Report calls for $2bn global fund to kickstart antibiotic development

BMJ 2015; 350 doi: (Published 14 May 2015) Cite this as: BMJ 2015;350:h2635
  1. Jacqui Wise
  1. 1London

A review on antimicrobial resistance commissioned by the UK prime minister has called for the establishment of a global innovation fund of around $2bn over five years to boost funding for “blue sky” research into drugs and diagnostics.

Its report said that there was a need to kickstart drug development to tackle the growing global problem of drug resistant infections.1 This was the economist Jim O’Neill’s third paper on the challenges of antimicrobial resistance.2

Another recommendation is for a global organisation to make lump sum payments to drug companies to incentivise the development of the most needed antibiotics. Payment would be set against selective criteria agreed in advance. The report said that this approach would “de-link” the profitability of a drug from volume of sales. It would get rid of the commercial imperative for drug companies to sell large quantities of new antibiotics, which had contributed to the spread of resistance.

The report, which David Cameron commissioned in July 2014, also called for innovative partnerships between academia and industry at the early stages of antibiotic development. It said that public bodies should facilitate clinical trials and that there should be a lowering of financial and regulatory barriers wherever possible in order to speed up drug development.

The report said that such interventions would need political leadership at a global level. Lessons could be learnt from successful initiatives such as UNAIDS, the joint United Nations programme on HIV and AIDS, and the global vaccine initiative GAVI.

The report analysed antibiotics that had been approved and those at various stages of development. It concluded that there was a mismatch between the antibiotics needed in the future, given emerging levels of drug resistance, and the number of drugs in the pipeline. Antibiotics were being developed, it said, but not the ones targeting the most urgent needs. For example, there was rising resistance to carbapenems, a class of drugs vital to tackle pneumonia and bloodstream infections. But only three compounds were currently under development with the potential to be active against most bacteria resistant to carbapenems.

The report estimated that a comprehensive package of interventions would cost between $16bn (£10.2bn; €14.2) and $37bn over 10 years. The costs were modelled on the basis of achieving 15 new antibiotics a decade, of which at least four should have truly novel mechanisms of action or novel therapeutic profiles. The report said that such sums were small in comparison with the cost of antimicrobial resistance, estimated at $20bn to the United States alone every year in excess healthcare costs. The report said that the drug industry should play a part in paying for the $2bn innovation fund.

O’Neill will spend the next year engaging with governments, non-governmental organisations, and drug companies to discuss the proposals contained in his report and will present a detailed package of actions by the summer of 2016.

Launching the report he said,We need to kickstart drug development to make sure the world has the drugs it needs, to treat infections, and to enable modern medicine and surgery to continue as we know it. My review on antimicrobial resistance has today published clear proposals to supercharge antibiotics discovery, potentially saving millions of lives for a fraction of the $100 trillion cost of inaction.”

The report has been broadly welcomed. John Savill, chief executive of the UK Medical Research Council, said, “More money will help to move antimicrobial research from the Cinderella status it’s currently in to the top of the global agenda. Jim O’Neill’s report echoes our view that this needs a cross academia, cross industry, and cross continent approach. It’s easy to look to big pharma to help stump up the bill for pushing new antibiotics through the pipeline, but only by working together to foster innovation and support change will we really get under the skin of this problem.”

Sally Davies, chief medical adviser to the UK government, said, “This latest report will stimulate important conversations between governments, pharmaceutical companies, and other funders. We have to respond to the challenge of antimicrobial resistance by making sure we secure the necessary antibiotics for generations to come, in order to save millions of lives and billions of pounds.”

Maureen Baker, chair of the Royal College of General Practitioners, said, “It is astonishing that a new class of antibiotic has not been produced in over 25 years, and we would strongly support more investment into research to develop new antibiotics to tackle emerging diseases, so that we can keep our patients safe now and in the future. But this isn’t going to happen overnight, and in the meantime it is important that we do whatever we can to help limit the growing, global resistance to antibiotics.”

The report was also welcomed by the drug industry. Patrick Vallance, GlaxoSmithKline’s president of pharmaceuticals research and development, said, “We are very encouraged by the ideas it sets out to modernise the economic model to encourage investment in research and ensure reasonable returns for successful innovation while discouraging unnecessary use of new antibiotics.”


Cite this as: BMJ 2015;350:h2635


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