A recent report by the healthcare unit of the KPMG consultancy lays out the stark human and financial cost of the devastating increase in antibiotic drug resistance.
The global economic impact of anti-microbial resistance forecasts that, if unchecked, drug-resistant infections could cost the world 10 million extra deaths a year and cost up to $100tn by 2050.
The report, commissioned by the independent Review on Antimicrobial Resistance established by the UK Prime Minister David Cameron and chaired by world-renowned economist Jim O’Neill, gathered data from across 156 countries.
Focusing on three bacteria and three diseases – Staphylococcus aureus (responsible for MRSA), E. coli and Klebsiella pneumoniae, and HIV, tuberculosis and malaria – the paper assesses the impact on GDP of increased mortality and morbidity by 2050, resulting in a smaller labour force and lower productivity. Four potential scenarios were used, with variations in resistance and infection rates.
Although no country is immune to the effects of growing resistance, the consequences are likely to be particularly damaging in lower income regions, with Africa the hardest hit. The worst-case scenario predicts a fall in GDP of $1.4tn by 2050, representing a tenth of the continent’s total economic output.
These projected figures could be considerably worse if resistant bugs, such as MRSA that are making routine medical procedures far more perilous, are taken into account. At the current rate of resistance, which is steadily climbing, doctors may have to weigh up the risk of a post-operative infection against the benefits of surgery – and could potentially conclude that the patient is safer living with the condition.
Microbes have an extraordinary capacity for developing resistance, accelerated by the over-use of anti-microbials in clinical and agricultural practice. Science has tried valiantly to keep one step ahead, but the lack of breakthroughs in recent decades is a huge cause for concern.
Between 1940 and 1962, more than 20 new classes of antibiotics were launched, but in the subsequent 50-plus years, just two new classes have emerged – with the most recent of these coming onto the market over a quarter of a century ago.
Rekindling anti-microbial innovation
Although doctors and veterinarians (and, indirectly, patients) have a responsibility to cut back the volume of antibiotic prescriptions, it is the pharmaceuticals sector that holds the greatest power to address resistance.
The KPMG report urges governments and global life sciences businesses to invest more in antibiotic research and development, yet, the recent acquisition of Cubist Pharmaceuticals by Merck & Co. notwithstanding, there is little sign of antimicrobials taking a more prominent place among firms’ drugs portfolios.
Phase III development presents one of the biggest hurdles to bringing new drugs to market, given the costs and time of achieving sufficient scale in testing, with all the attendant risks. Greater co-operation between pharma firms could help pool resources to create a larger testing infrastructure, although the industry is understandably wary of opening up its intellectual property.
Incentives could certainly ease the pain, in the form of greater R&D tax allowances, or even a public fund to encourage early development of antibiotics. Cash-strapped governments may initially baulk at such a suggestion, but a relatively modest investment at this stage could help avoid the huge costs of treating large numbers of patients unable to recover from infectious diseases, who would require alternative treatments, increased combination therapy and longer periods in hospital.
Lawrence Summers, Charles W. Eliot University Professor and president emeritus at Harvard University, is adamant that governments must contribute. He says: “We play with fire if we skimp on public health. Ignoring the tide of drug resistant infections risks rolling back the hard won medical advances of the last century at precisely the first moment in history when we can actually go the other way and close the global health gap.”
New pricing models could point the way forward in this debate
The anti-microbial sector would also benefit greatly from enhanced patent protection and faster regulatory approval, via new regulatory programmes such as the UK’s Early Access to Medicines Scheme (EAMS) and the FDA’s ‘fast track’ system. Therapeutic areas such as oncology have already enjoyed accelerated approval times to jump through regulatory hoops quicker.
With governments worldwide striving to manage healthcare budgets, pricing could prove a further barrier to investment, as pharma companies may be reluctant to invest big in products that struggle to provide a reasonable return.
New pricing models could point the way forward. For instance, price-volume agreements between payers and pharma companies allow them to plan their costs, particularly in post-launch marketing, manufacturing and distribution. This improves incentives for development and ultimately lowers price of products for patients.
Advances in genetics, genomics and computer science could provide another boost to research, enabling the development of highly personalised drugs based upon the specific susceptibility of a patient to a particular form of bacteria. Alternative therapies may also have a role in disrupting the rise in resistance.
Getting a better handle on resistance
The report does not claim to provide more than a rough (and probably conservative) estimate of the impact of resistant microbes, due to the lack of widespread credible data. Even in Europe and the US, which are considered to have the most robust figures, the picture is by no means comprehensive, while in other parts of the world much of the data is patchy, necessitating broad assumptions by the authors.
Health systems and the life sciences industry need better ways to track the response of anti-microbials and pinpoint hot spots. According to Professor Dame Sally Davies, chief medical officer for England: “The studies also demonstrate that there are simply far too many gaps in the monitoring and surveillance of bacterial infections across all parts of the world. Keeping track in real time of the emergence and spread of new resistant strains is essential if we are to act effectively at a global level to halt the rise of resistance.”
Armed with better data, and supported by appropriate grants and incentives, the life sciences industry can tackle the problem of resistance with renewed vigour. A surge in R&D, along with a sensible approach to prescriptions, could turn back the tide of resistance and maintain the progress that began with Alexander Fleming’s discovery of penicillin in 1945.