Many headlines stated today that UK wants to tax pharmaceutical companies again in order to contribute to a pooled fund against antimicrobial resistance (AMR). The proposed ‘pay or play’ mechanism is a bit more subtle than that. The report (full text here) is also suggesting other financing mechanisms (including the improvement of existing ones) as well as describing potential non-financial measures to reduce these resistances in the first place. Actually, financial measures occupy only about 6% of the report. But headlines need to be catchy. Let’s see a broader picture on tackling antibiotic resistance …
The WHO summarizes well the situation: “Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines. Bacteria, not humans, become antibiotic resistant. These bacteria may then infect humans and are harder to treat than non-resistant bacteria. Antibiotic resistance leads to higher medical costs, prolonged hospital stays and increased mortality.”
For Belgium, the Joint Programming Initiative on Antimicrobial Resistance displays a long list of governmental bodies and initiatives that study and/or tackle AMR. The Belgian Scientific Institute of Public Health has a dedicated program against AMR. Despite that, a recent study showed that, in 9 European countries, 99% of bacteria Streptococcus pneumoniae taken from nose of people aged 4 or more show antibiotic resistance (S. pneumoniae causes many types of pneumococcal infections like pneumonia or meningitis). The same study showed that Belgium has the worst resistance rate against the antibiotic cefaclor (fortunately authors also show there is little resistance against the most common antibiotics used against S. pneumoniae). A study from last year in 8 European countries (including Belgium) showed that approximately 4 out of 5 Staphylococcus aureus (another bacteria) isolates from individuals without specific health issues were resistant to at least one antibiotic and more than 7% of them are multidrug resistant. And we are talking here about Belgium, a country with a well developed healthcare system, following best practises in antibiotic stewardship and often considered as an example for the reduction of antibiotic consumption outside hospitals.
Coming back to the UK report, a big part of it advocates more or less what the 2015 WHO country situation analysis on antimicrobial resistance described too: countries need a plan to fight AMR, surveillance and laboratory capacities should be raised (no data = no knowledge of the situation and no capability to measure progression), antimicrobial medicines should be correctly used, public awareness campaigns should be deployed, and the prevention and control of infections allow to tackle the issue at the source.
The question raised in the report is also how to accelerate the discovery of new antimicrobial medicines? The report advocates for a “global innovation fund for early stage and non-commercial R&D”. And it correctly points that there are currently little incentives for companies to invest in research for products that will ultimately be priced very low (also thanks to generics) for a high volume to produce. Because in “normal times” (periods of “usual drug resistance”) competition between existing products drives prices down. However, if resistances become too high (and they will because they are selected over non-resistant bacteria), none of the existing medicine will be effective anymore, the willingness to pay for innovative drugs will be high but the time to develop them will still be in decades (i.e. too late to tackle the resistances).
Intervention 9 of the UK report tackle this issue with a complex reward mechanism (“the carrot”). But then the next section describes a very simple tax in one page (“the stick”). This ‘pay or play’ mechanism that was highlighted in the press and should indeed be the simplest mechanism that can be applied at a country level.
However, another mechanism could be to make the antimicrobial market attractive again. Allow for (moderately) increased prices on existing drugs (even the ones with competition from generics) and pharmaceutical companies will see opportunities to develop new medicines. Yes, they will become richer thanks to these price increases – but these funds are (partially) re-invested in research and development.