Extending the UK’s Leadership with an Antibiotic Subscription Model to Tackle AMR

Following the UK’s top ranking in the recent AMR Preparedness Index, Michael Hodin and Peter Jackson discuss the country’s novel antibiotic subscription model and the key actions it must take to cement its position as a global leader in the fight against AMR.

The UK is poised to lead our world’s response to one of the most dangerous, yet widely overlooked global health challenges that we face: antimicrobial resistance (AMR). According to a recently released Lancet report, AMR claims over 1.27 million lives around the world every year,1 more than HIV and Malaria, and this toll is projected to reach as many as 10 million by 2050.2 The UK’s pioneering AMR policies provide a critical model to avoid these dire projections and galvanise global action.

Like COVID-19 and climate change, AMR is a collective action problem with existential stakes. Our health systems urgently need new antibiotics, but there are no clear incentives to take on the high costs of developing these drugs, which would need to be held in reserve rather than sold and used at scale. Consider that in the UK only one new antibiotic was approved in the 15 years between 1999 and 2014, and fewer than 150 researchers are working on the problem in the industry, predominantly in small-to-medium-sized biotech companies.3

The toll of AMR is already significant and growing. Each year in the UK, AMR causes more than 12,000 deaths4 and incurs over £180 million in costs.5 But these figures pale in comparison to the threat of the decades ahead.

As the challenge worsens, the UK Government and the National Health Service have taken the lead in finding new solutions. The UK was ranked as the top country for proactive AMR policies in the 2021 AMR Preparedness Index, which recognised its comprehensive national AMR strategy and new strategies to encourage innovation.6

The first antibiotic subscription model

The heart of British leadership is a first-of-its-kind antibiotic ‘subscription’ model. Under the pilot programme, launched earlier this month,7 the UK Government pays companies for access to new antibiotics based on their usefulness to the NHS. The initiative, which NHS England and NICE are running, ‘de-links’ the value of new antibiotics from drug sales, reflecting a different kind of valuation focused instead on public health and the value to society of a needed new drug. At the same time, this antibiotic subscription approach limits the over-use of new treatments, preventing future widespread drug resistance from developing.

While global experts have long discussed such a model for AMR, the UK is the first to put this innovative idea into practice. Elsewhere across government, early-stage research and development into new AMR treatments are being supported, for example with £19m of Strength in Places funding for the North-West based Infection Innovation Consortium, iiCON.8Despite these positive steps, the 2021 AMR Preparedness Index also highlighted a lack of R&D capacity to address the urgent need for new AMR drugs.

Silhouettes of pill jars

Four key actions to become a global leader on AMR

As a country, we must now take four key actions to build on our momentum, cement our position as the global leader on AMR, and help defuse this health and economic threat.

First, policymakers can make the antibiotic subscription pilot permanent, increase its funding, and expand its scale across the whole of the UK to spur innovation across the antimicrobial market.

Second, we must implement reforms to reduce the time between regulatory approval and reimbursement decisions. The current lags in this process, which are largely bureaucratic side effects, only serve to impede patient access to urgently needed, new antimicrobials.

Third, we can better coordinate government support, so-called ‘push’ incentives, to help cover the upfront costs of drug development, which are estimated at over $1.5 billion to bring just a single antibiotic to market.9 These initial costs can be especially prohibitive for the small biotech firms and mission-driven research organisations that are primarily focused on AMR. The existing AMR Funders Forum should be beefed up to include industry and private investors to provide more effective and coordinated national leadership on AMR, in the same way, that the industry-led Vaccines Task Force delivered the UK’s world-leading position on COVID-19. By doing this and combining more effective ‘push’ incentives with the ‘pull’ of the antibiotic subscription model, the UK will truly have a best-in-class approach to help innovators overcome financial hurdles and accelerate toward new solutions.

Fourth, the UK can continue to raise the issue, share lessons from our antibiotic subscription pilot programme, and encourage other nations to take similar actions.10 We should build on our global leadership on AMR, fulfilling commitments made during our G7 presidency and helping to foster a more global, action-oriented response.11

While the recent G7 Health Ministers’ Communiqué calling for greater action on AMR is encouraging,12 we know that solving the AMR challenge will require innovative thinking, greater global collaboration, and more decisive action on a broader scale. By expanding our leading-edge AMR efforts at home, the UK can prove that these solutions work and further galvanise the world’s leaders to directly address this mounting crisis.

Peter Jackson
Former chairman of the steering committee created to establish the UK’s translational R&D centre focused on antimicrobial resistance, the AMR Centre
Executive Director of Infex Therapeutics

Michael Hodin
CEO
Global Coalition on Aging

This article is from issue 22 of Health Europa Quarterly.

References

1    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext#seccestitle10

2    https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf

3    https://globalcoaging.wpengine.com/wp-content/uploads/2021/06/GCOA-AMR-Preparedness-Index_FINAL.pdf

4    https://www.thebureauinvestigates.com/stories/2016-12-11/superbugs-killing-twice-as-many-people-as-government-says

5 http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/antimicrobial-resistance/oral/88745.html

6    https://globalcoaging.wpengine.com/wp-content/uploads/2021/06/GCOA-AMR-Preparedness-Index_FINAL.pdf

7    https://www.england.nhs.uk/2022/06/nhs-lands-breakthrough-in-global-battle-against-superbugs/

8    https://www.lstmed.ac.uk/news-events/news/iicon-creates-176-jobs-and-leverages-over-£150-million-investment-in-first-year

9    https://www.nature.com/articles/d41586-020-02884-3, referencing  https://pubmed.ncbi.nlm.nih.gov/28888660/

10  https://www.telegraph.co.uk/global-health/science-and-disease/superbugs-could-cause-disaster-worse-covid-dont-act/

11  https://www.gov.uk/government/publications/g7-finance-ministers-statement-on-actions-to-support-antibiotic-development#:~:text=Policy%20paper-,G7%20Finance%20Ministers’%20Statement%20on%20Actions%20to%20Support%20Antibiotic%20Development,silent%20pandemic%E2%80%9D%20of%20antimicrobial%20resistance

12           https://www.g7germany.de/resource/blob/974430/2042058/5651daa321517b089cdccfaffd1e37a1/2022-05-20-g7-health-ministers-communique-data.pdf

 

Latest Developments

We keep our members and partners in touch with the most recent updates and opinions in the worldwide dialogue on population longevity and related issues.

2024 AMR Preparedness Index Progress Report Highlights Urgent Need For Global Action Against Antimicrobial Resistance

Today, the Global Coalition on Aging (GCOA) and the Infectious Diseases Society of America (IDSA) launched the 2024 AMR Preparedness Index Progress Report. Released in the lead up to the United Nations General Assembly 2024 High-level Meeting on Antimicrobial Resistance (AMR) this September, the 2024 Progress Report assesses how the eleven largest global economies have advanced on calls to action laid out in the 2021 AMR Preparedness Index.

New Global Analysis Across Five Cities Shows Inequities in Adult Immunization Uptake, Signaling Need to Redesign Local and National Policy Interventions

GSK, in collaboration with the Global Coalition on Aging (GCOA), announced a new report from the IQVIA Institute for Human Data Science (IQVIA Institute). The report, funded by GSK, explores the role of social and structural determinants of health in adult vaccine access and uptake across five global cities with strong data about their aging populations: Bangkok, Thailand; Brussels, Belgium; Chicago, US; Manchester, United Kingdom; and New York City, US.

New Report From the Global Coalition on Aging Highlights the Connection Between Adult Immunization and Economic Health in Aging APEC Region

As leaders from across the Asia-Pacific Economic Cooperation (APEC) region convene in San Francisco over the next week, a new report from the Global Coalition on Aging (GCOA) points to investments in healthy aging as a growing economic imperative amid the region’s changing demographics. According to the new report, programs that keep populations healthy, active, and productive – like adult immunization – are increasingly becoming a prerequisite for economic stability and growth.

Menopause, the Silver Economy and Workplace Opportunities

As we recognise World Menopause Day, take a moment to consider the economic power, diverse expertise and skills, and incredible societal contributions of the estimated 1.1 billion post-menopausal women worldwide by 2025—a population on-par with China or India, and dwarfing any other country. Indeed, if we want to fuel the vibrant $15 trillion silver economy, societies, governments, and employers must empower older women in the future of work, including solutions that fight stigma and increase workplace support related to menopause.

Best Practices for Engaging a Multigenerational Workforce

Employers are grappling with a myriad of workforce-related issues ranging from productivity to attracting and retaining talent, but many may be overlooking some seismic shifts that are reshaping the future of work: longevity, population aging, and the multigenerational workforce.

Brazil Must Fight Antibiotic Resistance

The threat posed by antimicrobial resistance is urgent and spares no country - including Brazil. According to The Lancet, 63 deaths per 100,000 are associated with AMR in Brazil and Paraguay, a rate that exceeds the average for Latin America and the Caribbean. AMR-associated deaths in Brazil are second only to cardiovascular diseases and cancers.