This article is part of our special report From words to action: Exploring the ecosystem of antimicrobial resistance.
A ‘Netflix-style’ subscription service, regularly paid from governments to the pharmaceutical industry, could help incentivise the creation of sorely-needed new antibiotics and break the “toxic” environment of antibiotic research and development, according to an expert.
Antimicrobial resistance (AMR) is the ability of microorganisms to evolve to resist antibiotics, leading to infections becoming increasingly untreatable.
AMR claims as many as 33,000 lives in the EU every year, but this is set to drastically worsen, with AMR poised to become a bigger killer than cancer by 2050.
However, despite the looming threat of this so-called ‘silent pandemic’, research and development of new antibiotic treatments is toxic, according to Jeremy Knox, policy and advocacy lead on the drug-resistant infections priority programme of the Wellcome Trust, a charitable foundation focused on health research.
“The market is very unpredictable and delivers very low revenues, which has led decades of disinvestment by pharmaceutical companies,” Knox told EURACTIV, pointing out that, unlike other newly-developed drugs, new antibiotics are not made to be used, but to be kept back only in cases of emergency.
This has left only a small handful of major global pharmaceutical companies still in the AMR game, he said, as others opted instead to shift their business model to focus more on the lower-risk areas.
“[Companies] are starting with a small market, and then you’re only capturing a fraction of that small market. So it’s a really kind of toxic environment,” he said.
This has created a situation where there are “rising rates of resistance, existing drugs becoming increasingly undermined by those rising rates of resistance, but really far too few products in the pipeline,” Knox said, pointing out that this has been the case since the 1980s.
Breaking this cycle of under-investment and scientific roadblocks will be enormously challenging and require revolutionary new approaches, according to Knox.
Crucially, governments must find a way to deliver a predictable revenue which is large enough to offset the investment costs of all of the late-stage research and development (R&D) and up to being ready to enter the market, he said.
One way in which this could be achieved is via an upfront lump sum payment for products that meet defined criteria.
Another possible avenue that merits exploration is the idea of a ‘Netflix-style’ subscription service, he said, adding that this more “nuanced” approach has been gaining momentum in recent years.
In this way, governments would agree to regularly pay a set amount of money to support the industry, regardless of how many units of the antibiotics are sold.
This kind of subscription can create “stable, dependable revenues regardless of how much or how little of the antibiotic is used,” thus breaking the economic cycle of paying on a per pill basis, he said.
Such contracts could be awarded for 5-10 years, he suggested, with governments committing to pay an annual lump sum linked to the value of an antibiotic.
This can be seen as a “win-win” for all parties, Knox said, as developers would have “certainty around the revenues they’re going to make and the demands they will face” while the governments can “apply proper stewardship, there’s no incentive to overuse the product, and they have certainty that they will have fixed costs on this for years to come”.
While the idea is relatively new, he pointed out that this idea is currently being trialled in the UK, and the US is also moving to consider the possibility of such a subscription service.
There is also increasing interest for such a model in the EU, with Swedish MEP Jessica Polfjärd recently citing it during a recent EURACTIV interview as an example of how AMR business models could be more sustainable.
Translating this to the EU could be a struggle though, as Nathalie Moll, director general of EFPIA, pointed out during a recent event on tackling AMR,
“We see national prescription models, sort of subscription models like Netflix models in the UK and Sweden that seem to work in the US, but we need things that work for us here in Europe, because we’re not a single country,” she warned.
However, one thing all stakeholders were clear about is that there is no time to lose in addressing the issue.
“We can’t wait. We need to address things now,” Moll said, adding that initiatives such as the AMR fund, a $1billion facility aimed at overcoming technical and funding barriers in antibiotic development and ensuring a sustainable pipeline of new antibiotics to fight superbugs, is simply a “bridge” while waiting for longer-term solutions.
[Edited by Zoran Radosavljevic]