Is industry doing enough to tackle antibiotic resistance?
Illustration: Andrea Ucini
This article was written by David Prosser and published in The Times, all views and opinions are those of the publication unless otherwise stated.
The World Health Organization has described increased antibiotic resistance as one of the greatest threats facing global public health.
As disease-causing micro-organisms evolve and adapt, they naturally become more resistant to the antibiotics we have developed to destroy them, but the overuse and misuse of drugs is accelerating the process. A review commissioned by the UK government warned that the number of people dying worldwide every year from superbugs could increase from the 700,000 reported in 2016 to ten million by 2050.
The food and pharmaceutical industries are at the centre of this issue. Health professionals warn that the use of antibiotics early on in the food chain, with farmers administering drugs to animals to promote growth rather than treat disease, is a particular problem. So too is the overprescription of antibiotics to humans.
Policymakers are attempting to address the problem. In the US and the European Union (EU), many food and drug companies are now behaving more responsibly in response to tougher laws on the use of antibiotics in agriculture. Public health campaigns have focused on reducing the human use of antibiotics too.
In the developing world, however, change is happening more slowly. Indeed, some western companies are looking to developing markets to recoup the revenues they are now missing out on back home. In a globalised world, that has ramifications for everyone: with people and products travelling freely, antibiotic resistance developed by bugs in one region quickly spreads elsewhere.
Yes, they are
Philip Howard, Spokesman for the Royal Pharmaceutical Society and consultant antimicrobial pharmacist
"The school report for the UK would say the food industry is improving, but pharma could do better.
"In food, a UK government target to reduce antibiotic use in fish and farm animals was achieved two years early by 2016, and, more importantly, there was an 83 per cent reduction in colistin (a last-line antibiotic for human-use antibiotic) in food-producing animals. There has also been a strong push by supermarkets and all sectors of the farming industry to reduce antibiotic use while maintaining high standards of animal welfare.
"Elsewhere, the Responsible Use of Medicines in Agriculture Alliance highlights industry-wide education programmes to prevent infection, such as #ColustrumIsGold and #VaccinesWork, as being central to the success of the antibiotic campaign.
"As for the pharmaceuticals sector, scientific, economic and regulatory barriers have led many major pharmaceutical companies to limit or stop investing in antibiotic innovation. Subsequently, the Pew Charitable Trusts identified that the antibiotic pipeline has only 12 new antibiotics in development that will address the most critical pathogens on the WHO antibiotic-resistant priority pathogen list, and probably only one in five that enter the first phase of clinical testing will make it to market.
"Globally, the antibiotic supply chain has also seen regular shortages. Still, the AMR Industry Alliance has a coalition membership of over 100 biotech, diagnostic, research and research-based pharmaceutical companies that are working to improve access to current and new antibiotics, improve their use, reduce environmental contamination from manufacturing and increase research and development."
No, they aren’t
Cóilín Nunan, Campaign manager, Alliance to Save Our Antibiotics
"The intensive pig and poultry industries have finally accepted that the overuse of antibiotics is no longer tenable, as antibiotic resistance reaches new heights and pressure to act from scientists and politicians becomes stronger.
"But while they have been able to achieve large reductions in antibiotic use (about 50 per cent in the pig industry and 80 per cent in poultry) there is now record use of other routine medication; some of these drugs can still cause antibiotic resistance and are thought to be environmentally damaging.
"Instead, the industry should focus on major improvements to husbandry and animal health and welfare.
"Still, at least farmers are confronting the problem, whereas the pharmaceutical industry has done far less. Some companies are still selling antibiotics for purely preventative mass medication, deflecting criticism by saying that they are abiding by the law and that regulators are responsible.
"The good news is that the EU is on the brink of agreeing landmark legislation that will ban preventative mass medication. Less happily, it won’t come into force until 2022, after Brexit, and the government is refusing to commit to enforcing a ban here. The UK could end up with some of the weakest regulatory standards in Europe, which raises questions about the kind of trade deals we will be seeking with non-EU countries that often use much higher levels of antibiotics in farming."
In search of return
John Bowler, fund manager at Schroders specialising in healthcare, believes the pharmaceutical industry must find a way to generate sufficient returns on investment from the quest for new antibiotics.
"Given that so few products have come through development, you can certainly argue that the pharmaceutical industry isn’t rising to the challenge of increased resistance. Between the 1940s and 1960s, the industry developed around 20 different classes of antibiotic, but since then there have been just two more. Still there are some mitigating factors.
"First, the underlying science isn’t there: we haven’t seen the insight coming out of academia that will pave the way for new drug development. Second, the regulatory hurdles have been high, with the US Food and Drug Administration adopting a very conservative approach to new drug approvals over the past decade. And third, the commercial case for investing in new antibiotics is difficult, because providers will only want to use expensive new drugs in an emergency, particularly in the US, where hospitals are concerned about margins.
"Still, there are some positive signs of innovation. Pfizer, for example, is in the later stages of developing a vaccine against infection that people would take prior to surgery, a major cause of the infections that we now need antibiotics to treat. Genentech is developing a novel new antibody that will attack the reservoir of bacteria that remains in the body when someone has had an infection.
"From an investment perspective, these innovations have real potential, though they’re unlikely to prove transformative for their developers."
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