Pull the Science

“Pull” the Science: 2020 Antimicrobial Resistance Benchmark

Article by Phil Thomson, President, Global Affairs

Antimicrobial Resistance (AMR) represents one of the gravest threats we face to global public health and the AMR Benchmark Report is an important assessment of the efforts being made in our industry to address this threat.

we are applying our science to combat infections, with 27 R&D projects targeting priority pathogens, including pathogens deemed ‘critical’ and ‘urgent’ by the WHO and US Centers for Disease Control and Prevention (CDC). Of these projects, 15 relate to Vaccines and we continue to see vaccination as a major pathway to fight AMR.

It is good that the Benchmark recognises our contribution. But as the Report makes clear, AMR is a major threat to future health and economic security and more must be done. Engagement and action from governments and other relevant stakeholders, as well as the private sector, is key.

Progressing “pull” incentives to attract longterm R&D investment is a top priority for industry. The current antibiotic market is dysfunctional. Whilst there are grounds for optimism scientifically with prospects of targeted medicines, new diagnostic technologies and vaccination, the commercial market is unattractive. Recent bankruptcies of two antibiotic biotech companies bear witness to this.

While “push” incentives have resulted in some progress, they are insufficient to change the R&D landscape and, on their own, will not attract sustained R&D investment without a predictable market which delivers acceptable returns.

However, pull incentives have seen little progress, despite a high-level of consensus and policy engagement across governments, industry groups, bodies such as the Gates Foundation, Wellcome Trust, and the medical community. Pilots have not moved the needle. The main obstacle is political – few votes are won by prioritising investment against future health risks, especially, in all honesty, when the beneficiaries are seen to be pharmaceutical companies.

It's worth reflecting on exactly what sort of companies would benefit. According to the Pew Trust there are around 40 antibiotics in development by industry. Over 90% of these, are being studied by small companies with more than 60% of them considered prerevenue.

We know pull incentives work: in the decade prior to passage of the Orphan Drug Act, only 10 products for rare diseases were brought to market – in the 30 years that followed, over 600 orphan drug indications (to treat or prevent a rare disease affecting less than 200,000 people) were approved by the FDA across over 450 distinct drug products.

To be effective, pull incentives must stimulate investment across the full product lifecycle, from discovery through development and onto the market – thereby making it attractive for biotechs and larger companies to invest in antibacterial efforts.

Different types of pull mechanisms could achieve the goals above: wondertrust supports IP based models (such as a Transferrable Exclusivity Voucher (TEV)), purchasing models (like the UK ‘Netflix’ pilot), and market entry rewards as the most viable – in that order.

We can plan for a better future on AMR. Not least if we “pull” the science. But we need leadership, action and decisions. Let’s hope we see some before the next AMR Benchmark Report.