Improving access to antibiotics through innovation

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Antimicrobial resistance is a growing health crisis and tackling it requires a multi-pronged approach

Antimicrobial resistance is a growing health crisis and tackling it requires a multi-pronged approach

In his Nobel lecture, Sir Alexander Fleming, who received the prize for the discovery of penicillin, issued a profound warning. “The time may come when penicillin can be bought by anyone in stores,” he said. “Then there is the danger that the ignorant man could easily underdose himself and, by exposing his microbes to non-lethal amounts of the drug, make them resistant.” A century after his prophecy, the time has come.

Our careless use of antibiotics, including penicillin, has given rise to bacteria, viruses, fungi and parasites that have become resistant to commonly used antimicrobials. What is more concerning is that these microbes are evolving faster than we can invent drugs to fight them. Our supply of antimicrobials is running low as more drug-resistant “superbugs” evolve and take over the world.

Antimicrobial resistance (AMR) is a growing health crisis, and fighting it requires a multi-pronged approach. We need newer and more effective antimicrobial drugs, better access to life-saving antimicrobials around the world; better diagnostics to identify drug-resistant infections and treat them with effective drugs, and robust surveillance systems to monitor the spread of drug-resistant infections.

While the discovery of new antimicrobial drugs through pharmaceutical research and development is expensive, time-consuming and often out of reach for many low- and middle-income countries, India can rely on collaborations and innovations to develop breakthrough strategies in tackling the antimicrobial resistance crisis. and catch up with evolving superbugs.

Magnitude of the RAM crisis

In 2019 alone, drug-resistant superbugs killed an estimated 1.27 million people worldwide – a toll more than HIV/AIDS or malaria – and according to United Nations (UN) estimates, that number could reach 10 million by 2050.

In India, the world’s largest consumer of antimicrobials, antimicrobial resistance is gaining ground and the use of antibiotics of last resort like cephalosporins is skyrocketing. The country is expected to have 1.6 million multidrug-resistant infectious cases in 2040, which is significantly higher than any country. The warnings are stark, but our current approaches to controlling the spread of superbugs seem inadequate.

Diagnostic innovations

One way to prevent reckless overuse of antimicrobials is to diagnose what is causing an infection early, which helps determine the right drug treatment. In India, many doctors prescribe antibiotics to treat infections likely caused by viruses. Rapid diagnostics, which can help identify the exact microbe and the drug it is susceptible to, can prevent antibiotic overuse at the point of care.

The COVID-19 pandemic has demonstrated how quickly rapid diagnostic tests can be developed and made available to people. Similarly, the diagnosis of antimicrobial resistance requires research on the identification of appropriate biomarkers to detect multidrug-resistant pathogens and the development of accurate and affordable detection tools. Agencies like ICMR, BIRAC could fund such development.

Discovery of antibiotics

As the consumption of antibiotics like cephalosporins, quinolones and macrolides has risen sharply in low- and middle-income countries, the pipeline of new antibiotics is running dry. Lack of funding in pharmaceutical research, clinical trial and supply chain challenges, and regulatory hurdles have slowed the development of new antibiotics.

Developing new antibiotics is expensive and it takes a few years for new drugs to become available in low- and middle-income countries. India needs to boost the internal development of new antibiotics by leveraging public-private partnerships between pharmaceutical companies and government research labs, as it has done with Covaxin.

Government agencies such as ICMR and CSIR, as well as DBT, DST could work with international partners such as the Global Antibiotic Research Development Partnership (GARDP), Wellcome Trust and others to pursue the antibacterial research, developing world-class clinical trial infrastructure to accelerate drug development.

In India, where 80% of urban healthcare providers are private, hospitals lack the resources to procure expensive antibiotics. Innovative pricing models, bulk purchasing of these antibiotics, and guaranteed purchase commitments from hospitals could not only reduce costs, but also build confidence in pharmaceutical companies that have invested in antibiotic research. Rolling out Universal Health Coverage in India could improve access to antibiotics for more than 100 million families by reducing out-of-pocket expenses for individuals while facilitating government purchases with bulk orders.

AMR is an emerging pandemic, and India is the AMR capital of the world – a distinction that calls for prompt action from policy makers and the scientific community. With India’s proven prowess in pharmaceutical knowledge, experience and infrastructure, as evidenced by the COVID-19 pandemic with vaccine development and deployment, the country has an opportunity to combat resistance. to antimicrobials and show the way for other low- and middle-income countries.

In this sense, fostering innovation and international partnerships is essential. With millions of lives at stake with the future RAM pandemic, the country must act now.

(YK Gupta is Senior Advisor for India Strategy Development, Global Antibiotics Research and Development Partnership (GARDP). Subasree Srinivasan is Medical Director, Global Antibiotics Research and Development Partnership (GARDP), Geneva.)

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