Recent outbreaks of cholera in parts of Africa and the Middle East have served as timely reminders of the potentially devastating health, security, and economic threats posed by antibiotic resistance. Most recently, in light of the episodes that struck Kenya this summer, microbiologist Samuel Kariuki highlighted the growing risk posed by certain strains of the bacteria that have become resistant to drugs. Meanwhile, a cholera epidemic that started in April 2015 in Yemen has now infected almost half a million people and killed nearly 1,900. Concerns have been raised that many hospitals in the country are needlessly treating patients with intravenous antibiotics – a move that not only risks depleting the crippled nation’s scarce medical resources, but could also speed the evolution of drug-resistant strains of the bacteria that cause the disease in the first place.
Cholera is bad enough already, but coupled with the threat of antibiotic resistance, it could have the capacity to practically demolish undeveloped nations like Yemen. So it’s a promising sign that Germany has put both antibiotic drug resistance and development at the heart of its agenda for the G20 presidency this year. As head of the forum, Chancellor Angela Merkel is leading a drive to increase financing and provide focus on the issue of superbugs. This move comes at a welcome time as President Trump continues to hack away at the US’ formerly leading role in the global health sector. Most recently, at the end of last month’s summit in Hamburg, Merkel succeeded in rallying G20 members behind a new communiqué in which world leaders pledged to implement national action plans, crack down on the overuse of antibiotics in farming, and establish a new international R&D Collaboration Hub to “maximize the impact of existing and new anti-microbial basic and clinical research initiatives as well as product development.”
These are long-delayed steps, but absent adequate government policy innovations and greater funding for public-private partnerships (PPPs), the intentions expressed in the G20 communiqué simply won’t be enough to tackle a threat that is predicted to kill as many as 10 million more people annually by 2050. Far more comprehensive and immediate global action is required to prevent the spread of bacteria that could make diseases like cholera commonplace and render standard medical procedures such as C-sections too risky to perform.
First, to increase antimicrobial R&D, governments need to provide more funding for innovative financing solutions that will motivate pharmaceutical companies to invest in the field. Currently, pharmaceutical companies all too often prefer to bet on blockbuster drugs that command high prices and steady demand, rather than on less-profitable but badly needed antibiotics. To steer pharmaceutical priorities in the right direction, policymakers can use incentive structures and instruments like “transferable market exclusivities,” which allow companies to transfer a given antimicrobial medicine’s patented benefits to a different drug.
Market-based mechanisms can also help attract adequate private sector investment and reward fresh innovations. For instance, market entry incentive payments for developing new products that address microbes deemed “high priority” by the World Health Organization can help increase the return-on-investment of antibiotic research. If governments prioritize these kinds of mechanisms, it could go far towards making investment in the field more attractive for private pharmaceutical firms, critical stakeholders in the effort.
In addition to leveraging new incentive mechanisms, governments need to invest more funding into public-private partnerships, which have already shown success in bringing critical new drugs to the market. For instance, following the Ebola outbreak that hit Guinea, Sierra Leone, and Liberia, the Russian government created a new vaccine for the virus and delivered it to Guinea with the logistical support of Rusal. As the biggest foreign investor in Guinea, the company had already started numerous anti-Ebola initiatives, donating medicine and hygiene equipment to the Ministry of Health in April 2014, outfitting mobile sanitary posts in the seaport of Conakry, and financing the deployment of a mobile anti-epidemic research lab and hospital. Rusal also built and launched a new center for combatting viral diseases in Kindia, which is now serving as a center for testing the new vaccine.
More recently, in the spring of 2016, U.S. Army scientists invented a new vaccine to combat the Zika virus that had erupted in Brazil a year earlier. Soon thereafter, the army gave exclusive, royalty-bearing licenses to Sanofi Pasteur for two pending Zika-linked patent applications in exchange for having the pharmaceutical company carry out Phase 2 and Phase 3 trials. The army vaccine is one of several promising candidates that were developed by government-funded scientists. To be fair, the Zika vaccine has been the subject of controversy over allegations earlier this summer that Sanofi rejected a request from the army to set an affordable US price. But especially given the fact that it is remains the most viable weapon against the Zika virus, the successful collaboration only underscores the need for government guidelines on drug pricing. For example, the U.S. Senate is now toying with an idea to reign in drug prices for products that are sold at a premium in the country compared to other high-income economies.
Vaccines are set to be a critical part of the answer to antibiotic resistance, as preventing infections in the first place will foreclose both the use – and misuse – of antibiotics. Seen in this light, the G20’s proposed R&D collaboration hub is the most promising development in the field. If national governments enact parallel initiatives, the vaccines that result from new PPPs could eventually neutralize the threat from superbugs.
Photo caption: Rusal delivering Ebola vaccines to Guinea, (c) Flickr