What is that pill? ASM Policy paper! A movie trailer!

Dear All,

Today we have a collection of things all related to the global efforts to fight AMR. Two papers, a webinar, and a movie trailer! 

First, the Antibiotic Access and Use (ABACUS) project has released a very interesting paper entitled “Is this pill an antibiotic or a painkiller? Improving the identification of oral antibiotics for better use.” Before going any further in this newsletter, just look at the images just below from the paper — what do you think is going on, especially in (B)?

Now, here’s the caption from the ABACUS paper:
(A) “Three common capsules sold in Kintampo, Ghana. From left to right the capsules are: amoxicillin, tetracycline, and tramadol. Capsules that were referred to as red and yellow by the general public and medicine suppliers in several countries were found to be either tetracycline or amoxicillin, which are two different classes of antibiotic. Tramadol—a painkiller—can be mistaken for an antibiotic because it is dispensed as a capsule in settings where patients consider capsules to be antibiotics. Pictures taken as part of the ABACUS project in November, 2022.”

(B) “Bags of yaa chud (ie, mixture of unknown medicines) sold in the Kanchanaburi Health and Demographic Surveillance System area, Thailand. Yaa chud are often sold to people with respiratory symptoms and contain various unidentifiable medicines. The common practice of yaa chud highlights the key issue of medicine identification (i.e., which pill is what?). Picture taken as part of the ABACUS project in February, 2017.”

YOW! What an incredible figure!!

Clear and concise packaging is a luxury not everyone has and that clearly needs to change in order to aid the global efforts to curb AMR. A figure turning and looking like he is waving or shouting is not the best way to say “for respiratory symptoms” let alone the terrifying collection of seemingly random pills. No side effects listed, no labeling of what each pill is, just a collection of what someone thought you could possibly need. Scary yet fascinating. This article is an absolute must read! Well done ABACUS II project!

Second, the American Society for Microbiology has published a position paper entitled “Policy Pathways to Combat the Global Crisis of Antimicrobial Resistance”. The top eight summarized recommendations from the paper/ASM’s webpage are:

  1. Support innovative research into antimicrobial resistance to better understand the science of microbes, how resistance emerges and is spread and how pathogens react to countermeasures. 
  2. Champion bold solutions to the challenging antimicrobial marketplace and work with regulators to create a straightforward approval pathway for antimicrobials and other countermeasures. 
  3. Support and strengthen the microbiology workforce in public health, laboratory, veterinary and research settings. 
  4. Address data modernization to ensure that testing and tracking in humans and animals keeps pace with rapidly evolving microorganisms. 
  5. Improve detection models, especially rapid detection, for antimicrobial resistance to identify outbreaks before they spread, whether on the farm, in the hospital or in communities. 
  6. Foster stewardship models for antimicrobial prescribing that ensure the right person, animal or crop gets the right drug for the right infection while preserving the effectiveness of currently available antimicrobials long term. 
  7. Harmonize domestic and global policy frameworks to bolster antimicrobial stewardship and increase lab capacity in low- and middle-income countries, in coordination with the United Nations, the World Health Organization and global partners. 
  8. Promote and fund efforts with partner countries to develop a global assessment of AMR and provide technical assistance to researchers navigating global research frameworks. 

As always, read the paper yourself! To my Push/Pull incentives-focused eye, the following from page 5 jumped out at me:

  • “Currently, there is no incentive structure for antimicrobials to be brought along the development process after the initial discovery phase of research, leading to a significant dearth of pre-clinical products in the pipeline.
  • “Creating an incentive structure for antimicrobial development is one approach to addressing the gap between discovery and product development to encourage continued research, development and introduction of new antimicrobials.
  • “A new antibiotic drug can take over a decade to develop and can cost hundreds of millions of dollars without any guarantee of safety and/or efficacy, and it must be used sparingly to maintain its effectiveness, limiting profitability in a volume-based market.
  • “There are even fewer antibiotics available for food animal use than for humans, with more new antibiotics being approved for companion animals than for food animals.
  • “Even with an incentive structure for antimicrobial development in place, this gap will take years to fill.”

On 21 July 2023 (tomorrow!) at 12p EST, ASM will be holding a webinar briefing about this paper which I recommend you attend if you are able. I know this is short notice but mark your calendars if you have time tomorrow! (Addendum: The video from the webinar can be found on the policy paper’s webpage.

In closing, I’d like to share the exciting trailer for an upcoming AMR-focused documentary. Produced by BBC StoryWorks Commercial Productions with funding and support from the AMR Action Fund (AMRAF), Pfizer, Merck, and Shionogi, I am told that the full film will unpack the history of antibiotics, explain the basics of AMR, and convey the potential consequences if we don’t act. Per the description on Youtube, the film will be released on 5 September 2023 and I will be very excited to see it! (Aside: You may also know that I chair the Scientific Advisory Board for AMRAF but I was not involved in this project.)

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)

  • The AMR Industry Alliance has announced that applications are again open for its annual Stewardship Prize. The Alliance began the Stewardship Prize in 2021 to identify and support innovative approaches to combatting antimicrobial resistance in low-to-moderate-income countries — the winning application receives CHF 10,000. Applications close September 1, 2023; go here to see past winners and here to apply. 
  • The AMR Action Fund is now open to proposals for funding of Phase 2 / Phase 3 antibacterial therapeutics. Per its charter, the fund prioritizes investment in treatments that address a pathogen prioritized by the WHO, the CDC and/or other public health entities that: (i) are novel (e.g., absence of known cross-resistance, novel targets, new chemical classes, or new mechanisms of action); and/or (ii) have significant differentiated clinical utility (e.g., differentiated innovation that provides clinical value versus standard of care to prescribers and patients, such as safety/tolerability, oral formulation, different spectrum of activity); and (iii) reduce patient mortality. It is also expected that such agents would have the potential to strongly address the likely requirements for delinked Pull incentives such as the UK (NHS England) subscription pilot and the PASTEUR Act in the US. Submit queries to contact@amractionfund.com.
  • BARDA’s long-running BAA-18-100-SOL-00003 offers support for both antibacterial and antifungal agents. This BAA has offered 4 deadlines/year since 2018 … check the most current amendment for details.
  • INCATE (Incubator for Antibacterial Therapies in Europe) is an early-stage funding vehicle supporting innovation vs. drug-resistant bacterial infections. The fund provides advice, community, and non-dilutive funding (€10k in Stage I and up to €250k in Stage II) to support early-stage ventures in creating the evidence and building the team needed to get next-level funding. Details and contacts on their website (https://www.incate.net/).
  • These things aren’t sources of funds but would help you develop funding applications
    • AiCuris’ AiCubator offers incubator support to very early stage projects. Read more about it here.
    • The Global AMR R&D Hub’s dynamic dashboard (link) summarizes the global clinical development pipeline, incentives for AMR R&D, and investors/investments in AMR R&D.
    • Diagnostic developers would find valuable guidance in this 6-part series on in vitro diagnostic (IVD) development. Sponsored by CARB-XC-CAMP, and FIND, it pulls together real-life insights into a succinct set of tutorials.
  • In addition to the lists provided by the Global AMR R&D Hub, you might also be interested in my most current lists of R&D incentives (link) and priority pathogens (link).

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

  • 4-6 Aug 2023 (Bangkok, Thailand): The regional Medical Mycology Training Network Conference by ISHAM’s Asia Fungal Working Group is set to feature both hands-on workshops and clinical sessions for all those managing and working with invasive fungal infections. Go here for details. 
  • 19-22 Sep 2023 (Boston, USA): ASM-ESCMID Joint Conference on Drug Development to Meet the Challenge of Antimicrobial Resistance. This is an excellent development focused meeting … highly recommended! Go here for details and to register. 
  • 7-15 Oct 2023 (residential, Annecy, France): ICARe, the Interdisciplinary Course on Antibiotics and Resistance. Now in its 7th year, this course is a deep-dive into the world of antibiotic development. Intense, rigorous, and HIGHLY recommended. Seats are always limited … apply sooner rather than later! Go here for details.
  • 11-15 Oct 2023 (Boston, USA): IDWeek 2023, the annual meeting of the Infectious Diseases Society of America. Go here for details and to register. 
  • 20-23 Oct 2023 (Athens, Greece): 11th TIMM (Trends in Medical Mycology). Go here for details.
  • 6-7 Feb 2024 (online): Antimicrobial Chemotherapy Conference. This is an annual, free of charge conference that is co-organized by GARDP and the British Society for Antimicrobial Chemotherapy (BSAC). Details to follow — for now, just mark your calendar.
  • 27-30 April 2024 (Barcelona, Spain): 34th ECCMID, the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases. Go here for details.


WHO Antibacterial Pipeline Review: Update thru 31 Dec 2023

Dear All, WHO have released an update through 31 Dec 2023 of their ongoing series of antibacterial pipeline reviews! Here are the links you need: The report: 2023 Antibacterial agents in clinical and preclinical development: an overview and analysis and a press release about the report. Infographics: Key facts and recommendations from the 2023 antibacterial agents in clinical

The (confusing!) language of AMR: ChatGPT tries to help!

Dear All (Wonkish alert! Not technical but lengthy … so settle in and enjoy the ride!): Regular readers will know of my fascination with language: e.g., this 20 Feb 2020 newsletter entitled “Language Matters: CRE vs. CPE; SDD vs. I; And MDR, XDR, PDR, UDR vs. DTR.” How about that for acronymics taken to Olympian

Mitigating environmental AMR: Grants from ICARS

Dear All, Our colleagues at ICARS have just announced a fascinating grant opportunity focused on environmental AMR. They don’t want surveillance — they want research on to how to intervene! Excerpting from their website: ICARS seeks “projects to mitigate the evolution and transmission of resistance in the natural or built environment”. Proposals are expected to

Casting call: Lifeline (Sir Alexander Fleming, the musical)

Dear All, I have just learned that Lifeline, the musical formerly known as The Mould that Changed the World, is seeking scientists, medics, and healthcare professionals to be part of the cast for a portion of a planned 5-week off-Broadway run of the show around the time of the High-Level Meeting (HLM) on AMR at UNGA 2024 in New York City NY! The deadline to

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