Weak systems and lack of investment in new antibiotics are major threats to global health

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Health systems must work with people, communities and patients to address the response to COVID-19 and other health risks

Russia’s war in Ukraine is draining resources to build better healthcare systems, while Sino-American rivalry is undermining the global solidarity needed to deal with future pandemics.

But massive underinvestment in new antibiotics to fight drug-resistant “superbugs” and weak primary health care systems could be the greatest enemies of global health.

So said world health leaders discussing how to attract better investment in health at an event organized by the European Investment Bank (EIB) and the World Health Organization. Health (WHO) on Monday.

One of the biggest investments needed is research and development (R&D) of new antibiotics in the face of growing drug resistance – yet this area attracts less than 5% of venture capital investment in pharmaceutical R&D.

One of the main reasons for this is the “high risk of failure”, according to Barbara Kerstiens, head of the Disease Control Unit at the European Commission’s Directorate-General for Research and Innovation.

Barbara Kerstiens, Head of the Disease Control Unit at the European Commission’s Directorate-General for Research and Innovation.

“Under the Innovative Medicines Initiative, we’re funding a huge program to support the development of new antibiotics, and after 10 years or more, there’s still nothing on the horizon, so it’s just high risk,” Kerstiens said.

The European Commission was working with the EIB to provide “incentives to stimulate the development of these new antimicrobials”, she added.

John Reeder, director of TDR, the Special Program for Research and Training in Tropical Diseases and director of the Department of Health Research at the World Health Organization (WHO), also favored special incentives to develop new antibiotics.

“We see that this [field] doesn’t really fit into Big Pharma’s current model for doing this, because it’s a very long time before you make a profit against fairly high investments,” Reeder said.

“We really need to think about alternative models and one of the things that has really impressed me over the past decade has been the rise of product development partnerships, which have focused on diseases that don’t have no market – many of the neglected tropical diseases – while being able to form partnerships that drive the production of new therapies,” he said.

He gave the example of how a medicine for sleeping sickness had received approval from the United States Food and Drug Administration (FDA) in 2021 after being developed through such product development partnerships.

Drugs, Fexinidazole, was developed through an innovative partnership between the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDI) and the pharmaceutical company Sanofi.

“We need to think about the model and how we engage the pharmaceutical industry, but not just rely on them,” Reeder said.

He also stressed the immediate need to ensure that countries introduce “better management” of antibiotic use to slow the development of drug resistance.

“It’s usually the high-income countries that use antibiotics more intensively and use the newer antibiotics at much higher volumes that now face these big problems,” Reeder said.

“Like most biological organisms, [pathogens] are really quite smart and quite complex and they’ve been pushed into an evolutionary state of dodging around the tools that we have in front of us,” Reeder said.

Jeremy Farrar, Wellcome Trust

“Without antibiotics you can’t perform surgeries safely, you can’t give birth safely. You cannot prevent infections in people who need intensive care or who die after trauma or surgery. So we’re talking about the whole of modern medicine here, and yet, as a world, we’re not ready to invest,” said Jeremy Farrar, director of the Wellcome Trust.

“We must not underestimate the long-term nature of research and innovation, and we must understand that the private sector has a crucial role to play. But if we want vaccines, therapies, tests for which there is no commercial model, or even antibiotics to treat new infections, then we must understand that the public sector and philanthropy must be ready to invest and to pay for those products for which, at the moment, he may not be a commercial driver.

Farrar added that the world has not valued antibiotics or vaccines enough.

“We looked at antibiotics as something as cheap as chips. Like Smarties, you can buy them at very low prices in many parts of the world. We haven’t dealt with them as well as we could and should have, which means drug resistance will come sooner.

“If we lose this class of drugs, or if TB becomes more resistant or malaria becomes more resistant, then we will have a growing pandemic of these diseases that we really should be able to fight.”

Farrar also favors “a different model between the public and private sectors, with companies being incentivized to develop these essential medicines for the future, which would also ensure that they are more accessible to all regions of the world”.

Dr. Tedros

Primary health as a foundation

WHO Director General Dr Tedos Adhanom Ghebreyusus has called for investment in primary healthcare, commending the EIB for its €500 million commitment to primary healthcare in sub-Saharan countries.

“When health is protected and promoted, individuals, families, communities, economies and nations can thrive. The best way to achieve this is to invest in health systems and reorient them towards primary health care as the foundation of universal health coverage,” Tedros said.

“Over 90% of essential services can be provided through primary health care, including many services to promote health and prevent disease and avoid or delay the need for more expensive secondary and tertiary care.

Meanwhile, EIB Vice-President Thomas Östros warned that “long-term investments in health and life sciences could be further suspended due to the current geopolitical situation”.

“National budgets are being strained by the food and energy price shocks triggered by the Russian invasion of Ukraine,” Östros said. “Fiscal pressures are increasing, but long-term health care challenges remain. What is clear is that we need to prioritize investments in healthcare before the next crisis hits.

Former New Zealand Prime Minister Helen Clark, co-chair of the Independent Pandemic Preparedness and Response Group, said “building more resilient national health systems that can adapt quickly to cope with crises while maintaining all services” was essential for pandemic-proof countries.

“The World Bank’s new pandemic fund, in coordination with the WHO, requires a minimum of $10.5 billion each year, primarily to invest in safeguards in low- and middle-income countries. But so far that fund has commitments totaling just over a tenth of that amount. It is not sustainable funding.

[Correction: An earlier version of the story attributed various quotes made by Dr John Reeder to the European Commission’s Dr John Ryan.]

Picture credits: Flickr: Rumi Consultancy/World Bank.

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