]
2. World Health Organization, new report calls for urgent action to avert antimicrobial resistance crisis, 29 April 2019. Available at New report calls for urgent action to avert antimicrobial resistance crisis (who.int) [last accessed, 16 November 2022]
3. Wellcome Trust, Why is it so hard to develop new antibiotics? Available at Why is it so hard to develop new antibiotics? (wellcome.org) [last accessed, 16 November 2022]
4. Pharmaphoum, UK launches its ‘Netflix-style’ payment model for antibiotics, 12 April 2022. Available at https://pharmaphorum.com/news/uk-launches-its-netflix-style-payment-model-for-antibiotics/ [Last accessed, 21 November 2022]
5. The Financial Times, Pandemic Holds Back Fight Against Antibiotic Resistance, 11 November 2022. Available at https://www.ft.com/content/5b2eb35b-5364-47c6-a1cb-57919ad72b75 [last accessed 16 November 2022], source data can be found at: https://amrcountryprogress.org/#/map-view (question 2.3 in drop down menu)
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