Report calls for drug companies to finance new antibiotics

A report into antimicrobial resistance by economist Lord Jim O’Neill has suggested that drug companies should “pay or play” by developing new antibiotics themselves or funding others to do so. It also recommends that doctors be prohibited from prescribing antibiotics until they have tested to ensure that a patient’s infection is bacterial. Such tests do not yet exist and the report calls for incentives to develop them. Lord O’Neill also called for measures to reduce the use of antibiotics in animals. The report argues that if no action is taken to address this issue, up to 10m lives could be lost annually by 2050 at a cost of £69tn ($100tn) a year. The Association of the British Pharmaceutical Industry immediately rejected the pay or play proposal. 

A blueprint to end the scourge of antimicrobial resistance proposes that drug companies should foot the bill for the development of new antibiotics and that patients should not be able to get them without a test to ensure they are needed.

Economist Jim O’Neill, charged two years ago by David Cameron with finding answers to one of the most pressing problems in the world today, says the global financial cost of no action would be the loss of 10 million lives a year by 2050 and £69tn ($100tn) a year.

“One million people have died while we have been doing this review,” said Lord O’Neill, who became a minister while completing the report. Without action, he said, there would be more people dying in the future than are dying of cancer.

Many antibiotics that were once thought to have put an end to infectious disease are no longer working because the bugs have become resistant to them. Tuberculosis was thought to be no longer a killer because of antibiotics, but multi-drug resistant forms are exacting a death toll around the globe.



The two most eye-catching proposals advanced by O’Neill are:

To force the pharmaceutical industry to “pay or play”. Drug companies must either research and develop new antibiotics or be prepared to fund other companies to do so. “We think there is a credible case for the pharmaceutical industry itself to pay, given how important antibiotics are for 7 billion people around the world,” he said.

To ban doctors from prescribing antibiotics until they have carried out rapid tests to prove the infection is bacterial. “We must stop treating antibiotics like sweets, which is what we are doing around the world today,” he said. However, there must be incentives to develop such tests which do not yet exist.



The pay or play idea was immediately rejected by trade body the Association of the British Pharmaceutical Industry. “[It] fails to recognise the need for a collaborative response which this long-term review has consistently identified,” said Dr Virginia Acha, director of research, medical and innovation at the ABPI. “Putting the onus on any one group will not solve the problem and is not a sustainable solution.”



She said the industry had already done more than anyone to tackle the issue, investing 3.7% of its annual $137bn (£94bn) global R&D spend in anti-infectives as well as vaccines, which the report says should be used more.

Lord Jim O’Neill. Photograph: Dominic Lipinski/PA

Companies already involved in antibiotic research were less hostile. Sir Andrew Witty, GlaxoSmithKline’s chief executive, called the report helpful and added: “Governments, industry and other relevant groups must now work together to develop these ideas into practical steps that encourage and reward further research and ensure a supply of effective new antibiotics for future generations.”



O’Neill said that stopping the over-use of antibiotics – also fed in vast quantities to animals for growth promotion as well as to treat disease, especially in the United States – may be even more important than incentivising the development of new drugs.



Antibiotics are wrongly prescribed for coughs and colds caused by viruses because GPs do not have instant tests that can tell them whether their patient really does have a bacterial infection. The report says the development of rapid diagnostic tests must be an urgent priority.

“I find it incredible that doctors must still prescribe antibiotics based only on their immediate assessment of a patient’s symptoms, just like they used to when antibiotics first entered common use in the 1950s,” O’Neill said in the report.

Doctors and policymakers need to get out of their comfort-zone, he added. “By 2020 it should become mandatory to use rapid diagnostics before antibiotics are prescribed.”

That would be an incentive for industry to invent the rapid diagnostic tests needed and a new Global Innovation Fund worth $2bn over five years would help pay for this and other research. Low and middle-income countries should be subsidised to buy the tests.

There must be urgent action to stop the use of highly critical antibiotics in animals, which are the last line against infection in humans, said the report. Recently bugs resistant to Colistin, one of the antibiotics of last resort, were found in China, where the drug has been used in farm animals.



“In some parts of the world, probably in the largest emerging economies and almost definitely in the United States, the use of antibiotics in animals is greater than in humans and that means the misuse is probably higher too,” said O’Neill.

A change in consumer habits might help. O’Neill said: “An emerging generation is becoming more choosy about what they eat.” Products should be labelled so consumers could see where antibiotics have been used, he added.

O’Neill said too few people really understood the AMR problem and he wanted “a massive global public awareness campaign” which would cost between $40m and $100m a year. He estimates his entire package of proposals would cost $40bn over ten years. “This is tiny in comparison to the cost of inaction,” said the report. “It is also a very small fraction of what the G20 countries spend on healthcare today: about 0.05%.”

O’Neill, now a minister in the Treasury, is looking to the G20 meeting in China and a special session of the UN general assembly to take the proposals further.

The man he described as his boss, the chancellor, George Osborne, was one of those who applauded the report, saying that antimicrobial resistance “is not just a threat to health but also to the world economy. Apart from the moral case for action of the sort Lord O’Neill proposes, the economic cost of failing to act is too great to contemplate.”

Margaret Chan, director general of the World Health Organisation, called it “a thorough and compelling review” which tackled “the burning need to find incentives that can get new products into the pipeline”.