Among the world’s big pharmaceutical companies, GlaxoSmithKline (GSK) is doing the most to combat the global antimicrobial resistance (AMR) crisis, followed by Johnson & Johnson, according to a new ranking of industry efforts revealed today at the World Economic Forum in Davos, Switzerland. A separate ranking of manufacturers of generic antibiotics has Mylan, Cipla, and Fresenius Kabi Global in the lead, while U.S.-based Entasis Therapeutics tops a chart for biotech companies.
The "Antimicrobial Resistance Benchmark" was produced by the Access to Medicine Foundation in Amsterdam, which has also ranked companies' efforts to ensure that their products reach people in developing countries since 2008.
AMR causes an estimated 700,000 deaths annually, a number expected to rise sharply in the coming decades. New antibiotics are desperately needed, but the industry has little incentive to invest in their development because antibiotics don't bring in the revenues that drugs for cancer or cardiovascular disease do.
Still, industry has pledged to help: About 100 companies and 15 industry associations have signed the "Davos Declaration," presented at the 2016 World Economic Forum, in which they promised to "reduce the development of antimicrobial resistance, invest in research and development of new treatments and diagnostics, and improve access to current and new antibiotics."
To gauge their commitment, researchers at the Access to Medicine Foundation asked companies for detailed information about their research and development programs, manufacturing processes, efforts to make drugs available to populations who need them most, and "stewardship," which includes prevention of misuse and overuse. Among their questions: Does the company have a policy to curb the release of wastewater containing antibiotics into the environment? Is it helping collect and share data on antibiotic resistance? Does it educate doctors on the appropriate use of antibiotics?
GSK and Johnson & Johnson both did well because of their efforts to serve the neediest people and to educate physicians. Both also invest considerably in research; GSK has 55 products in the pipeline, more than any other company. (Among them are 13 vaccine candidates, which were counted because they can help reduce the use of antibiotics.) Johnson & Johnson has a major program for tuberculosis drugs. GSK, Pfizer, and Shionogi also scored points because they don’t pay sales agents bonuses if they sell more antibiotics; Novartis has reduced such bonuses.
There is quite a distance to go to keep up with what the companies have promised in Davos 2 years ago.
The report put generic medicine and biotech companies in separate categories with different criteria because most generics companies don't invest in novel antibiotics, and most biotechs don't bring their own products to the market. In the generics sector, Mylan, Cipla, and Fresenuis Kabi ended up on top because they put much effort into ensuring appropriate use; Mylan also has lower prices for developing countries and has an environmental risk management strategy. But on the whole, the generics companies provided little information and had low scores on both access and stewardship. “These companies seem to care too little how their antibiotics are used, which is crucial since they are producing large quantities,” says Jayasree Iyer, executive director of the Access to Medicine Foundation.
A total of 28 novel antimicrobials are in phase II or phase III clinical trials, according to the report; that sounds impressive, says Iyer, “but is not enough." Plans to ensure widespread access and avoid unnecessary use are in place for only two of the drugs, she says.
The foundation acknowledges that its index provides a limited and selective impression of what the industry is doing to battle AMR. The researchers only asked companies already active in the field, and of the 30 they selected, only 21 filled out their questionnaire; the remaining nine were assessed based on public data. Although it is “a good exercise,” one shouldn’t put too much stock in the list, says Ramanan Laxminarayan, who heads the Center for Disease Dynamics, Economics & Policy in Washington, D.C. Still, the report shows that “there is quite a distance to go to keep up with what the companies have promised in Davos 2 years ago,” Laxminarayan says; the benchmark could help keep companies accountable if they don’t live up to their promises.
A separate report released on 18 January by the AMR Industry Alliance, a coalition of over 100 companies and trade associations, says that industry invested at least $2 billion in research and development for AMR-related products in 2016, but calls on governments and philanthropic organizations to help make such investments more attractive.
The Access to Medicine Foundation hopes that its benchmark will encourage companies to remain active—or even rejoin—the market for antibiotics. One promising example is Roche, which had all but abandoned the field but began investing anew in the wake of the Davos Declaration, Iyer says. It ended in eighth and last place of the big pharma index, but could find itself in a better position when the second edition of the benchmark is released in 2020, she says.
Correction, 24 January 2018, 5:35 p.m.: A previous version of this story attributed a report released on 18 January to the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). The report was produced by the AMR Industry Alliance, of which IFPMA is a member.