The World Economic Forum, held annually in Davos, Switzerland, has become a platform where politicians, scientists, economists, and other global influencers gather to discuss the future of global development. During the most recent convening, the Access to Medicines Foundation, an independent nonprofit based in the Netherlands, released a new index that grades pharmaceutical companies by their efforts to mitigate the spread of antimicrobial resistance. The index, dubbed the Antimicrobial Resistance Benchmark (ARB) has been heralded as the first of its kind.
Antimicrobial resistance (AMR) has often been referred to as the “Superbug” threat. The World Health Organization (WHO) defines AMR as a phenomenon where microorganisms undergo genetic alterations when exposed to antimicrobial drugs, such that they develop resistance to the drug and render it ineffective.
The WHO regards AMR as a serious threat to current efforts to control and treat infections caused by bacteria, parasites, viruses, and fungi. Among the many consequences of AMR are compromised surgical and chemotherapy outcomes, increasing costs of healthcare for patients with resistant infections, and complications for ongoing efforts to combat prolific diseases like tuberculosis, HIV, and malaria. While AMR does occur naturally and inevitably, global misuse and overuse of antimicrobials have been rapidly accelerating the inefficacy of certain drugs.
With AMR widely recognized at the highest levels of global leadership as a serious problem, the ARB seeks to hold the pharmaceutical industry more accountable for their role. Importantly, rather than publicly shaming pharmaceutical companies, the ARB sought instead to recognize companies for their ongoing actions against AMR and point out areas of improvement, with the hopes that it will incentivize companies to bolster their activities and increase their engagement with the issue.
The ARB evaluated 30 pharmaceutical companies, a cross-section of the industry, against a priority list developed by experts from the WHO, the European Union, and various governments and research groups. The criteria were research and development for new antimicrobial drugs, responsible antimicrobial manufacturing processes, and accessibility and appropriate usage, or stewardship, of antimicrobials.
GlaxoSmithKline and Johnson & Johnson were recognized as the two research-based pharmaceutical companies most active against AMR.
One notable finding from the report was that four companies, GlaxoSmithKline, Shionogi, Pfizer, and Novartis, decided to uncouple bonuses for their sales representatives from the volume of antimicrobials they sell. Johnson & Johnson also decided that its anti-tuberculosis drug, bedaquiline, will only be provided through national tuberculosis programs, thus eliminating marketing. These measures were commended for encouraging the prudent use and distribution of existing drugs.
Another key finding was that of the 28 antibiotics currently in the late phases of the development pipeline, only two have access and stewardship provisions established.
Eravacycline, by Tetraphase, is being developed to treat complicated intra-abdominal and urinary tract infections due to S. aureus and other pathogens. Tetraphase is seeking to increase the drug’s accessibility through licensing partners in certain regions where accessibility would otherwise be poor. It is also providing hospitals with strips that test whether a patient’s infection is susceptible to the drug.
The other drug that was recognized was also bedaquiline by Johnson & Johnson, which is currently being adapted to treat multidrug resistant tuberculosis in pediatric patients. Johnson & Johnson will continue to use the managed access program that it already uses for adult-specific bedaquiline, and is providing educational materials for pediatric healthcare professionals to improve awareness of its appropriate usage.
The index concluded that current efforts by pharmaceutical companies represent a promising start. However, it pointed out that too few antimicrobials are being developed to replace the products that are losing their efficacy. For products already available, more concrete plans are still needed to ensure the proper accessibility and stewardship. The report also urged responsibility on the part of governments to ensure that the antimicrobial market offers enough incentive for companies to continue their activity in developing new products.
References
- Access to Medicine Foundation. Antimicrobial Resistance Benchmark 2018. 2018. https://amrbenchmark.org/wp-content/uploads/2018/03/Antimicrobial-Resistance-Benchmark-2018.pdf
- McNeil D. New Index Rates Drug Companies in Fight Against “Superbugs”. The New York Times. 2018. https://www.nytimes.com/2018/01/23/health/antibiotic-resistence-glaxo-johnson.html?rref=collection%2Fcolumn%2Fglobal-health&action=click&contentCollection=science®ion=stream&module=stream_unit&version=latest&contentPlacement=5&pgtype=collection
- World Health Organization. Antimicrobial resistance. 2018. http://www.who.int/mediacentre/factsheets/fs194/en/
Kylie Jenkins is a medical student in the Class of 2021. She graduated from Barrett, the Honors College at Arizona State University with an economics degree and briefly worked as an analyst before beginning medical school. She is a notorious speed reader and loves writing, bouts of intense physical activity, and planning her next vacation.