By Sascha Marchang, Policy Manager, EPHA

A recent debate organised by thinktank Bruegel brought together policymakers, civil society and industry representatives to discuss the recommendations of the UK Review on AMR published in May 2016.

The event ‘Tackling antimicrobial resistance’, was moderated by Professor Dame Sally Davies, who reiterated that AMR represents not only a major threat to modern medicine (in terms of interventions becoming much more difficult and life-threatening) but also threatens the economy as every drug-resistant infection generates additional costs in hospitalisation and treatments, and lack of productivity. Tackling drug-resistant infections involves many different sectors; among others these include human and veterinary medicine, food production and agriculture, and drugs production.

Presenting the results of his AMR Review for the UK government, Lord Jim O’Neill explained the importance of the Review in defining AMR as an economic issue, not least by placing a price tag on the cost of inaction: 100 trillion USD over the next 35 years.  He recapped the final report’s ten-point plan, which includes action in all crucial areas of the One Health approach coupled with awareness-raising and pooled innovation funds at global level, with the UN and G20 as key international channels to bring about the required shift in mind-set and stimulate action.

With his background in the financial services industry, O’Neill warned that the pharmaceutical sector could be heading for a similar crash if it fails to make necessary changes.

James Anderson of GSK pointed out that his is one of very few pharma companies continually working on the development of new antibiotics, which is where he sees the pharma industry’s primary role. New drugs and tools remain essential in the fight against AMR. Charles Knirsch of Pfizer acknowledged the difficulties involved in ‘fixing a complete market failure’ and called for new incentive models.

The European Commission’s Director General for Health and Food Safety Xavier Prats-Monné warned that the pharma industry could not have it both ways since antibiotics are a public good. All relevant actors needed to take responsibility including the food industry as well as the pharmaceutical sector. He stated that while the UK Review’s work was critically important and focused on the global level, the EU’s added value lies mainly in acting as a best practice region including issuing guidelines for human and animal medicine, continuing to lead on research and innovation, the forthcoming update of the action plan on AMR, and in influencing the global effort.  The plan to establish a One Health Network, as called for in June’s Council conclusions should tackle the false belief that ‘going it alone’ is better and that national authorities must work together and across borders to rise to the challenge.

The European Association of Hospital Pharmacists emphasised the need for very robust European guidelines on prudent use in human medicine and stressed that the current efforts fall short. Mr Prats-Monné agreed to the need for a clear definition of healthcare professionals’ roles in these guidelines.

Following up on the environmental dimension of AMR, EPHA challenged the industry representatives present to explain their actions to clean up their global supply chains. There was agreement that transparency and controls are important in this area given the pollution of water and soil caused by the disposal of manufacturing waste in countries that are producing active pharmaceutical ingredients; GSK stressed the need for industry alignment and advocated a set of agreed standards.

When asked about what specific role the UK Review has in mind for the EU, Lord O’Neill mentioned the need for Europe-wide awareness raising, adoption of reduction targets for unnecessary use in agriculture at European and national levels, promotion of rapid diagnostics to support informed prescribing and the application of ‘play or pay’ schemes to access the EU markets to incentivise pharmaceutical companies to invest in development.

The latter proposal – an investment charge for firms selling pharmaceutical / healthcare products or devices as a condition for accessing markets, paid into a pooled fund for new product development – merits reflection and discussion, alongside other economic incentives such as a tax on antibiotics, especially in veterinary medicine, which were raised in the final report of the UK AMR Review.

As raised by several speakers, Europe must prepare a strong, coordinated position with clear commitments to action to prevent the spread of drug-resistant infections for the upcoming UN General Assembly in September.  2016 must be a turning point for Europe to demonstrate leadership and is an opportunity that must not be wasted given the time-sensitivity of the threat.

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