Big Pharma Should Tackle Antibiotics Emergency Together, says Report Author
Comments from the UK chief medical officer this week reveal her fears for the future state of the global health system as diseases have become resistant to existing drugs. A co-author of the report calls on Big Pharma to provide a united front in the next war on bacteria.
Over the last few decades, new infectious diseases are being discovered on almost an annual basis yet there have been no new antibiotics since 1987. Rather than run for the (ideally bacteria-free) hills, what can be done to combat this “ticking time bomb” and prevent the decline of the health system worldwide?
The real objective
As many as 5,000 patients die each year in the UK of gram negative sepsis (where bacterium gets into the bloodstream), according to Professor Dame Sally Davies’ annual report(Volume 2), and in half the cases the bacterium is resistant to drugs. But despite (or perhaps because of) the extensive media coverage this week, physicians, patients and the general public may not have interpreted the main objectives of her warning, says Dr. Edmund Ong, infectious disease specialist and consultant at The Royal Victoria Infirmary, Newcastle, and a significant contributor to the original Davies’ report. “Yes, there has been a growing amount of multiple drug resistance in both gram-positive and [more so] gram-negative species bacteria but [Dame Sally Davies] wants to emphasis these challenges only in light of what needs to be pursued.”
“This involves better stewardship and control around the distribution and dispensation of antibiotics. [Davies] also emphasises the importance of the development and deployment of repeat diagnostics for infection and resistance while trying to re-energise antibiotics development across the pharma industry.”
Davies’ call for action follows closely after the announcement of the EU’s €2 billion (£1.73 billion) Innovative Medicines Initiative (IMI) as part of its ‘new drugs for bad bugs’ programme. The IMI’s antimicrobial resistance research projects will combine the efforts of researchers at universities, institutes and small and medium sized enterprises throughout Europe with large pharmaceutical companies, including Bayer Pharma, AstraZeneca, Sanofi, Merck, Sanofi-Aventis and GlaxoSmithKline.
Ong applauds the development that is occurring in the EU – and elsewhere – but says that this is not enough to make the dramatic change required. “There are only five new antibiotics in the controlled drug pipeline which are in either Phase II or Phase III that could combat gram negative resistance bacteria. And none of these new drugs are of a new type or class of antibiotics,” he maintains, adding, “[I understand] it takes a lot of resources – particularly financial resources – for pharma companies to delve into the development of new antibiotics or new antiviral agents for that matter. But if we do not optimise therapy for individual patients, we are going to have a problem.”
These recent comments have obviously piqued the media interest – a helpful development as people must be made aware of the misuse and “abuse” of antibiotics worldwide. For example, in some regions in Africa and India, you can purchase intravenous antibiotics from a chemist without prescription and this is the kind of anchorage drug resistance requires. And, despite some sensational headlines and questionable scaremongering, it’s nonetheless crucial that the public has knowledge of this antibiotic resistance concern, and the fact that it’s not just a UK problem but very much a global issue.
Collaboration is key
The second part of Davies’ annual report focuses on antimicrobial resistance and infectious diseases, citing that the development of new antibiotics has waned over the last 30 years as “there are fewer economic incentives”’ to produce new antimicrobial agents than for other classes of drugs.
Defining antimicrobial resistance as an international problem now calls for global action and a partnership between the private sector, public institutions and academia in order to elicit an effective result. Ong agrees: “The plan for the future is to get much more international collaboration as antibiotics are essential to modern medicine and lifesaving.”
But the education of individual practitioners is also just as much a relevant focus, says Ong. “We want to inform physicians who prescribe antibiotics as they have a responsibility to their patients and have that public health obligation to prescribe optimally. Avoiding broad spectrum antibiotics, we want them to actually document in the clinical notes, giving some indication why they prescribed these antibiotics and encourage them to send appropriate specimens to the microbiology lab. In this way, antimicrobials susceptibilities can be used to either deescalate or substitute agents or switch from intravenous to oral therapy.”
Further to this, Ong – and Davies – wants physicians to be aware of antibiotic cost (are the resources available?), the types of agents selected as an antibiotic (beware of encouraging resistance in the body) and the way in which it is administered to the patient (single dose of antibiotics where possible). Naturally, the general public has a part to play in this too. Says Ong: “When a patient goes to see a GP with a viral infection, they should not expect an antibiotic to be prescribed. Not taking antibiotic treatment diligently when prescribed will also encourage resistance.”
Yet, ultimately collaboration between pharma is required, according to Ong, and he gives an example of how effective this type of union can be. As an expert in infectious diseases, Ong conducts many clinical trials and treats a lot of patients with HIV injection. “There is precedence set that there is a single fixed dose drug regiment to treat HIV. It consists of three drugs and those three drugs actually belong to two different competing pharma companies. These drugmakers know that for the benefit of the patient and to make sure that patient adherence is high (not letting the patient themselves given the opportunity to not take the medication), this partnership is crucial.”
Some of the recent EU projects that have been mentioned above involve collaboration between different pharma companies. So why doesn’t the entire pharma industry sit down together and combine all their research and development into one single output or tablet? asks Ong. “Big pharma companies should feel obliged to collaborate,” he says, “If these firms put their heads together they could actually help tackle this issue much more effectively.”