The world needs to keep an eye on improving access to antibiotics, even as it grapples with the over-use of these medicines and the resistance that is developing as a result, said Jayasree Iyer, Executive Director of Netherlands-based Access to Medicine Foundation.
While there is some progress on the part of drug companies bringing out new drugs, society cannot take it for granted, she said. The scenario could change tomorrow if even one large company retreats from making a product, as that would have a massive impact on access to these medicines, Iyer told BusinessLine , speaking from Davos, ahead of the launch of the foundation’s 2020 Antimicrobial Resistance (AMR) Benchmark report at the World Economic Forum.
Twin issue
The practical challenge is that companies need finance to research new antibiotics, but they also need to be careful not to over-sell the medicine, she observed. Since the twin problem is an economic one as well, Iyer said, she was in Davos to urge the heads of companies and governments to stay committed to keeping old and new antibiotics accessible, specially in low- and middle-income countries.
More people die from the lack of access to a drug, than resistance, she said.
And yet, the statistics are staggering. “Antibiotic and antifungal resistance is estimated to kill 35,900 people in the US alone each year. In the EU/EEA (European Economic Area), resistance accounts for at least 17 per cent of infections, and AMR is responsible for 33,000 deaths each year. In India, resistance exceeds 70 per cent for many widespread bacteria,” a note on the report said.
Too much reliance on too few
The good part of the report’s finding is that “more companies are moving to discourage the overselling of their antibiotics and antifungal medicines to doctors and other healthcare professionals. Most companies have a strategy to prevent antibacterial residue being released in factory wastewaters. Furthermore, pharmaceutical companies are sharing more data on where drug resistance is emerging.”
But there is also too much reliance on too few, says Iyer. Compared with 2018, the pipeline for priority bacterial and fungal infections remains small, with only 51 candidates in late-stage clinical development. Also, antibiotics are not being made widely available in low- and middle-income countries through registration filings or supply strategies, the report found.
“Since the 2018 AMR Benchmark, two more companies — Novartis and Sanofi — have retreated from new antibiotics R&D, while two further companies — Achaogen and Melinta — have filed for bankruptcy,” it added.
Thirty companies with a stake in the anti-infectives market, including multinational pharmaceutical companies, biotechnology firms and manufacturers of generic medicines, were evaluated on their response to drug-resistant infections. They are among the last to remain committed to developing and producing these products. “There are presently more than 1,500 antibacterial or antifungal medicines or vaccines on the market and account for almost 40 per cent of antibiotics in development.”
Company performance
The report identified three companies as leaders in 2020 — GlaxoSmithKline (GSK), Entasis and Cipla. GSK has the biggest pipeline and is developing the bulk of new vaccines. However, it has regressed in some areas since 2018, the report found.
Pfizer leads in terms of stewardship, and is the first pharmaceutical company to publicly share its raw surveillance data.
Johnson & Johnson performs strongly for the second year, largely for its actions to improve access to treatment for tuberculosis (TB), the report said.
Cipla found a mention as one of the three companies to fully decouple its sales agents’ bonuses from sales volumes, a significant step in discouraging overselling, the report said.