I would like to draw your attention to a superb new book by William Hall, Anthony McDonnell, and Jim O’Neill. The names of the authors may be familiar as Jim O’Neill chaired the UK AMR Review and William Hall and Anthony McDonnell were two of the members of the core team who produced the Review’s seven excellent reports on AMR published during 2014-2016.
Entitled Superbugs: An Arms Race Against Bacteria, and available on Amazon, the book features a foreword by Dame Sally Davies (Chief Medical Officer of the UK) followed by an introduction that crisply lays out both the problem of AMR and the goal of the book:
- “At its heart, AMR is a problem of economic and political failure.
- We need pharmaceutical companies to develop new antibiotics, but we must at the same time limit their use, which then makes it difficult for companies to recoup their investment.
- The current rewards-based system does not work.
- In this book, we combine economic policy ideas with our experience of global politics and global business investment to present workable solutions that policymakers can implement.”
The book’s survey of first the problem and then possible solutions (see below my signature for a summary of the chapter headings) is clearly written. Full of readily understood examples and supported by pithy quotes from current thought leaders, the book is perfect for a general audience. I thought the book did an especially good job of covering two key topics from a variety of perspectives:
Learning to think in economic terms. The book’s economic flavor brings together ideas in compelling ways. A great example of this is on pages 42-45 where the authors estimate the cost of AMR in several ways. Using the statistical value of a life (as estimated by the amount we routinely spend to prevent traffic fatalities!), the estimated cost is ~$900b/year. Using math grounded in health care costs and loss of productivity, the cost is $225b/year. Neither figure is perfect, but their scale is similar and the amounts needed to address AMR are a rounding error relative to the costs of AMR. For example, the final DRIVE-AB report calls for public sector push funding of $800m/year and pull funding of $1b/new antibiotic. Similarly, Superbugs itself recommends a global spend of about $4b/year to implement the full suite of approaches to tackling AMR.
Layout the options for solving the problem. Here the book drew heavily on both the UK AMR Review’s analyses + the ideas that were emerging in parallel from DRIVE-AB. The discussion of incentives for new agents builds on the need for public funding for research, collaboration by developers, and implementation of market entry rewards. The insightful discussion of prevention covers infrastructure, infection prevention, and behavior change. And the discussion of approaches to reducing use both in human medicine and food agriculture provide balanced perspectives on aspirations and reality in this space.
The book concludes by describing AMR as “a problem that can be solved.” I agree both with this and with the authors’ assertion that the challenge now is to find the political will to act. On this note, I am encouraged by the existence of ongoing conversations on both sides of the Atlantic. We’re not there yet, but at least we are talking.
Please consider reading and sharing this book as part of ensuring that this ongoing conversation continues!
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/
Outline of Superbugs
- Part 1: The problem
- Ch. 1: When a scratch could kill
- Ch. 2: The rise of resistance
- Ch. 3: Failures in tackling drug-resistant infections
- Part 2: Solutions
- Ch. 4: Incentives for new drug development
- Ch. 5: Prevention is better than cure
- Ch. 6: Reducing unnecessary use of antibiotics in humans
- Ch. 7: Agriculture and the environment
- Ch 8: Next steps
Upcoming meetings of interest to the AMR community:
- 4-7 Jun 2018 (Boston): BIO (multiple AMR-focused sessions are expected)
- 7-11 Jun 2018 (Atlanta): ASM Microbe
- 12-13 Jun 2018 (Washington): National Academies of Science workshop: Understanding the Economics of Microbial Threats
- 14 June 2018 (Washington): Duke-Margolis & FDA event: “Understanding the Development Challenges Associated with Emerging Non-Traditional Antibiotics”
- 21-22 Jun 2018 (I presume London but don’t know for sure, announcement is pending): joint EMA-FDA-PMDA workshop on pediatric development of antibacterial agents.
- 22-27 Jul 2018 (Bryant University, Smithfield, RI): Gordon Research Conference on Drug Resistance for Cancer, Infectious Disease and Agriculture
- [NEW] 21-22 Aug 2018 (Rockville, MD): NIAID-NINDS-DTRA workshop entitled “Infectious Disease in The CNS and Therapeutic Strategies to Cross the Blood-Brain Barrier”
- 4-7 Sep 2018 ESCMID-ASM Conference (#3) on Drug Development for AMR (Lisbon, Portugal)
- [NEW, for those with fungal interests] 24-28 Sep 2018 (Big Sky, Montana): MSG-ERC (Mycoses Study Group) Biennal meeting
- 3-7 Oct 2018 (San Francisco): ID Week
- 6-14 Oct 2018 International Course on Antibiotics and Resistance(ICARe, Les Pensières, Annecy, France)