Antibiotic procurement models for LMICs / G7 Leaders call for Pull!

Dear All, Two stops on our tour today: (i) an excellent survey of incentive models and (ii) a final communique from the recent G7 meetings.

First up, CGD (Center for Global Development) have released a report (link) entitled “Leveraging Purchasing Systems to Ensure Access, Stewardship, and Innovation: A Landscape Review of Current and Potential Market Structures for Antimicrobials.” This report is the first product of a working group (confession: I am part of the working group) with the equally long title of “A New Grand Bargain for Antimicrobial Procurement: Improving Purchasing Systems to Enhance Access, Stewardship, and Innovation for Antimicrobials in Low- and Middle-Income Countries (LMICs).”

Yes, that’s a mouthful … so let’s catch our breath after reading that paragraph and break it down a bit.

CGD starts by reframing the idea of antibiotic incentives as one of purchasing models: What is the optimal purchasing model for antibiotics? How do feasible purchasing models differ between high-income countries (HICs) and low- to middle-income countries (LMICs)? How can we leverage possible purchasing models to support the access-stewardship-innovation triad?

As a foundational document for their review, CGD has produced an outstanding survey of all prior work on antibiotic procurement/incentive models, whether focused on HIC or LMIC. The report offers these major conclusions:

  1. The literature on antimicrobial procurement is overly focused on high-income countries (HICs). While 51 percent of papers mention an LMIC, fewer than 10 percent exclusively focus on LMICs. Also, less that 13 percent of papers with listed authors include an author based in an LMIC. Priorities in LMICs and HICs differ based both on interviews conducted for the review and the findings in the literature. 
  2. There is broad agreement that a new purchasing system is needed for antimicrobials in LMICs. Although there’s no consensus in the literature, HICs are coalescing around subscription models in which purchasers pay annually for a drug, regardless of how many units are needed. There is less clarity on the optimal system for LMICs.
  3. There is insufficient research on how to implement policies and—with the exception of the GAIN Act, a 2012 piece of US legislation that grants an additional five years of exclusivity for qualifying antimicrobials—a dearth of research evaluating previously implemented initiatives.

Taken with “Incentivising the development of new antibacterial treatments,“ the recent survey of models from the Global AMR R&D Hub & WHO, you have a pair of reports that provide a complete and concise summary of all the incentive ideas discussed to date. Very helpful! 

And CGD is just getting started. According to their blog commentary, CGD is going to use this summary as the basis for research into procurement models that could make a difference. Several case studies in LMICs are underway that will report an in-depth look at the purchasing systems and policy landscape for new procurement arrangements for Brazil, India, and (possibly) sub-Saharan Africa.

If you’d like to learn more, there will be a webinar on 30 June (9-10a ET) discussing the paper … go here to register.


As follow-up on the recent calls for Pull incentives by the G7 Health and Finance ministers (21 May 2022 newsletter; 14 Dec 2021 newsletter), we now have a communique by the G7 leaders following their 26-28 June 2022 meeting. Jump to the top of page 14 where you find this exciting paragraph (broken into bullets for ease of reading, emphasis is also mine):

  • Acknowledging the rapid rise in antimicrobial resistance (AMR) at the global scale, we reiterate that we will spare no efforts to continue addressing this silent pandemic.
  • “We will continue to
    • “promote the prudent and responsible use of antibiotics in human and veterinary medicine,
    • “raise awareness on sepsis,
    • “lead in the development of integrated surveillance systems based on a One Health approach,
    • “concurrently advance access to antimicrobials,
    • “strengthen research and innovation for new antibiotics in international partnerships, and
    • incentivise the development of new antimicrobial treatments with a particular emphasis on pull incentives.

Yow! It is marvelous to see global political leadership acknowledging the need for action!

All best wishes, –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://amr.solutions/blog/. All opinions are my own.

Current funding opportunities (most current list is here)


Upcoming meetings of interest to the AMR community (most current list is here):

  • [NEW] 30 June 2022 (virtual, 9-10a ET): Webinar entitled “A Grand Bargain for Antimicrobial Procurement: Leveraging Purchasing Systems to Address AMR” from the Center for Global Development (CGD). The webinar will discuss CGD’s review of procurement models for LMICs. Go here to register.
  • 6 July 2022 (virtual, 15:00 CET/ 09:00 ET): WHO webinar entitled “Enhanced use of data to monitor safety and effectiveness of paediatric medicines”. Go here for details. 
  • 11-14 July 2022 (Sydney): Australian Society for Microbiology Annual National Meeting is a hybrid event that will feature a range of lectures and symposium sessions, as well as extensive opportunities for networking. Go here for details.
  • 26 July 2022 (virtual, 10a-11.30a ET): REVIVE webinar entitled “New approaches for antibiotic discovery”. Go here for details. 
  • 24-27 July 2022 (Il Ciocco, Tuscany): Gordon Research Conference entitled “New Antibacterial Discovery and Development”. Go here for details, go here for the linked 5-6 Mar Gordon Research Seminar that precedes it.
  • 28-31 July 2022 (Singapore): 10th International Congress of Asia Pacific Society of Infection Control is a hybrid event for professionals in the Asia Pacific region. Go here for details and to register.
  • [NEW] 10 Aug 2022 (virtual, 11a-12.30p ET): REVIVE webinar entitled “Animal models to study the activity of antibiotics.” Go here for details. 
  • 10 Aug 2022 (virtual, 10a-4.30p ET): USDA ‘s APHIS (Animal and Plant Health Inspection Service) will host a public meeting on Antimicrobial Resistance. Co-hosted with USDA’s FSIS (Food Safety Inspection Service) and REE (Research, Education and Economics) mission area, the webinar will review lessons learned since the first AMR workshop 2012 as well as discuss plans for the future. Go here to register.
  • [NEW] 23 August 2022 (virtual, 11a-12.30p ET): REVIVE webinar entitled “The Challenges and options in developing antibiotic combinations.” Go here for details. 
  • [NEW] 30 August 2022 (virtual, 8.30a-5.00p ET): Webinar sponsored by CDC and FDA entitled “Drug Development Considerations for the Prevention of Healthcare-Associated Infections.” This is very timely as developing products for prevention is surprisingly hard. As just one example, see this 20 Dec 2018 newsletter about a valiant  (but failed, sadly) effort to develop a S. aureus vaccine. Go here for additional details and to register. 
  • 12-13 Sep 2022 (virtual, 9a-5p ET): This meeting of PACCARB is going to “identify key issues and critical policy gaps through a series of facilitated discussions examining a hypothetical large-scale disease outbreak scenario based on historic examples and estimates of future AMR outbreaks.” Sounds like pandemic wargaming (Center for Health Security; pre-COVID 19 May 2020 NPR article) to me! Go here for details.
  • 20-24 Sep 2022 (New Delhi): 21st Congress of the International Society for Human and Animal Mycology (ISHAM). Go here for details.
  • 4-7 Oct 2022 (Dublin, Ireland): The 2022 ASM/ESCMID Joint Conference on Drug Development to Meet the Challenge of Antimicrobial Resistance. This is an excellent meeting, especially for developers … and if you’ve missed it, the recordings from the 2021 meeting are online. Go here for details on the 2022 meeting.
  • 19-23 Oct 2022 (Washington, DC): IDWeek 2022, the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP). Go here for details.
  • 15-23 Oct 2022 (in person, residential, Les Pensières, Veyrier-du-Lac, France): The 6th edition of Patrice Courvalin’s fabulous ICARe residential training course covering all things AMR is on for 2022! This is a soup-to-nuts training in AMR: it is very intense, very detailed, and always gets rave reviews from attendees. Registration is open 21 Mar 2022 to 21 June 2022 and is limited, so book your slot as soon as you can. Go here for details.
  • 19-23 Oct 2022 (Washington, DC): IDWeek 2022, the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP). Go here for details.
  • 25-28 Oct 2022 (Stellenbosch, South Africa): The University of Cape Town’s H3D Research Centre will celebrate its 10th anniversary with a symposium covering the Centre’s research on Malaria, TB, Neglected Tropical Diseases, and AMR. Go here to register.
  • 17-20 Nov 2022 (Kuala Lumpur, Malaysia): The International Congress on Infectious Diseases will take place for the first time as a hybrid event. Go here for details. 
  • 27-30 Nov 2022 (Perth, Australia): 32nd International Congress of Antimicrobial Chemotherapy is the biennial congress of the International Society of Antimicrobial Chemotherapy (ISAC). Go here for details.

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