ANTIMICROBIAL R&D IS NOT ATTRACTIVE TO VENTURE CAPITALISTS 13 Less than 5% of venture capital investment in pharmaceutical R&D between 2003 and 2013 was for antimicrobial development. Total venture capital investment $38bn Antimicrobial venture capital investment $1.8bn Source: Renwick MJ, Simpkin V, Mossialos E, International and European Initiatives Targeting Innovation in Antibiotic Drug Discovery and Development, The Need for a One Health – One Europe – One World Framework, Report for the 2016 Dutch Presidency of the European Union.
14 AMR-related research between 2009 and 2014, compared to 18.6 percent (more than five billion USD annually) to cancer research13. This trend has begun to turn in some areas, with the US Government and initiatives such as the Europeanbased Joint Programming Initiative on AMR (JPIAMR) helping to channel more public funding into AMR research. Two key programmes specifically supporting antibiotic development, the US Biomedical Advanced Research & Development Agency (BARDA) Broad Spectrum Antimicrobials programme, and the European Innovative Medicines Initiative (IMI) New Drugs For Bad Bugs (ND4BB) programme, together provide direct financial support to nearly 20 percent of all antibiotics currently under development globally, and half of those targeting Gram-negative bacteria14. Nonetheless, there remains much more to do to close the profound gap with funding for R&D in non-communicable diseases – something we will address in the next chapter. Finally, this lack of investment and interest by companies and governments has in turn contributed to a decline in the attractiveness and prestige of the field. Academic careers do not reward the skills required for antibiotic discovery, where advancement and prestige is driven by publishing in journals seen as focused on ‘cutting-edge science’ – not something often associated with microbiology15. There is no excuse for not taking action now There is no excuse for inaction given what we know about the impact of rising drug resistance. The reality is that governments will sooner or later bear the cost of AMR: they can either do so proactively by taking action now and pay less for better outcomes, or remain unprepared and end up spending much more taxpayer money on far worse outcomes further down the line. Governments always have to make very difficult financial allocation choices. Understandably, they often find it easier to react to visible and immediate threats rather than longer term and less visible problems even if the latter are very large, such as AMR. epidemic globally and domestically; while the UK spent 1.9 billion USD tackling the 2009 swine flu outbreak. These crises were of course impossible to predict and required a quick response with large sums of money, from a position of relative weakness – but the vast sums involved illustrate the almost uncontainable cost of responding to a major health crisis once it reaches an acute phase. In contrast, the unfolding global threat of rising drug resistance is essentially predictable, and the costs that we present here for mounting an effective pre-emptive response to it are substantially lower than the expense of responding once it becomes a true public health emergency. This principle of investing prudently to pre-empt future health challenges is well-established. A seminal World Bank report in 199316 demonstrated the enormous returns on investing in improved health, with more recent studies underlining how relatively low-cost investments in global health security can yield substantial dividends. For instance, the recent Commission on a Global Health Risk Framework for the Future estimated that global investment of 4.5 billion USD a year would mitigate the risk of pandemic disease threats that could cost the world 60 billion USD annually17. The most critical lesson that the global community can learn from this, and from the real experience of responding to Ebola and other health crises like it, is that the most powerful and cost-effective response is to anticipate the future threat and to act upon the conditions allowing it to unfold. reality is that governments will sooner or “The later bear the cost of AMR: they can either do so proactively by taking action now and pay less for better outcomes, or remain unprepared and end up spending much more taxpayer money on far worse outcomes further down the line. ” When threats such as SARS, Swine Flu and Ebola arise, governments spend vast sums, often in haste and with vision clouded by the imperative to respond to an acute global health crisis. For instance, the US Government appropriated 5.4 billion USD in a single year to underwrite its response to the Ebola 13 Review on AMR, Tackling a global health crisis: initial steps, 2015. 14 Eichberg MJ, Public funding of clinical-stage antibiotic development in the United States and European Union. Health Security 2015, 13, 3, 156-165. 15 Zorzet A, Overcoming scientific and structural bottlenecks in antibacterial discovery and development, Uppsala Journal of Medical Sciences, 2014, 199, 170‐5. 16 World Bank, World Development Report 1993: Investing in Health, 1993, New York: Oxford University Press 17 Commission on a Global Health Risk Framework for the Future, The Neglected Dimension of Global Health Security: a Framework to Counter Infectious Disease Crises, 2016.
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