This article was originally published (in German) in Neue Zürcher Zeitung (NZZ) on November 14, 2019.
Antimicrobial resistance: A ticking time bomb
The more indiscriminate antibiotics are used in everyday medical practice, the higher the likelihood that they will lose their effect. Pathogenic bacteria are enormously adaptable. If we want to win the fight against them, investment in research must pay off again.
World Antibiotic Awareness Week (18-24 November) is designed to alert people all over the world to the inescapable fact that overuse of antibiotics speeds up the development of resistant strains of bacteria and renders the drugs less effective. Common bacterial infections are proving increasingly deadly, and are putting at risk the progress made by modern medicine.
Antimicrobial resistant (AMR) bacteria (so-called superbugs) have rapidly developed to the point that in Switzerland, there were an estimated 7000 cases in 2018 resulting in 300 deaths. According to estimations by the WHO, by 2050, superbugs could kill as many as 10 million people a year worldwide.
Enormously adaptable bacteria
Switzerland adopted a strategy to contain and combat AMR in 2015. In comparison with other countries, Switzerland ranks in the middle: On a per capita basis the number of infections via resistant bacteria is lower than in France but higher than in the Netherlands.
Curbing the irresponsible use of antibiotics is a vital part of this struggle, so that the antibiotics can be effective against superbugs for as long as possible. Because bacteria are highly adaptable and are constantly developing new resistances, it is also necessary to develop new antibiotics. The problem: antibiotic research is commercially unattractive, because new antibiotics should be kept on reserve to prevent new resistance and should thus only be used as a last resort.
Swiss researchers and companies are at the forefront of discovering breakthrough medicines. CARB-X, a global public-private partnership, is investing nearly CHF 10 million to help Basel-based biotech company BioVersys to develop a new drug to treat infections caused by virulent MRSA bacteria. Similarly, the Federal Council put up CHF 20m in 2015 to fund the national research program on AMR.
But investing in research is not enough. The bankruptcy of Achaogen, a Californian biotech company, illustrates this . It had developed a new antibiotic, having received significant push funding (nearly CHF 200 million). As the cost of manufacturing and commercialization could not be covered by the minuscule sales revenue, Achaogen ended up filing for bankruptcy.
Create market incentives
The example shows that subsidizing research alone will not solve the AMR problem. Coming together in Okayama, Japan, the health ministers of the G20 just called on the international community to examine whether new economic models can solve the problem. The idea is to address the current market failure in antibiotic research by not simply subsidizing research per se, but by creating market incentives for successful research. Similarly, a motion, recently submitted to the National Council, called on the Swiss Federal Council to seize the initiative for an international conference to discuss what incentives are needed to advance the research and development of new antibiotics.
On November 18 the Federal Council launches the national campaign “Antibiotics: use them properly, it’s important” to encourage the return of unused antibiotics. In Switzerland, the use of antibiotics has indeed fallen: in 2017 it was ten percent less in hospitals. Incidentally, one of the most effective measures for reducing the (inappropriate) use of antibiotics would be a significant improvement in the seasonal influenza vaccine coverage.
Thomas B. Cueni is Director-General of The International Federation of Pharmaceutical Manufacturers & Associations (IFPMA).
Read the original article (in German) here.