Dear All: Three important documents were released at / during / around the World Economic Forum meeting that occurred this week in Davos.
First and foremost, we have the final report from DRIVE-AB. It's a substantial document and you'll need to set aside an afternoon to read it. As a way to get started, my 11 Sep 2017 blog post provided a good overview of DRIVE-AB's conclusions and also offers a downloadable PowerPoint lecture containing the key ideas. In brief, the multidisciplinary DRIVE-AB team has:
The third report on our tour doesn't speak to direct incentives but rather to the important role that planning for stewardship and access for new antibiotics will play in acceptance and implementation of meaningful Pull incentives. Provided by the Access to Medicines Foundation, the first AMR Benchmark Report shows that companies are working on priority pathogens, setting limits on antibiotic discharges, decoupling bonuses from sales volume, and tracking resistance. It's not a surprise that the efforts are somewhat uneven across companies, but the trends are there and are encouraging.
Putting it all together, this figure from the DRIVE-AB reports shows that we've seen an impressive array of Push efforts implemented in the past two years:
But, you'll immediately note that the Pull side of this figure is pretty lonely with only the GAIN Act in the United States keeping the box from being entirely empty.
The real question now is thus about global creation of strong Pull incentives and that's where I hope that ripples from Davos will begin to drive this during 2018 and beyond. Every report reaches the same conclusion about the critical role of Pull incentives:
But, we don't pay for fire extinguishers only when we use them -- indeed, we much prefer to admire them and NOT use them ... except in the knowledge that they are available. Similarly, we simply must stop paying for antibiotics on a per fire basis ... this simply makes no sense and is not sustainable.
And while ~$1b per new antibiotic sounds like a lot of money, it's important to look at other examples of cooperative international funding. The International Space Station had a cost in 2010 of $150b (and an astronaut/day cost of $7.5m). The CERN Large Hadron Collider cost ~9b to build and requires another $1b/yr to operate. So, it is possible!
I don't exactly know how the needed Pull incentives will come about and there are still questions to be answered: Should all antibiotics get the same reward? If not, how do we created and adjudicate a suitable differential scale? Once you decide to provide a reward, how do you deliver it to the innovator? Different mechanisms would seem likely to be required in different territories (e.g., transferable exclusivity seems to make a lot of sense in the US due to its 100s of payors but single-payor countries would likely use a single central mechanism). And, how do you connect all this stewardship and access provisions in the developing world?
All best wishes, --jr
John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Expert-in-Residence, Wellcome Trust. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: http://amr.solutions/blog-index.html
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