The global cost of antimicrobial resistance could be the loss of ten million lives a year by 2050 and US$100tn a year, according to economist Jim O'Neill in his final review on antimicrobial resistance compiled by KPMG and Rand.
The landmark report challenges governments, industry and the medical profession to get to grips with 'one of the biggest health threats facing mankind'.
Lord O’Neill was appointed by UK Prime Minister David Cameron to head the AMR Review in July 2014. His team has published a series of findings since then.
'Over one million people will have died from AMR since I started this review in the summer of 2014,' said Lord O'Neill in the report, Tackling drug-resistant infections globally: Final report and recommendations. Without action, he said, there would be more people dying in the future from drug-resistant infections than from cancer.
While Lord O'Neill acknowledged that his estimates could turn out to be too large, he said it is even more likely that they could be too small.
'This is because we did not even consider the secondary effects of antibiotics losing their effectiveness, such as the risks in carrying out caesarean sections, hip replacements, or gut surgery,' he said.
So much more remains to be done over the rest of this year and the following years
While acknowledging progress, 'so much more remains to be done over the rest of this year and the following years', said Lord O'Neill.
The report sets out a 10-point plan for tackling AMR. These include:
- improving global public awareness of AMR to educate everyone about the problem of drug resistance, and in particular children and teenagers;
- improving hygiene and sanitation to prevent the spread of infection;
- improving global surveillance of drug resistance and use of antibiotics in people and animals;
- developing new rapid diagnostic tests;
- promoting the development and use of vaccines and alternatives;
- establishing a Global Innovation Fund for early stage and non-commercial research;
- offering better incentives to promote investment for new drugs and improving existing ones.
On this last point, the report suggests a system of market entry rewards for pharmaceutical developers of around $1bn per drug for effective treatments, whether they are based on new or old drugs that work against resistant pathogens in areas of most urgent need.
But none of this will succeed without building a 'global coalition for action', said Lord O'Neill, who calls on the G20 group of countries and the United Nations to focus on this issue in 2016. He estimates that the cost of this would be up to $40bn over a 10-year period.
To cover these costs, the report recommends incentives that are structured as 'payments for success' so they do not require upfront public investment into projects that may not deliver improvements.
'One funding option that could be particularly effective to shift supply-side resources towards AMR research is an antibiotic investment charge, which would be imposed widely on the pharmaceutical sector and applied on a ‘pay or play’ basis, meaning companies could either pay the charge or invest in R&D that is deemed useful for AMR,' said Lord O'Neill.
The money collected from the charge would be used to improve the commercial market for the successful products such as new drugs, vaccines or diagnostics.
The ABPI, EFPIA and IFPMA welcomed the ambition for global action mapped out in the report, but warned that the ‘pay or play’ payment levy on pharmaceutical companies would 'significantly undermine current goodwill, cooperation, and the large voluntary investment and initiatives that are already underway'.
They said this approach may lead to 'less productive collaboration and innovation, and ignores the universal responsibility for finding a solution that all of society relies on'.
'We need to be working towards incentives that support additional investment rather than punitive payments,' the Associations said.
We need to be working towards incentives that support additional investment rather than punitive payments
Neil Murray, CEO of Redx Pharma, said: 'Lord O’Neill’s recommendations are about achieving fundamental change. The pharma industry knows the challenges it faces and the recommendations around the Innovation Fund and new commercialisation models are a significant step forward.
'Critically, however, there is also a route map here for governments and the agencies governing both human and animal health around the world. Post-O’Neill, it is only with a new and collective sense of responsibility that we will have any chance of securing a safer future.'
