Dr Haileyesus Getahun
Director, Global Coordination and Partnership on Antimicrobial Resistance, WHO
Antibiotics are the weakest link in our health and economic security and their discovery and access needs government investment and partnership.
The 2019 UN Political Declaration on Universal Health Coverage (UHC) called for equitable access to affordable, safe, effective and quality antibiotics and other antimicrobial medicines. The Declaration also recognised antimicrobial resistance as a threat to universal health coverage and committed to increase research and regulatory capacity, as well as antimicrobial stewardship activities.
Health care as a public good has been debated in the strictest economic terms. The on-going COVID-19 pandemic is stark evidence of the intricate link between health and economic development and should help to change such narrative. Nonetheless, these political commitments and renewed efforts in many countries on universal health coverage help to facilitate health care as a public good.
Antibiotics – the orphaned Achilles heel of UHC
Universal access to high quality and affordable antimicrobials is the backbone of universal health coverage. Antimicrobials include antibiotics, antivirals, antifungals and antiparasitics and are used to prevent and treat infections in humans, animals and plants. They play a significant role in keeping communities and economies safe and productive.
Inadequate access to antibiotics alone kills nearly six million people annually, including a million children who die of preventable sepsis and pneumonia. This presents an immense toll.
There is no sustainable pathway to ensure access to newly developed and lifesaving antibiotics to treat drug resistant bacterial infections.
Despite antibiotics being the Achilles heel of universal health coverage, they are orphaned by political leaders and the pharmaceutical industry. Big pharma dropped antibiotic discovery and production as the market failed. Small and medium sized companies who tried to fill the gap in discovery are also increasingly failing.
Recurrent shortage of existing antibiotics
Shortage of old antibiotics needed to treat common clinical conditions are becoming recurrent even in countries with strong economies. There is no global mechanism to systematically address the recurrent lack of access to existing and new antibiotics. However, national governments are partnering to promote and subsidise production of antibiotics to address acute shortages such as fuelled by the COVID-19 pandemic. There is no sustainable pathway to ensure access to newly developed and lifesaving antibiotics to treat drug resistant bacterial infections.
Current efforts need more government investment
The challenges of research and development for new antibiotics are currently addressed by efforts of the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) and the Global Antibiotic Research and Development Partnership (GARDP), which are non-profit global partnerships.
The AMR Action Fund is a new mechanism that is expected to invest more than US$1 billion in smaller biotech companies and provide industry expertise to support the clinical development of novel antibiotics.
The G7 and G20 countries’ political declarations on health since 2014 consistently mentions and commits to containing antimicrobial resistance and enhancing antibiotic research and development including through support for ‘pull’ and ‘push’ mechanisms. However, these commitments are yet to translate into action.
National and grass root civil society movements needed
The ongoing crises of antimicrobial resistance will not be addressed without active political leadership and the financial investment of all national governments. The COVID-19 pandemic showed that societal and personal livelihoods are intricately linked with health.
Labeling antibiotics as public goods within the context of universal health coverage presents a unique opportunity to enhance their access to citizens of countries. This will not be easy to achieve. It can be facilitated by mobilising informed national and grass roots civil society movements which are able to influence governments and broaden public awareness of antibiotics as the weakest link in our health and economic security.