Richard Saynor
CEO, Sandoz
Ian Ball
Global Head, Anti-Infectives, Sandoz
There are two common assumptions about how to tackle antimicrobial resistance (AMR): that the short-term answer is just to use fewer antibiotics, and that the long-term solution is all about new drugs. Reality, as ever, is more complicated.
Antibiotics are the backbone of modern medicine, treating millions of previously fatal infectious diseases and enabling routine surgeries or treatments where the immune system is temporarily suppressed.
The global spread of antimicrobial resistance, which occurs when microbes evolve to resist antimicrobial medicines, threatens to change all that. To quote Britain’s former CMO, Dame Sally Davies, failing to curb AMR could spell ‘the end of modern medicine.’
What can we do to stop that from happening? Richard Saynor, CEO of leading global generics company Sandoz, says: “The starting point is simple: don’t kill the cure. There are two parallel threats facing the continued use of modern antibiotics, and we need to address both simultaneously.”
AMR: clear and present danger
“The first is AMR, which threatens to take us all back to the days when a scratch from a rosebush could prove as deadly as falling off a cliff. This is a clear and present danger — but the solution is not to reduce access to essential medicines, it is to get access right.”
Ian Ball, Sandoz Global Head, Anti-Infectives, points to two numbers that should drive global decision-making priorities: “This year’s Lancet study estimates that nearly 1.3 million annual deaths are directly attributable to AMR, as many as malaria and HIV combined. Meanwhile, we still have 5.7 million people who die every year because of lack of access to antibiotics.”
Ball believes that to effectively combat AMR, we need a balanced approach combining responsible manufacturing, responsible access, responsible use and innovation. He highlights the importance of responsible access: ensuring the right antibiotic is available for the right patient at the right time.
This means ensuring the stable supply of a broad range of high-quality antibiotics, backed by state-of-the-art surveillance data and diagnostics to understand the real clinical need. Ball says: “We would need this without AMR — but evolving global resistance patterns, as well as significant regional differences, make it even more critical.”
Beating AMR will require a concerted global response across all four pillars of the global response strategy.
Richard Saynor
A dysfunctional market
However, the AMR policy debate still focuses largely on incentives for new antibiotics, in what Saynor calls “a misguided search for a silver bullet.” This is a critical part of the global response strategy, “but it is not the strategy.”
The science is clear: new medicines will also face resistance once they enter clinical use: “It’s called evolution — you can delay it, but you can’t stop it.”
This imbalanced focus leads directly to the second major threat: the increasing dysfunctionality of the market framework for existing antibiotics.
Ball says: “Antibiotics today are treated largely as commodities, but with one big difference: producers have to supply at fixed price levels, regardless of supply and demand changes. This is simply not sustainable. We need to change the operating framework, to introduce basic concepts such as inflation-linked pricing and tenders with criteria that go beyond price.”
A new Hippocratic Oath?
Saynor says: “Beating AMR will require a concerted global response across all four pillars of the global response strategy.”
Patients must understand the threat of AMR and how to use antibiotics properly; healthcare providers must consider the consequences of every prescription; manufacturers must minimise environmental impacts and focus on reliable supply; and policymakers must prioritise the creation of stable, sustainable market frameworks.
Saynor concludes: “Just as physicians have an underlying duty to ‘first, do no harm,’ anyone serious about the future of modern antibiotics should start from the principle of ‘don’t kill the cure.’ Think of it as a new version of the Hippocratic Oath.”
