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Guarantee drug companies a profit to develop new antibiotics, U.K. report says
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Long-awaited report outlines how to fight antimicrobial resistance—and how to pay for it

Food producers should label meat to reflect the quantity of antibiotics used in producing it. Pharmaceutical companies should receive a $1 billion windfall for developing a drug effective against particularly dangerous resistant pathogens. And a massive global campaign should be launched to make the world more aware of the dangers of antimicrobial resistance (AMR). These are just three conclusions from a widely anticipated report on how to tackle the spread of antimicrobial resistance, which was published today. Commissioned in 2014 by U.K. Prime Minister David Cameron and the Wellcome Trust, the report was led by economist Jim O’Neill, currently the commercial secretary to the treasury in the United Kingdom.

Using antimicrobial drugs (not just antibiotics but also drugs against fungal, viral, or parasitic infections) invariably leads to the spread of pathogens that can tolerate them, and the problem is reaching crisis proportions, health experts widely agree. More and more pathogens are becoming resistant even to drugs seen as the last line of defense. Already, an estimated 700,000 people die every year from drug-resistant infections. (It’s important to note, however, that this estimate includes many who would have died even if their infection had been susceptible.) By 2050, drug-resistant infections could kill more people than cancer, according to the new report.

Although the O’Neill report is not the first such warning, it is noteworthy because it comes at the request of the U.K. government and proposes specific solutions. What’s more, the issue has caught the attention of world leaders, who discussed it at recent summits and will return to it at the United Nations General Assembly later this year. “The main reason this may be impactful in ways different from earlier reports is Jim’s background and credibility in financial and government sectors,“ says Ramanan Laxminarayan, who directs the Center for Disease Dynamics, Economics & Policy in Washington, D.C., and New Delhi. “I hope this report by ‘one of their own’ helps bring attention to the fact that this is not an esoteric medical problem … but rather a global ecological problem that affects us all.”

The report’s authors contend the economic case for tackling AMR is strong. In addition to its health toll, by 2050 AMR could cost the world $100 trillion in lost economic output, they argue. By contrast, acting on the recommendations in the report, such as supporting the development of new antibiotics and diagnostics and strengthening surveillance, could cost as little as $3 billion to $4 billion a year, about 0.05% of what the G20 countries spend on health care today.

The experts call for a two-tiered approach: Lower the use of available antimicrobials and increase the supply by stimulating the development of new ones. For instance, improved hygiene, faster and better diagnostics, and new vaccines could reduce unnecessary use of antibiotics. The authors also advocate a worldwide campaign to educate people about the dangers of resistance to keep patients from demanding antimicrobial drugs and doctors from prescribing them—an idea Laxminarayan endorses.

The report urges that some critical antibiotics not be used in agriculture at all, where the drugs are commonly given to livestock to treat infections or boost growth. Certifying meat as raised with “responsible use” of antibiotics could allow consumers to drive down their use. Nicholas White, a malaria researcher at Mahidol University in Bangkok, says he expects pushback from the agricultural sector. To counter that, he says there is a critical need to “support trials of alternative approaches in the agro industry.”

The report also offers concrete suggestions on how to boost the development of drugs effective against resistant infections. Many pharmaceutical companies have abandoned antimicrobial drug development because it is not very lucrative. Global sales of patented antibiotics are roughly $4.7 billion a year—about as much as a single top-selling cancer drug, the authors note. A Global Innovation Fund endowed with up to $2 billion is needed to fund early-stage research; a bonus of $1 billion for a company that develops a new drug that is effective against resistant infections could also help. The money could be raised as a levy from these companies through a “pay-or-play” strategy, in which companies can either pay up or invest it in research and development to fight AMR.

Laxminarayan says he is “curious” about the pay-or-play idea. “On the face of it, it is interesting but leaves a lot to be determined in how AMR-relevant research is defined,” he says. White adds that in low-income countries, many people, particularly children, still die because they do not get much-needed antibiotics; he calls for redirecting some of the money to be spent fighting resistance toward delivering antibiotics to these neglected patients.

Andrew Read, an evolutionary biologist based at Pennsylvania State University, University Park, who studies resistance, says the report is “a call to action, and we sure need that.” But although curbing the use of unnecessary antibiotics is important, he thinks the bigger challenge is learning to use the drugs when needed in a way that doesn’t select for resistant strains. “If evolutionary considerations became an essential component of medical best practice, we'd get immense gains—even bigger than those that will come from rapid diagnostics and less agricultural use.”