Linking Sustainable Use Policies to Novel Economic Incentives to Stimulate Antibiotic Research and Development

Abstract

There is now global recognition that antibiotic resistance is an emerging public health threat. Policy initiatives are underway to provide concrete suggestions for overcoming important obstacles in the fight against antibiotic resistance, like the alarming current paucity of antibacterial innovation. New economic models are needed as incentives for the discovery and development of novel antibacterial therapies especially for infections with too few patients today to justify private sector research and development (R&D) investments. These economic models should focus on rewarding the innovation, not the consumption of the antibiotic since sustainable use policies will reduce selection pressure and slow the emergence of resistance. To effectively stimulate greater innovation, the size of the reward must be commensurate with revenues from other therapeutic areas, estimated at about a billion dollar total pay-out. Otherwise R&D investment will continue to move away from antibiotics to areas where returns are more attractive. A potential sizeable public investment, if implemented, must be protected to ensure that the resulting antibiotics have a lengthy and positive impact on human health. Therefore, public investments in innovation should be bound to sustainable use policies, i.e., policies targeted at a range of actors to ensure the preservation of the novel antibiotics. These policies would be targeted not only at the innovating pharmaceutical companies in exchange for the reward payments, but also at governments in countries which receive the novel antibiotics at reasonable prices due to the reward payment. This article provides some suggestions of sustainable use policies in order to initiate the discussions. These are built on planned policies in the US, EU, WHO and have been expanded to address One Health and environmental aspects to form One World approaches. While further discussion and analyses are needed, it is likely that strong sustainable use policies will help to protect the sizeable public health investments.

Veterinary Medical Students’ Perceptions, Attitude and Knowledge about Antibiotic Resistance and Stewardship: How Prepared Are Our Future Prescribers?

“…The misperception by majority of NVS (71%) that new AB will be developed in the future to keep up with the problem of ABR calls for concern. Medical students in China (Yang et al, 2016) had a stronger misperception (76.9%) that new AB will be developed in the future to keep up with the problem of ABR whereas medical/pharmacy students elsewhere (Abbo et al, 2013;Justo et al, 2014;Wasserman et al, 2017) had a better perception/understanding (15%-27%) in terms of difficulties associated with the development/manufacturing of new AB in the future (Theuretzbacher et al, 2017).…”

Multidrug resistance among Escherichia coli and Klebsiella pneumoniae carried in the gut of out-patients from pastoralist communities of Kasese district, Uganda

“…Abuse of antibiotics has resulted into the fast-growing problem of antimicrobial resistance on far, in health care settings [ 9 , 10 ] and the community [ 11 ] [ 12 ] [ 13 , 14 ] Previous studies in Uganda report inappropriate usage of antimicrobials in animal husbandry as a major contributor to the emergence of antimicrobial resistance among microbes [ 15 ]. Additionally, 40% of the individuals who visit a health- care facility in Uganda are treated with antibiotics [ 4 ] [ 16 ]. These antibiotics are mostly given over the counter in drug shops and community pharmacies in sub-therapeutic doses.…”

Encouraging the Development of New Antibiotics: Are Financial Incentives the Right Way Forward? A Systematic Review and Case Study

“…The second most popular suggestion among the articles was an MER, with 14 articles recommending this pull mechanism. 17 , 25 , 28 , 38 , 39 , 45 , 47–50 , 54–56 , 59 Articles outlining how the MER should be implemented, awarded, and distributed varied widely in their proposed approaches, with model differences being observed between the eligibility criteria for marketed antibiotics, the value of award payments, the extent of disruptiveness to existing market systems, and whether or not they are concerned with promoting antibiotic stewardship.…”