Humankind is in danger of an insidious threat to global health that could result in millions of deaths each year. Sound familiar? This isn’t the next pandemic but rather the growing problem of antimicrobial resistance (AMR).
“Antimicrobial resistance is one of the biggest threats to public health today,” says Orlaith Gavan, country medical director for Pfizer. “It can affect anyone of any age in any country, so it doesn’t discriminate.”
It isn’t hyperbole to say the discovery of antibiotics changed the face of modern medicine; as Gavan notes, humans live an average 23 years longer as a direct result of the availability of antibiotics. But the pathogens they target are continually changing and evolving in a bid to resist the effect of these medications. This ultimately means the antibiotics and other antimicrobials we are lucky to have in our arsenal against a large number of infections are becoming less effective. The implications of this are stark, Gavan says.
“If AMR continues to rise unchecked, minor infections could become life threatening and serious infections could become impossible to treat,” she explains. “Another key point is that many routine medical procedures could become too risky to perform as the risk of infection would be too great.”
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This threat is as big as it is real: it is anticipated that the expected rise in AMR could cause 10 million deaths globally each year by 2050.
“To put that into context, that is more deaths than are caused by cancer each year,” Gavan points out. “It is a silent threat, but it is already here, and it urgently needs to be addressed.”
Indeed, AMR has been flagged by the World Health Organisation (WHO) as one of the “biggest health challenges of our time”. According to Gavan, learnings from the Covid-19 pandemic must now be applied to this growing threat - including the need to prepare. “The recent pandemic was a stark reminder of the health economic impact of infectious disease and after what we have all been through it does reinforce the continuous need for new anti-infectives targeting these emerging and difficult to treat infections,” she says.
AMR poses a similar threat to global public health, she says. “It has reinforced a need to invest in the development of new antimicrobials now, to be able to prevent these future global health crises.”
But this isn’t a future threat - AMR already causes approximately 700,000 deaths annually, Gavan notes. “If we don’t find a solution this devastating impact is likely to worsen significantly,” she says.
Gavan says it is important to acknowledge the work the HSE has done in this area. The Health National Action Plan on Antimicrobial Resistance 2021 – 2025 shows how seriously the problem of AMR is being taken, she says. There is heightened awareness in recent years, which has led to improvements in appropriate prescribing of antibiotics by clinicians as well as increased public recognition that antibiotics are not always required for every minor infection, some of which are viral and not treatable with antibiotics.
But the urgency of the issue means multistakeholder action is required at the highest level. “Slowing the spread of AMR does require a collaborative multifaceted approach with policy changes and an emphasis on reimbursement reform with an active stewardship,” she says. “Without action by Governments, industry, the healthcare sector and society as a whole, the threat of AMR will just keep growing.”
One problem is that the area of antimicrobials has seen a paucity of innovation in recent times - almost all of the antibiotics we use nowadays were developed decades ago. The need for new antibiotics to tackle drug-resistant infections has been highlighted by WHO, who have criticised the lack of innovation in this area.
Infectious disease is one of Pfizer’s specialist areas, and Gavan says that the development of new antibiotics for common infections are a core element of this. “Pfizer is committed to patients suffering from infectious diseases,” she says. “We are one of the few large research-based pharmaceutical companies that is still active in R&D for anti-infectives, and we are continuing to look for these creative solutions to help grow the pipeline of effective therapies, whether that’s through our own research and development efforts or seeking out partners with new treatment candidates. No company alone can solve the AMR crisis, and this is why creative solutions are required.”
According to Gavan, the industry needs incentives in order to be able to deliver innovation in this area, as well as novel models of reimbursement by the Government that adequately assess the value of these therapies. She cites a recent partnership by Pfizer in the UK that saw them partner with NHS England and other stakeholders to launch a world-first cross-industry initiative that would see an innovative subscription-type model developed for antibiotics.
“If we look at new antibiotics to treat bacterial infections, these are undervalued by the traditional models of health technology assessment (HTA) which assess drugs for cost effectiveness,” she says. “It is really difficult to assess the value of the new antibiotics against much older drugs and it is also difficult to assess the value of holding these drugs in reserve for when we need them to treat multi-drug-resistance infections.” The bottom line is that policy reform would help to reframe the area of anti-infectives as one that is attractive for investors. “New reimbursement models could drive the substantial additional R&D investment we need.”
The difference between AMR and the COVID-19 pandemic is that we have been given a head start - we know the scale and the seriousness of what we are facing. The urgent need for better options to fight the risks of growing resistance must be recognised at all levels, says Gavan.
“Pfizer is really committed to this, and we are really focused on it. Collaboration and innovation are needed - we cannot ignore it, we have to take action now.”