G20 Health Ministers’ Meeting: Fighting Antimicrobial Resistance
Introductory remarks by Angel Gurría,
Berlin, Germany, 20 May 2017
(As prepared for delivery)
I would like to congratulate the German Presidency for hosting this first ever meeting of G20 health ministers, and in keeping antimicrobial resistance (AMR) on the international agenda. It is an honour that you have invited me to address you.
Yesterday you heard Minister Gröhe, Director-General Margaret Chan and Chancellor Merkel tell us that antimicrobial resistance is a major threat to the health of our populations and the future of our economies. They are right.
- 700,000 people worldwide are already dying each year because of drug-resistant infections. This number will grow dramatically if no proper action is put in place now
- Each patient developing a resistant infection results in about USD 10,000 to 40,000 extra healthcare costs.
- The cumulative economic cost of AMR will reach 100 trillion dollars by 2050, and two-thirds of this cost will be borne by low and middle income countries (LMICs) through multi-drug resistant tuberculosis for example, or failing treatments for pneumonia.
All countries, regardless of their situation, the strength of their health systems or their level of antibiotic consumption, will face dramatic social and economic consequences if the spread of AMR is not contained. Minister Gröhe referred to the horrifying prospect of a post-antibiotic world.
This is why it requires a global response. The report we are preparing with the WHO, OIE and FAO shows the need for a three-pronged approach:
- First, promoting conservation. We need to use antimicrobials in a prudent way;
- Second, while responsible access is crucial, it also means avoiding both, underuse and overuse of drugs, as both contribute to AMR.
- Third, investing in innovation to keep pace with evolving diseases. We need to bring new antimicrobials, vaccines and diagnostics to the market.
Many initiatives have been put in place to tackle conservation and access to antimicrobials. By implementing existing international commitments and recommendations of the WHO, FAO and OIE, countries can promote a more appropriate use of antimicrobials in a true ‘One Health’ framework.
This would be further sustained by putting in place a forum where countries could share best-practices and make the economic case for investing in prudent use of antimicrobials in both the human health sector and agriculture. The G20 can help build this momentum.
But it is particularly on innovation that we are failing most dramatically. Facts:
- The approval of antibiotics has fallen to a meagre one eighth of what it used to be 30 years ago. One eighth!!The last major new class of antimicrobials was discovered three decades ago.
- The number of antibiotic-related patents filed at the global level decreased from 8600 in the years 2004 - 2005 to roughly 5000 now.
- The number of large pharmaceutical companies that are active in this field has declined from 18 in 1990 to 6 in 2016.
The problem is that investing in the development of a new antimicrobial drug is not financially attractive. Governments, foundations and the pharmaceutical industry have taken some steps to kick-start the R&D pipeline for antimicrobials. Current incentives amount to some 600M USD/year globally.
The vast majority are “push” incentives – they support basic scientific research in the early phases of the R&D process.
This research results in promising discoveries but most of these discoveries fail to make it beyond the lab due to lack of funding. Pharmaceutical companies are hesitant to turn them into drugs because they cannot see a clear prospect for a good return on investment. To make a profit, they want either high prices or high volumes. High prices reduce access. High volumes, if used indiscriminating, may lead to resistance. On the other hand, low prices and low sales mean that good ideas never make it out of the academic journals.
That is why we need so-called “pull” incentive mechanisms: pay companies for the innovation, and not according to how many pills they sell.
“Pull” incentives mean that companies are rewarded adequately, regardless of sales volume and prices. Separating investment costs from returns (referred to as ‘de-linkage’) means that prices for any new antimicrobial can be kept affordable, while new drugs would be available when needed. Thus, companies would have an incentive to bring new antimicrobials to market.
There is very widespread support for this approach. It was included in the UN General Assembly resolution on AMR last year. Business seems keen – they have signalled this on several occasions, including through a new World Economic Forum process. There are ongoing discussions in the United States, and at the European level. We actually have some good examples of what similar approaches can achieve, for example in the area of vaccines . What will make it happen, this time for antibiotics, is your leadership.
There are three things we should address:
- Fostering increased coordination among incentives already in place, such as CARB-X and JPIAMR. Here, a platform to facilitate the exchange of existing knowledge would ensure that further R&D efforts are aligned with your priorities. The OECD can work with you and for you, together with other IOs, to design, develop and deliver this co-ordination platform.
- Strengthening “pull” incentives. The OECD estimates that bringing to the market four new first-in-class antibiotics over the next 10 years would require additional funding of about 500 million USD per year (stress additional). This would correspond to an almost negligible 0.02% of the projected annual costs of AMR. There does not need to be a single fund, but rather close, effective and functional alignment and co-ordination between the different sources of funding.
- Ensuring that, as a condition for getting funding from any “pull” scheme, new antimicrobials be made available at an affordable price in all countries, provided they commit to implement appropriate control mechanisms.
Dear Ministers, antimicrobial resistance is a fundamental threat to our health, our economies and our future. Beyond that, as Chancellor Merkel reminded us yesterday: Progress in tackling AMR will also increase support for the G20 among our populations. They will understand the implications and clearly relate to an issue which is very close to them personally. Thus, we must act together and we must act now. Count on the OECD, in close cooperation with the WHO and other partners, to help the G20 advance this agenda.
Before closing I would like to take this opportunity to thank Margaret Chan for her inspirational leadership on AMR and so many other health issues in her time as the WHO Director General and wish her all the best for the future. It has been a privilege and a pleasure to serve with you.