UK launches subscription style model for antibiotics to encourage new development

The UK has launched its subscription style payment model for antibiotics, with the first two drugs to be selected and evaluated next year.

The scheme hopes to incentivise companies to invest in researching and developing new antibiotics in the face of growing antibiotic resistance. It will see pharmaceutical companies paid upfront for their products, based on the value it provides to the NHS rather than how much is used.

The scheme was first announced in July 2019,1 but officially launched 17 June 2020 after nearly a year of set up, in which the Department of Health and Social Care worked closely with the National Institute for Health and Care Excellence (NICE) and NHS England. Suppliers can now register their interest on NHS England’s eTendering service.

According to the launch announcement, two antibiotics that are proven to be safe and effective will be selected to undergo a NICE health technology assessment throughout 2021, using adapted methods for antimicrobials.

The government has said it is particularly interested in antibiotics that can provide alternative treatment options for serious infections, such as bloodstream infections, sepsis, and hospital acquired pneumonia.

NICE chief executive Gill Leng said, “Alongside the threat of coronavirus is the increasing risk posed by antimicrobial resistance, exacerbated by a sparse antimicrobial development pipeline. That is why we need to incentivise investment in innovative antimicrobial drug development as soon as possible.”

“We hope that this project will inspire healthcare systems across the world to consider adopting similar models so that, collectively, we deliver meaningful incentives that reinvigorate the global antimicrobial pipeline.”

Jayasree Iyer, executive director of the Access to Medicine Foundation, an independent non-profit organisation, told The BMJ that for the scheme to work, the government needs to be “ambitious.”

She said, “As a society, we need to replace many antibiotics to tackle drug resistance. Several innovators, such as biotech companies, have gone bankrupt because of the lack of financing and a viable market. I’m optimistic that this scheme can stimulate more biotechs to engage in developing antibiotics and guarantee that these reach patients. The scheme has the potential to make a big impact, but it must be ambitious—to include more antibiotics, to benefit many more people globally, and fast.”

The Access to Medicine Foundation produces the Antimicrobial Resistance Benchmark report, which in 2020 reported that while some improvements are being made, the change is not happening at the scale needed to radically impact the threat from drug resistance.2

Meanwhile, others have said wider system changes are needed to achieve long term change.

In a statement, Richard Stabler and Rebecca Glover from the Antimicrobial Resistance Centre at the London School of Hygiene and Tropical Medicine, told The BMJ, “We welcome the government’s continued commitment to tackling antimicrobial resistance, however one or two new antibiotics are not a long term solution.

“For meaningful reductions in antimicrobial resistance rates in the UK to be achieved and sustained, structural solutions such as strengthening health systems, reducing poverty, improving sick pay and workers’ rights, and improving access to clean water and sanitation need to be adequately funded both at home and abroad.”