Dr. Peter Jackson
Vice-President of the Board of BEAM Alliance
Antimicrobial resistance (AMR) is a serious and growing global threat to public health.
According to a new study in The Lancet, AMR claimed over 1.27 million lives globally in 2019, which is more than HIV and malaria. In July, the EU’s Health Emergency Response Authority declared AMR as one of its top three health threats.
Subscription agreements
We desperately need drug developers to invest the hundreds of millions required to develop new treatments, but we need to keep them in reserve and limit their use to the most critical cases to prevent future drug resistance from emerging.
NICE and NHS England took the first steps towards tackling this issue with the pilot of an innovative subscription model, where drug companies are paid a fixed annual fee for new antibiotics, based on their importance to public health. This approach ‘de-links’ the value of drug sales and limits the overuse of new treatments.
The two drugs involved in the trial — Shionogi’s Fetroja and Pfizer’s Zavicefta — are eligible to receive a subscription payment of up to £10 million per year for up to 10 years. Following this world-leading success, the scheme now needs to be implemented permanently and rolled out across the whole of the UK.
AMR claimed over 1.27 million lives globally in 2019, which is more than HIV and malaria.
Global action
For global-scale impact, further international action is needed. The US Government is debating a similar incentive under the draft PASTEUR Act. Depending on the clinical need, this could provide subscription payments of at least $750 million up to $3 billion over 10 years for guaranteed access to a new drug.
The EU Commission is also evaluating a similar approach which could be worth €1.5 billion. Although, the complexity of EU funding between the Commission and Member States’ systems needs to be carefully addressed.
Funding approaches
The next question is how to pay for these new subscription agreements. The UK funding comes from taxpayers through the NHS budgets. One alternative under consideration is ‘transferable exclusivity extension’ (TEE) vouchers. Under this approach, a company bringing a new antimicrobial drug to market would receive a one-year extension to the exclusivity period before generic competition is allowed.
The TEE could be used for another product in their portfolio or be sold to another company, providing the reward required to secure a new pipeline of badly needed AMR drugs. The AMR silent pandemic is here, and international reimbursement reform at the global level is needed to have any chance of beating it.
