Superbug review urges Big Pharma to ‘pay or play’ on antibiotics

LONDON — Drug companies should agree to “pay or play” in the urgent race to develop new antibiotics to tackle a global threat of antimicrobial resistance (AMR), according to a British government-commissioned review.

Led by former Goldman Sachs chief economist Jim O’Neill, the review said every sector affected by the growing threat of superbug infections — from patients, to doctors, to governments, to the healthcare industry — must be forced “out of its comfort zone” if the issue is to be successfully tackled

This should include pharmaceutical companies, O’Neill said, which should be subject to a surcharge if they decide not to invest in research and development (R&D) to bring successful new antibiotic medicines to market.

For who do decide to “play”, he said, a reward of between $1 billion and $1.5 billion should be paid for any successful new antimicrobial medicine brought to market.

“If we don’t do something, we’re heading towards a world where there will be no antibiotics available to treat people who need them,” O’Neill told reporters at a London briefing as he presented a final report from his team’s 18-month review.

He repeated the review’s previous estimation that AMR could kill an extra 10 million people a year and cost up to $100 trillion by 2050 if it is not brought under control. [

Any use of antibiotics promotes the development and spread of superbugs — multi-drug-resistant infections that evade the antimicrobial and antibiotic drugs designed to kill them.

O’Neill was asked last year by Britain’s Prime Minister David Cameron to conduct a full review of the problem and suggest ways to combat it.

Launching his final report, O’Neill said it had identified 10 areas where the world needs to take action. Some of these focus on how to reduce unnecessary use of antibiotics, while others look at how to increase the supply of new ones.

“Our arsenal to defeat superbugs is running out and needs to be replenished,” the review said.

Costs of action, and inaction

O’Neill’s review called for a group of countries such as the G-20 to reward companies for finding and developing new antibiotics.

“These market entry rewards, of around $1 billion each, would be given to the developers of successful new drugs, subject to certain conditions that ensure they are not over-marketed but are available to patients who need them wherever they live,” it said.

O’Neill said the review’s proposals would cost up to $40 billion over 10 years — a figure “dwarfed by the costs of inaction”. A little more than half of that — up to $25 billion — should probably come from the drugs industry, he said.

He suggested several possible funding sources, including allocating a small percentage of G-20 countries’ health spending, reallocating a fraction of global funding from international institutions, applying a “pay or play” antibiotic investment charge on drug companies who don’t invest in antimicrobial research and taxing current antibiotic use.

“Given the systemic risk to the pharmaceutical industry, the sector could contribute to supporting market entry rewards — on a pay or play basis,” he told reporters.

Industry hits back

The drug industry hit back on Thursday at a proposal and said the idea would “undermine goodwill”.

Trade associations representing British, European and international drug companies said in a joint statement that such a surcharge would be “punitive” and counterproductive.

“The potential imposition of a tax on just one segment of the life sciences sector to fix a supply-side issue will significantly undermine current goodwill, cooperation, and the large voluntary investment and initiatives that are already under way,” they said.

“We need to be working towards incentives that support additional investment rather than punitive payments.”

The world has seen very few new antibiotics in the past few decades, as industry has retreated from the field to focus on more profitable disease areas, although recently there has been some increase in investment, prompted by the superbug threat.

The industry bodies said pharmaceutical companies were currently working to develop 34 experimental antibiotics and infection-preventing vaccines.

A separate global association representing manufacturers of veterinary medicines also criticised elements of the O’Neill report, which included a call for big cuts in antibiotic use in farming, saying it was “negatively biased towards agriculture”.