Dear All (moderately wonkish, so settle in for the ride — and the reason for the title of this newsletter will become obvious!),
The GLG AMR (Global Leaders Group on Antimicrobial Resistance) released a report on 3 April 2024 providing recommendations for consideration by UN Member States in the outcome document of the High-Level Meeting (HLM) on AMR to be held during the UN General Assembly of September 2024 (UNGA 2024). The report is a superb compilation of key ideas — but equally important is the accompanying new economic study that lays out the costs of inaction. Below find the links you need. To get started, I suggest reading the reports in this order:
- 3 Apr 2024, The new GLG AMR report: “Towards Specific Commitments and Action in the Response to Antimicrobial Resistance”
- 4 Apr 2024, The economic study used in the GLG AMR report: “Building the Investment Case for Action Against Antimicrobial Resistance”
- Webpage. Note the interesting title … building the INVESTMENT case …
- 4 Apr 2024, Useful background document: Report of the Eighth Meeting of the Global Leaders Group on AMR
- Webpage. A 4-page document providing good background reading on how the GLG AMR report and supporting economic study came together.
- 20 Feb 2024, Useful background document: “GLG recommendations to address the antibiotic pipeline and access crisis in human health”
- Webpage. An important prior report that is referenced in the above documents
Let’s look in detail at the new GLG AMR report and then the economic study.
THE NEW GLG AMR REPORT: AMR is lethal … let’s have a global target for reduction in AMR-related deaths
As noted in the opening paragraph, the GLG AMR report focuses on providing material for the outcome document that would be released after the AMR HLM during UNGA 2024 (you’ve got to appreciate the acronymics!). The report creates a list of 10 ideas (see page 5) that are usefully summarized in buckets (#s in parentheses link to the numbered ideas in the report):
- Oversight: (#1) Create an oversight panel and (#6) formalize the QJS-AMR (Quadripartite Joint Secretariat on AMR).
- National and Global Action Plans (NAPs): Create and fund them globally (#2, #5), including creation of a Global Action Plan (#4).
- Create more evidence: Convene an Independent Panel on Evidence for Action Against AMR (#3).
- Surveillance: Enhance global surveillance in both human and animal health (#7).
- A collection of 7 SDG-like goals / targets for 2030:
- By 2030, all countries to have measures to prevent environmental contamination in their NAP.
- By 2030, all countries to have strategies to implement WASH (Water, Sanitation, and Hygiene).
- By 2030, reduce global deaths due to AMR by 10%.
- By 2030, 80% of human antibiotics should be from the ACCESS category of WHO’s AWaRe classification.
- By 2030, reduce antibiotic use in agri-food systems by 30-50% from current levels.
- By 2030, eliminate the use of medically important human antibiotics in animals for non-veterinary medical purposes.
- By 2030, eliminate the use of medically important human antibiotics in crop production and agri-food systems for non-phytosanitary uses (I had to look that last one up — see this document for details).
All of these are hugely important, but to my eye the jewel in the crown is the list of 7 concrete, measurable goals/targets that very much has the flavor of a set of Sustainable Development Goals (SDGs, note that the numbering in the report differs from my numbering).
All are important, but the big one for me is “By 2030, reduce global deaths due to AMR by 10%.” This one is especially powerful because it puts the consequence (death) squarely in line with the cause (AMR) in a manner that cannot be ignored.
THE NEW ECONOMIC STUDY: AMR is expensive … and a remediation package would pay for itself in savings
Underpinning the report is a superb new economic study that was commissioned by the QJS. The details on methods and authorship are scant (and I suspect a big launch event must be coming), but the essential message is that an expert economic group has been working since 2022 to build an economic case for investment in AMR. The result of their work is three estimates that combine to show the return on investment of work to address AMR:
- “A business-as-usual (BAU) scenario to estimate the current and projected cost of AMR should no greater action be taken.
- “A list of priority AMR interventions across sectors and the sub-selection of a package of interventions for which cost-, and effectiveness-related data is available.
- “An estimation of the return on investment (RoI) from implementing the package of interventions globally.”
And (drum roll, please), the key answers are (this is my summary … please do read the report):
- If we take no action beyond current activities, average global life expectancy will fall by 1.8 years over the next decade due to AMR.
- The annual global cost of AMR is ~$900 billiion/year.
- $855b/year, to be precise due to direct health care spend cost of $412b/year plus $443b/year in productivity losses.
- A complete remediation package would cost $1,420 billion through 2050.
- Note the ratio of the cost/year ($900b) to the TOTAL cost over time of the remediation package ($1,420b … or, a 1.5 years worth of cost)
- Net effect: For every $1 spent, the return is $7 to $13
Woot, woot! This is a VERY BIG DEAL! As we’ve discussed many times, seeing AMR through the eyeglasses of the economic community is key to the argument that AMR requires intervention. If this is new to you, please see the 19 Mar 2024 newsletter entitled “Tragedy of the (Antibiotic) Commons: A True Market Failure” and associated YouTube discussion.
What exceptionally fine work! At a technical level, the project’s simulations have been built from a regional to a global level in a way such that individual countries will be readily able to adapt the data to fit the economic investment case that makes the most sense for the given country. This, of course, will facilitate all those arguments about engaging in this work!
Fabulous … and I look forward to seeing expanded details both in print and at future meetings!
And with that let’s get busy so that we can ensure that we will “By 2030, reduce global deaths due to AMR by 10%“!
Onward to UNGA 2024 with this as our banner!
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.
- BARDA’s long-running BAA (Broad Agency Announcement) for medical countermeasures (MCMs) for chemical, biological, radiological, and nuclear (CBRN) threats, pandemic influenza, and emerging infectious diseases is now BAA-23-100-SOL-00004 and offers support for both antibacterial and antifungal agents (as well as antivirals, antitoxins, diagnostics, and more). Note especially these Areas of Interest: Area 3.1 (MDR Bacteria and Biothreat Pathogens), Area 3.2 (MDR Fungal Infections), and Area 7.2 (Antibiotic Resistance Diagnostics for Priority Bacterial Pathogens). Although prior BAAs used a rolling cycle of 4 deadlines/year, the updated BAA released 26 Sep 2023 has a 5-year application period that ends 25 Sep 2028 and is open to applicants regardless of location: BARDA seeks the best science from anywhere in the world! See also this newsletter for further comments on the BAA and its areas of interest.
- HERA Invest was launched August 2023 with €100 million to support innovative EU-based SMEs in the early and late phases of clinical trials. Part of the InvestEU program supporting sustainable investment, innovation, and job creation in Europe, HERA Invest is open for application to companies developing medical countermeasures that address one of the following cross-border health threats: (i) Pathogens with pandemic or epidemic potential, (ii) Chemical, biological, radiological and nuclear (CBRN) threats originating from accidental or deliberate release, and (iii) Antimicrobial resistance (AMR). Non-dilutive venture loans covering up to 50% of investment costs are available. A closing date is not posted insofar as I can see — applications are accepted on a rolling basis; go here for more details.
- The AMR Action Fund is open on an ongoing basis 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.
- 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-X, C-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).
John’s Top Recurring Meetings
Virtual meetings are easy to attend, but regular attendance at annual in-person events is the key to building your network and gaining deeper insight. My personal favorites for such in-person meetings are below. Of particular value for developers are the AMR Conference and the ASM-ESCMID conference. Hope to see you there!
- 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.
- 17-20 Sep 2024 (Porto, Portugal): ASM/ESCMID Joint Conference on Drug Development to Meet the Challenge of Antimicrobial Resistance. Go here for the meeting’s general website. You can’t register (yet) for the 2024 event, but save the date!
- 16-20 Oct 2024 (Los Angeles, USA): IDWeek 2024, the annual meeting of the Infectious Diseases Society of America. Save the date! More details to come!
- 25-26 February 2025 (Basel, Switzerland): The 9th AMR Conference 2025. Go here to register!
Upcoming meetings of interest to the AMR community:
- [NEW] 23 Apr 2024 (online, 9-10.30a EDT): GARDP-sponsored webinar entitled “Efflux inhibitors: A strategy to tackle multidrug resistance.” Go here to register.
- 26 Apr 2024 (Barcelona, Spain): ESCMID workshop entitled “Using Data Science and Machine Learning for Infection Science: A Hands-on Introduction.” Click here to register or here for more details.
- [NEW – IMPORTANT!!] 26 April 2024 (Barcelona, Spain but also live-streamed): From 15:30 to 19:00 CEST, ECCMID and the AMR GLG (Global Leaders Group on AMR) are hosting a pre-ECCMID event entitled “Forging partnerships between science and policy: A high-level Antimicrobial Resistance (AMR) event.” A similar event held last year was very instructive — please plan to attend if possible! Go to https://www.eccmid.org/glg-escmid-amr-meeting for details.
- In addition, there is a pre-event ESCMID-organised “think tank” symposium on the importance of diagnostics in AMR, from 14:00 – 15:00 CEST.
- 27-30 April 2024 (Barcelona, Spain): 34th ECCMID, the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases. See Recurring Meetings list, above.
- [NEW] 15 May 2024 (in person, New York City, USA; there will be a listen-only webstream): A multistakeholder Hearing for 2024 UNGA HLM on AMR will be held by the Quadripartite Joint Secretariat (QJS-AMR). This is part of the prep for the Sep 2024 High-Level Meeting (HLM) on AMR. Preregistration by 24 April 2024 is required — go here for the registration portal.
- [NEW] 21-22 May 2024 (hybrid in-person and online, Falls Church, VA, 9a-4p ET both day): 25th PACCARB public meeting. The primary topic is a report to the Secretary of Health and Human Services. Additional topics will cover AMR in conflict zones, the environment, and the voice of the patient.
- As a special event during the meeting, the first of a pair of short films on AMR (18-19 minutes each) will be screened. Collectively titled HOLOBIOME, these films were created with funding from NovoNordisk Foundation and with advisory support from WHO. The films are from the same team (small-r.com) who created the excellent 2015 RESISTANCE movie and cover (i) the story of AMR in a young kidney transplant patient (ii) a sci-fi / documentary hybrid exploring the need for innovation.
- Go here to register for the PACCARB meeting; go here for a preview trailer (~2 minutes) of the short films.
- 26-31 May 2024 (Montreal, Canada): EDAR7, the McGill AMR Centre’s 7th edition of their Environmental Dimension of Antimicrobial Resistance conference. Go here for details; final abstract deadline is 21 Dec 2023.
- 28-29 May 2024 (in person, Uppsala, Sweden): Uppsala Antibiotic Days, a broad-ranging 2-day program hosted by the Uppsala Antibiotic Center. Go here for details and to register.
- 30-31 May 2024 (face-to-face in Rockville, Maryland as well as online, 8.30-5.30p ET on 30 May, 9-2.40p on 31 May): NIAID-sponsored workshop entitled “Towards realizing the promise of adjunctive immune therapy for invasive fungal infections”. The agenda covers host immunity to invasive fungal infections, immune modulators in the context of fungal infections; and strategies for testing immune modulators as adjunctive therapy. Go here for more details and to register.
- 9-13 June 2024 (in person, Ascona, Switzerland): “New Approaches to Combat Antibiotic-Resistant Bacteria, 2nd Edition” is a Sunday-Thursday residential workshop focused on the deep biology of AMR. Sponsored by NCCR AntiResist (a Swiss National Science Foundation consortium), the scientific program has the feel of a Gordon Conference. Space is limited, so you are encouraged to apply promptly — go here for details.
- 13-17 June 2024 (Atlanta, Georgia): ASM Microbe, the annual meeting of the American Society for Microbiology. You can’t register yet, but you can go here for general details.
- 17-20 Sep 2024 (Porto, Portugal): ASM/ESCMID Joint Conference on Drug Development to Meet the Challenge of Antimicrobial Resistance. See Recurring Meetings list, above.
- 16-20 Oct 2024 (Los Angeles, USA): IDWeek 2024, the annual meeting of the Infectious Diseases Society of America. See Recurring Meetings list, above.
- 19-27 Oct 2024 (Annecy, France, residential in-person program): ICARe (Interdisciplinary Course on Antibiotics and Resistance). Now in its 8th year, Patrice Courvalin directs the program with the support of an all-star scientific committee and faculty. The resulting soup-to-nuts training covers all aspects of antimicrobials, is very intense, and routinely gets rave reviews! Seating is limited, so mark your calendars now if you are interested. Applications open in March 2024 — go here for more details.
- 4-5 Dec 2024 (in person, Washington, DC): “Fungal Dx 2024: Fungal Diagnostics in Clinical Practice” is a 2-day in-person workshop organized by ISHAM‘s Fungal Diagnostics Working Group. The program and registration links are available at https://fungaldx.com/; the agenda is comprehensive and features an all-star global list of speakers.
