INNOVATION AND ANTIMICROBIAL RESISTANCE
If antibiotics fail to receive sufficient returns on investment, how can we incentivize the development of novel antibiotics?
Could the low return on investment for antibiotics be a reflection that less than 40% of systemic anti-infectives were withdrawn over a two-decade period?
What alternative approaches to drug discovery might rejuvenate the development of new classes of antibiotics? What might the story of teixobactin tell us? Might there be promise in crowdsourcing from natural product sources?
JPIAMR releases new AMR Research Funding Dashboard
The Joint Programming Initiative on Antimicrobial Resistance announced the launch of their new AMR Research Funding Dashboard, a dynamic tool that includes funding data since 2017 from over 22 JPIAMR member countries (Canada, Czech Republic, Finland, France, Germany, Israel, Italy, South Africa, Sweden, and Norway, among others), the European Commission, and the Wellcome Trust. Categorized into the JPIAMR Strategic Research Agenda’s (SRA) six priority topics - therapeutics, diagnostics, surveillance, transmission, environment, and interventions - the data mapped in this dashboard shows a total of €1.794 billion in antimicrobial resistance (AMR) research from a total of 1,939 projects over the time period 2014-2017. Broken down, 76.2% of total investments in the projects reported were for research projects in antibiotic resistance, followed by 20.6% for anti-parasitic and 3.2% in anti-fungal resistance research. As published in the follow-up Mapping of AMR research funding report, 57.6% of research grants were dedicated to priority area therapeutics, followed by 13.1% in diagnostics and 11.3% in interventions. Overall, the mapping showed an increase in funding for AMR as a national priority among JPIAMR member countries across all funding categories. However, the data suggests that further commitments, especially at the national level, in detection and prevention of the spread of AMR are needed to fulfill a “one health” framework against AMR.
Source: Joint Programming Initiative on Antimicrobial Resistance
Development of a genetic test for antimicrobial resistance
A new report in BMC Infectious Diseases highlights the development of a new genetic test that can determine whether bacteria carry genes coding for resistance to two common antibiotics used to treat respiratory illnesses. Developed by researchers at American University, this test determines if the patient carries bacteria containing the mef(A) gene, a gene that causes resistance to erythromycin and azithromycin, two common macrolide antibiotics used to treat strep throat and other respiratory illnesses. Currently, antibiotics are prescribed based on patient history and past antibiotic referral, consisting of mostly guesswork, with patients returning if the prescribed antibiotics fail. Using this new genetic test, physicians can know within 10 minutes whether a certain antibiotic will work on a patient, saving both time and resources in treating common illnesses, in addition to reducing the costs associated with potential failed treatments. In addition, with approval from the FDA, this test could help track antibiotic resistance, offering researchers the ability to monitor the prevalence and spread of antimicrobial drug resistance.
Source: BMC Infectious Diseases
Lancet commission on tuberculosis calls for greater funding and R&D on AMR
The Lancet released “Building a Tuberculosis Free World: The Lancet Commission on Tuberculosis,” an outline of the political need and funding needed to facilitate prevention methods and treatments for those who need them. In this report, the Lancet asserts that reducing tuberculosis (TB) mortality by 90% by 2030 will not be possible without an increase in TB R&D investment up to at least $2 billion per year for the next four years. However, it is quantified that every dollar invested into TB R&D could yield $16-82 if new tools are developed to fight TB. Serving as both a status-check and a call-to-action, this report hopes to spur both policymakers and funders alike to commit the resources necessary to end tuberculosis worldwide, especially in low- and middle-income countries (LMICs).
Source: The Lancet
Drugmakers and health groups urge US lawmakers to increase R&D by incentivizing FDA antibiotic approvals
Though CARB-X’s public financing boasts bringing 12 new antibiotic classes into the pipeline, large pharmaceutical companies have continued to lose interest in R&D for developing novel antibiotics. Drugmakers, again allied with the Infectious Diseases Society of America and Pew Charitable Trusts, have sent a letter to urge U.S. Senators to pass “pull incentives.” The letter notes the exodus of large pharmaceutical companies, such as AstraZeneca, Sanofi and Allergan, not to mention Novartis, from antibiotic R&D. On the heels of the GAIN Act in 2012 that extended market exclusivity to novel antibiotics and the Limited Population Antibacterial Drug regulatory approval pathway that lowered clinical trial requirements, the letter argues that additional incentives are still needed after antibiotics come to market. Such a package of incentives could include “a mix of tax incentives, novel pull incentives, reimbursement changes, and even a low-interest loan program, along with continued investment in NIAID and BARDA.”
Source: Infectious Diseases Society of America
The role of economics in antibiotic resistance
Like climate change, the incentives of individual firms fail to take into account the societal costs of antimicrobial resistance. Because antimicrobial resistance (AMR) foreshadows a world with no antibiotics, one review published in Science examines barriers to addressing AMR from an economics perspective, drawing parallels to climate change. By exploring economics concepts such as externalities and the principal-agent relationship, researchers conclude that dealing with the impacts of AMR is prevented on the supply side by a lack of incentive for firms to develop new antibiotics, while the demand side is characterized by the abuse of antibiotics as a public good. As a result, the question of how to incentivize innovation such that new antibiotics are not distributed until AMR renders existing ones ineffective is imperative to answer, as well as the bigger question of how to incentivize the production for goods that must be avoided for as long as possible. By examining these central questions and reaching a consensus in the economics of AMR, economists and public health professionals alike could help mitigate this pressing epidemic.
Innovate4AMR invites students to design tomorrow’s solutions for antimicrobial stewardship
Innovate4AMR invites student teams from around the world to design innovative solutions for antimicrobial stewardship in resource-limited, healthcare settings. The global online competition seeks to engage student teams to propose strategies to tackle the underuse, overuse and misuse of antibiotics, which persist in healthcare settings from hospitals and clinics to outpatient pharmacies. In addressing AMR, student teams working across disciplines have much to contribute in proposing how to redesign the healthcare system.
“We hope to engage and enlist the next generation of leaders in developing innovative approaches to ensure more effective stewardship of antibiotics. Those in healthcare have a particularly critical role to play -- finding new solutions for a world free from the fear of untreatable infections,” said Anthony So, MD, MPA, Director, ReAct Strategic Policy Program and IDEA (Innovation+Design Enabling Access) Initiative at the Johns Hopkins Bloomberg School of Public Health.
ReAct – Action on Antibiotic Resistance and the IDEA (Innovation+Design Enabling Access) Initiative at the Johns Hopkins Bloomberg School of Public Health are teaming up with the International Federation of Medical Students’ Associations (IFMSA), representing 1.3 million students from 127 countries, to organize this global competition. The World Health Organization will support and co-fund the capacity-building workshop for the winning teams.
The competition’s website provides educational resources, so no prior experience in working on AMR is needed to participate in the competition. Teams have until September 16 to put forward impactful and sustainable solutions. Winning teams will present their final proposals to an expert panel at a capacity building workshop in Geneva during the World Antibiotic Awareness Week in November 2019. There, experts will work with student teams to enable them to operationalize their projects.
As Teodor Blidaru, IFMSA Liaison Officer to Student Organizations, notes: “As future healthcare professionals, we acknowledge the huge threat and burden of Antimicrobial Resistance and we feel the need to take urgent action. Through Innovate4AMR, we aim to build a community of health students and empower them to tackle AMR in original, effective ways.”
Last year’s competition drew 145 team applications, and eleven moved onto the winner’s circle, advancing proposals ranging from innovative outreach approaches to the mothers of children in Peru among the Quechua and Aymara-speaking rural towns to track-and-trace systems using QR codes on antibiotic packaging. For more information, visit Innovate4AMR.org.