TACKLING DRUG-RESISTANT INFECTIONS GLOBALLY FINAL REPORT AND RECOMMENDATIONS

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time focusing on this over the last two years. Given my own
background and the nature of the AMR challenge, it was obvious
that the G20 Leaders as well as their Finance Ministers would
need to play a central role, and we are pleased that the pieces
are in place for successful progress. It is a historic opportunity
for global governance that China is hosting the G20 in 2016
for the first time; it is in China’s power to lead the world in
tackling the AMR problem meaningfully and globally from
their presidency onwards.
Four interventions are going to be particularly important, out of
the 10-point plan for tackling AMR set out in our final report.
First, we need a global public awareness campaign to educate
all of us about the problem of drug resistance, and in particular
children and teenagers. I see this as an urgent priority and
urge international campaign developers, industry experts, and
non‐governmental organisations to consider how they could
help to support an urgent global campaign on AMR. I think this
is something that could, and should, begin this summer if we
are to really make progress on AMR, and it could be supported
at the UN General Assembly in September.
Secondly, we need to tackle the supply problem: we need new
drugs to replace the ones that are not working anymore because
of resistance. We have not seen a truly new class of antibiotics
for decades. It is in policymakers' hands to change this. We have
recommended that countries must review carefully how they buy
and price antibiotics, to reward innovative new drugs without
encouraging unnecessary use of new antibiotics. In addition to
this work at the national level, we need a group of countries
such as the G20 to get together and provide for a reward to
developers of new antibiotics after they are approved for use
by patients. These market entry rewards, of around one billion
USD each would be given to the developers of successful new
drugs, subject to certain conditions to ensure that the new drugs
are not ‘over-marketed’ and yet are available to patients who
need them wherever they live. It is great to see this idea already
being discussed by senior G20 officials. I hope this discussion
will translate into tangible action during their Heads of States’
meeting in September.
Thirdly, we need to use antibiotics more sparingly in humans
and animals, to reduce the unnecessary use that speeds up drug
resistance. To do this, we need a step change in the diagnostic
technology available. 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. When a test is used to
confirm the diagnosis it is often based on a slow technology that
hasn’t changed significantly since the 1860s. I can understand
why this is the situation: there aren’t enough good and rapid
tests to confirm the professional judgment of the doctor, and
the tests that are available are often more expensive than
prescribing the drugs ‘just in case’. Yet this is not acceptable:
we need to encourage more innovation and, importantly, must
ensure that useful products are used. I call on the governments
of the richest countries to mandate now that by 2020, all
antibiotic prescriptions will need to be informed by up-to-date
surveillance information and a rapid diagnostic test wherever
one exists. This will open the door to investment and innovation,
by showing clever developers that if they build rapid tests they
will find a market for them. Once the technology has improved,
markets in developing countries can be supported with a system
we have called a diagnostic market stimulus, not dissimilar to the
great work that Gavi, the Vaccine Alliance, has done to improve
global child vaccination.
“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.
”
Fourthly, we must reduce the extensive and unnecessary use of
antibiotics in agriculture. We first need to improve surveillance
in many parts of the world, so we know the extent of antibiotic
use in the agricultural sector. We have then proposed that
targets should be set by individual countries for antibiotic use
in agriculture, enabling governments to have the flexibility to
decide how they will reach lower levels of use. Alongside this we
need to make much faster progress on banning or restricting
the use in animals of antibiotics that are vital for human health.
I hope the United Nations meeting in September will take action
on each of these points and make progress with the World
Health Organization (WHO), Food and Agricultural Organization
of the United Nations (FAO), and the World Organisation for
Animal Health (OIE).
There are a number of ways to raise the funding required for
action from the public or the private sector: the amounts are