New OHE report on incentives for antibiotics

Dear All:
Just hitting my inbox today is this report from OHE. The paper reviews in detail the incentive proposals in the 2016 O’Neill Report on incentives from the UK AMR Review commissioned by UK government and the 2017 GUARD Report entitled “A Call for Concerted Action on Antibiotics Research and Development” commissioned by the German government.
This well-written and detailed paper is a welcome addition to the global discussion! In particular, it is especially helpful to see an additional approach to estimating the required size of the incentive fund.
The conclusions are broadly similar to those I see coming from other groups during 2017. You’ll want to read it for yourself, but my high-level notes on the paper are found below my signature.
Best wishes,
John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Chief Strategy Officer, CARB-X | Expert-in-Residence, Wellcome Trust. Follow me on Twitter: @JohnRex_NewAbx
The bulk of the report focuses on incentives for new antibiotics but there are also short discussions of vaccines.
Three pull mechanisms are reviewed in detail: Priority Review Vouchers (PRV), Transferrable IP Rights (TIPR), and a lump sum Market Entry Reward. There are detailed reviews of each, including a good discussion of how MER differs between the O’Neill and GUARD models.
PRV is thought the least widely applicable of the three, TIPR is thought to risk overpayment unless suitable guardrails are used, and MER is thought to carry political risk. The paper proposes that TIPR and MER be explored in more detail for European implementation.  
Based on their cost modeling, the paper estimates that the global reward pot for 15 drugs over ten years should be US$2 billion a drug and hence a “pull” commitment of US$30 billion a decade, or US$3 billion per annum. The paper notes that O’Neill estimated that a range of $16-37b would be needed for the 15-drug scenario whereas GUARD proposed $1b/drug. The paper argues that the ~$1b/drug figure used by GUARD and taken as a single summary figure from O’Neill is too low to stimulate R&D unless companies are expected to also make profit from sales during the patent period.
The paper acknowledges research funding from Pfizer but states that OHE retained editorial control and that the paper is the sole responsibility of the 3 authors (Ferraro, Towse, and Mestre-Ferrandiz).


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