Push! Pull! Push! Pull! / Highlights from Davos 2018

Dear All: Three important documents were released at / during / around the World Economic Forum meeting that occurred this week in Davos.

First and foremost, we have the final report from DRIVE-AB. It’s a substantial document and you’ll need to set aside an afternoon to read it. As a way to get started, my 11 Sep 2017 blog post provided a good overview of DRIVE-AB’s conclusions and also offers a downloadable PowerPoint lecture containing the key ideas. In brief, the multidisciplinary DRIVE-AB team has:

• Created 3 blocks of insight: (1) a common language for measuring things like sustainable use, (2) models to predict emergence & spread of AMR, and (3) new HTA metrics for antibiotic value and
• Used these insights to propose four types of pragmatic and effective incentives
  • Two types of Push incentives (Grants and a Pipeline coordination)
  • Two types of Pull incentives (Market Entry Rewards and a Long-Term Continuity Model)
• Given us three key takeaway messages:
  • It’s an ecosystem: We need Push and Pull. No single thing fixes it.
  • Push: Given the weakness in the overall pipeline (see my 5 Jan 2018 blog summary of the recent pipeline analysis by Pew), DRIVE-AB suggests that current global Push funding (~$550m/year) should be increased ~50%.
  • Pull: Detailed modeling by the DRIVE-AB team shows that a global market entry reward of ~$1b per new antibiotic would mean we’d have ~16-20 new novel antibiotics over the next 30 years rather than just the ~4 we’d currently expect.

That we’re making at least some progress on AMR-related work already is shown by the second report on our tour, 2016 R&D summary released by the AMR Industry Alliance. Per their progress report, Alliance companies invested > USD 2 billion during 2016 in R&D dedicated to a wide range of AMR-related products that include therapeutics, vaccines, diagnostics, and other preventative products. This is of course good to see, but the 48 traditional and the 32 non-traditional antibiotics in all phases of development as of Sep 2017 is certainly dwarfed by comparison with the more than 600 oncology drugs in Phase 2 or beyond (I could not find a good number for Phase 1).

The third report on our tour doesn’t speak to direct incentives but rather to the important role that planning for stewardship and access for new antibiotics will play in acceptance and implementation of meaningful Pull incentives. Provided by the Access to Medicines Foundation, the first AMR Benchmark Report shows that companies are working on priority pathogens, setting limits on antibiotic discharges, decoupling bonuses from sales volume, and tracking resistance. It’s not a surprise that the efforts are somewhat uneven across companies, but the trends are there and are encouraging.

Putting it all together, this figure from the DRIVE-AB reports shows that we’ve seen an impressive array of Push efforts implemented in the past two years: