Sparks: Reimagining global partnerships to tackle antimicrobial resistance

This blog is a follow-up to Sparks: Igniting new ideas, an IDS event on 28 January to present new ideas on addressing key social and environmental challenges.

Antimicrobial resistance (AMR) is a rapidly growing global health threat. Infections resistant to existing antibiotics are increasing, undermining the effectiveness of routine medical care. It can be slowed by measures to reduce unnecessary use of antibiotics, but that will only delay an unavoidable reality: new ways to treat infections are urgently needed. Yet progress in developing new antimicrobial drugs has been dangerously slow.

Ten years ago, a report commissioned by the UK Government highlighted that large pharmaceutical companies were abandoning work on new antibiotics. These products are unprofitable because of the need to delay the emergence of resistance by limiting their use. The review called for a combination of ‘push’ incentives to fund discovery and early-stage development of new drugs and “pull” incentives to reward companies for bringing new antibiotics to market.

Watch’s Gerry Bloom’s presentation at Sparks

Despite international efforts to implement these incentives, the capital committed has been relatively modest. Large pharmaceutical companies have continued to withdraw from the research for new antibiotics and fewer people are working on this issue.

The key idea that can create change

The rapid development of effective vaccines and treatments in response to COVID has underscored how the global life sciences sector has changed.

First, innovations in the use of big scientific infrastructure and the application of artificial intelligence have made it possible to accelerate the discovery of new drugs through new kinds of partnership between academic research centres, specialised scientific infrastructure and companies with expertise in the development and manufacturing of new drugs.

Second, several middle-income countries demonstrated significant capacity in the life sciences sector. These countries are experiencing higher levels of resistance to antibiotics and they have a greater need for new and effective products.

Third, many countries experienced problems with access to vaccines leading to pressure for more inclusive approaches to drug discovery.

These developments are creating opportunities for accelerating the discovery and production of new antibiotics. But this will require a shift from a reliance almost exclusively on governments, scientific institutions and companies based in the global north to a more inclusive strategy.

Evidence from emerging partnerships

IDS has participated in the creation of LEAD, a coalition led by Chris Dowson, a senior scientist based at Warwick University. The partners include leaders in science, public health and policy engagement. Its purpose is to support national and international efforts to accelerate the discovery and development of new antibiotics.

The work began in the UK and Japan with the organisation of policy fellowships for future leaders from the Japan Institute for Health Security and the UK Health Security Agency. These are key organisations in the country’s effort to protect public health. They are now partners of LEAD. The Graduate Institute of Policy Studies in Tokyo organised the activities in Japan. The aims were to build mutual understanding of the strengths and weaknesses of each country’s antibiotic innovation ecosystem, identify options for change and agree areas for future bilateral collaboration.

We have also organised meetings with potential partners in India and China. Below are some findings:

The UK

The UK has led the mobilisation of an international effort to address AMR. Its government has provided funds for both push and pull incentives. The so-called Netflix model, that pays a fixed amount per year to the producer of an effective new antibiotic, regardless of the quantity used, is viewed as a model of good practice. More recently it has published an industrial strategy that sets a target to become one of the top three countries in the life sciences sector through the implementation of a systems-level approach. This strategy emphasises the importance of international partnerships. We will facilitate a meeting in Parliament next month to explore how this approach can accelerate the discovery of new antimicrobial drugs – building on, amongst other things, UK strengths in cutting edge science and in leadership of the global effort to tackle anti-microbial resistance.

Japan

The Japanese Government has recently established the Japan Institute for Health Security to coordinate the development of vaccines and drugs to address infectious diseases. There is a lot of interest in the potential for collaboration between Japan and the UK in antibiotic discovery. Japan is also exploring options for collaboration with countries in Southeast Asia and is organising a meeting in March to agree next steps.

India

India has a successful pharmaceutical sector that is a major supplier of generic products to the global market. In collaboration with the Public Health Foundation of India, we have met with academic research centres, private pharmaceutical companies, government agencies and philanthropies to explore opportunities for UK-India collaboration on antibiotic discovery. We found a strong interest at the highest level of government.

The next step will be to organise opportunities for policy actors and scientists from India and the UK to explore opportunities for collaboration and identify actions for overcoming constraints such as cooperation between regulatory agencies, collaboration on high quality clinical trials and agreement on how to deal with intellectual property. The aim is to build strong partnerships that take into account the relative strengths of the two countries.

China

The Chinese pharmaceutical sector has a lot of capacity for research and development. But, will it contribute to the development of new antibiotics, despite the lack of a profitable market? The Chinese Government has made several statements supporting global health and it has made commitments to contribute to the development of global public goods. The Department of Global Health at Peking University, a major source of policy advice to the government, has agreed to join the LEAD coalition and explore possibilities for collaboration. Last week Chinese and British researchers met in Beijing to identify priorities for bilateral collaboration as part of what is called a Track 2 process. The joint development of new antibiotics, as a global public good, would be an excellent area for collaboration.

Links to broader policy processes

We are fast approaching 2030, the target date for the Sustainable Development Goals. There are grounds for concern about whether it will be possible to reach agreement on new and implementable global development priorities in the current context of intense economic competition and geopolitical contestation. There is a broad consensus on the need for collaboration on health issues and this may be an area on which agreement will be possible.

Two ideas that Mark Carney, the Prime Minister of Canada, presented in his speech at Davos point towards a way forward.

First we need to name reality. In global health this means recognising the need to shift from a segmented view of global health governance with countries in the global north putting in place many norms and standards to regulate their health sectors and with so-called “global health”, mostly concerning countries supported by international aid. Policies that affect the availability, cost and safety of key inputs to health services are at least as important as those concerning development assistance. We need to move towards more inclusive governance arrangements based on widespread agreement on objectives for global health and on roles and responsibilities of each country. It may not be realistic to expect global agreement on new governance arrangements for this large and complex sector any time soon.

In the meantime, we need to build different coalitions for different issues based on common values and interests. The process we have been following to build collaboration for antibiotic discovery is an example of how this might work:

• There is a need to agree on specific problems to be addressed.
• For each problem it will be important to identify a coalition of the willing and to then build mutual understanding of the current situation and options for addressing the problem – involving technical experts from all relevant countries.
• This can lead to the formulation and implementation of strategies for addressing the problem, beginning with collaboration between a few partners or with a focus on a specific region but with the potential to extend to a wider group of countries
• It will be important to ensure learning about what works well and what does not to contribute to broader discussions of appropriate governance arrangements.

We are at a very early stage in the efforts to build more inclusive governance arrangements for a rapidly changing world. But antimicrobial resistance offers a compelling test case for how global partnerships can be reimagined to deliver life-saving public goods.