The launch of the Antimicrobial Action Fund to support the development of new antibiotics injects new hope and money in antimicrobial drug development. Becky McCall reports.
The launch of a new, US$1 billion antimicrobial resistance (AMR) Action Fund on July 9, 2020 promises to provide some much-needed relief to a dwindling pipeline of new antibiotic drugs, which provide one of the cornerstones of everyday medical practice. Currently 23 pharmaceutical companies have pledged towards the recently launched fund, including some of the biggest names in the sector, including GlaxoSmithKline, and Pfizer. The joint fund aims to support research and development (R&D) that will bring two to four new antibiotics to patients by 2030, as well as create market conditions that enable sustainable investment in antibiotics.
John Rex, Chief Medical Officer at F2G Ltd, warmly welcomes the fund, having worked in the field of AMR policy for over 30 years. “The announcement of the AMR Action Fund was awesome. Indeed, it brought tears to my eyes”, he says, adding that medicine needs a reliable supply of diverse antibiotics.
Bringing the reality of AMR home to the clinic, he says recently a colleague's patient whose malignancy was under control died of a resistant infection because no drug could be found to treat it. “This doctor was very senior and if she couldn't find a suitable antibiotic then it wasn't out there”, says Rex. “So much of medicine hinges on having the right antibiotic to hand at the moment it's needed.”
Good clinical judgement and antibiotic stewardship are important but so too are innovative solutions from governments and industry. The Director-General of the International Federation of Pharmaceutical Manufacturers & Associations, Thomas Cueni, points out that “If we want to change the game in the antibiotic field, then industry needs to step up and collectively bring real money to the table”.
Decades can pass before new classes of antibiotics are discovered, and only a small handful of companies continue to operate a research pipeline in the field, many having exited the space in recent years due to the lack of commercial sustainability. Now, many are returning, via the new fund, which spreads the risk across multiple companies. “Until now, small start-up companies only saw a dark tunnel with no light at the end. We hope this will inspire confidence so that new companies as well as products enter the field”, stresses Cueni.
Early stage molecules fall off a cliff after the early drug development phase, when developers realise that projected returns on costly clinical trials (comprising around 80% of R&D spend) are not worth the risk. CARB-X, a global non-profit partnership based in Boston, is one of very few organisations that are reviving early-stage antibiotic research with support for over 60 antibiotic development projects. But upon reaching clinical development, other funds are needed. This is where the AMR Action Fund will step in.
The Wellcome Trust, alongside WHO and the European Investment Bank all lend their support to the new fund. Jeremy Farrar, director of the Wellcome Trust says, “[…] a long-term fix for the broken antibiotics market remains elusive, threatening the very survival of the companies who are driving vital innovation…This will provide an urgently needed lifeline for innovators who currently struggle to find investors to support late-stage development costs”.
However, reforms around procurement and reimbursement of antibiotics by the healthcare provider are still needed. The UK is currently piloting a new model that requires the NHS to pay pharmaceutical companies up front for access to effective antibiotics, rather than reimbursing them based on the quantity of antibiotics sold. Sweden is also piloting a new reimbursement model that aims to ensure the Swedish healthcare system will not risk being without active antibiotics for patients with hard-to-treat infections. The state guarantees a minimum annual revenue to the supplying pharmaceutical company.
Welcoming the new fund, Professor Dame Sally Davies, UK Special Envoy on AMR noted that, “the UK is leading the way by encouraging companies to produce new antibiotics to stay one step ahead of life-threatening diseases”. She adds that, “the new subscription-style payment model for antibiotics could mean that patients will benefit from new antibiotic treatments as early as 2022”.
Bacteriologist Matthew Avison, from the University of Bristol says the recent COVID-19 pandemic has highlighted the power of untreatable infections, and points out that while the current focus is on COVID-19, “more funding for AMR research is essential if we are to dampen down this slow-burning pandemic”.
“Antibiotic resistance makes once treatable infections untreatable and is projected to kill around 700 000 people this year”. Importantly, Avison adds that unlike COVID-19, “there will never be herd immunity to antibiotic resistant infections, nor a universal vaccine. If we don't do these things, the impact of antibiotic resistance will dwarf the impact of COVID-19 over the next decade”.
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