Well, the
UK’s O’Neill Commission released its final
report on tackling antibiotic resistance. This is a very detailed report
looking at all sides of the problem and trying to take a global perspective. I
won’t review it today – but you can read it yourselves. There is a nice review in The
Atlantic.
I want to
talk about the relationship between our public perceptions, priorities and
policies and provide a contrast between the US and the UK in that regard. The
UK, under Prime Minister David Cameron and Chief Medical Officer Dame Sally
Davies, has undertaken the battle against antibiotic resistance in a public and
committed way. News articles and press
releases are constant. The Review on Antibiotic Resistance (I call it the
O’Neill Commission) was undertaken under UK leadership. The UK has made
enormous strides in educating the public on the dangers of inappropriate
antibiotic use and the consequences of resistance. The UK has established
strong guidelines for the stewardship of antibiotics and has provided teeth to
help make sure physicians comply with these guidelines. They have also carried out extensive public
education campaigns to try and decrease patient demand for antibiotics for
inappropriate indications. These efforts have begun to bear fruit with a demonstrated
decrease in antibiotic prescribing. Combined with the general
strategy proposed by the AMR Review under O’Neill to incentivize the antibiotic
pipeline, the UK program show us all a way forward – at least in general terms.
How does the
US look compared to the UK? Does our Surgeon General call for antimicrobial
stewardship or incentives for antibiotic discovery or development? A look at his website shows no headliners for
antibiotics at all. A search for
articles on antibiotics on the website turns up older documents from previous
surgeon generals. Although there are one or two articles on the need to reduce
inappropriate antibiotic use, there is nothing like what can be found in the
UK.
What about
the presidential campaign in the US. I was unable to find anything meaningful from
any of the candidates on the problem of antibiotic resistance by searching on
Google. A search of the candidates’ websites shows nothing specific about
antibiotics. Hillary Clinton has posted
her thoughts on HIV-AIDS, but not on antibiotics and antibiotic
resistance. Neither Bernie nor Donald
have anything to say.
How about
the use of antibiotics in animals?
Europe including the UK have essentially banned
the use of antibiotics in animal feed for the purpose of growth promotion. The
UK is now considering other proscriptions such as against the use of certain
antibiotic prophylactic regimes for poultry and other animals as has been done
by certain other EU countries. In the US – we’re still working on gathering
data. Again our candidates are silent.
Has the US
really done nothing? No. President Obama has been more engaged in the
problem of antibiotic resistance than any other US President in history. A
number of important initiatives have been established under his watch. These
include a report from his Council of Advisors on Science and Technology and a subsequent
plan for implementing many of the suggestions from that report. There has even been an increase in funding for
NIH and BARDA to support these plans. Our regulatory agency has made great
strides in providing feasible pathways for the development of new antibiotics,
but they still lag behind Europe in that regard. The CDC website is replete with information, but we are just beginning to carry out surveillance for antibiotic use and we do not have the kind of teeth that UK and Europe do to alter prescribing habits. There has been nothing
like the attention given to antibiotic resistance in the UK and in Europe. There
is little discussion in the US of the kind of post-market incentives that will
be so important going forward.
I am
supposed to head to Amsterdam next week to attend a meeting of Drive-AB – the
EU-funded effort to actually find ways to implement the strategies being
promulgated by the O’Neill Commission. In thinking about this meeting, I am of
two minds. I am disappointed that the US
is not more of a leader in this area.
But I also agree with President Obama (and, help me, Donald Trump) that
Europe needs to do more to pull its own weight.
Historically,
the US has accounted for about 50% of the total pharmaceutical market. As of 2013, it still accounted for over
40%. That’s one country – 40% of the
world dollar volume in prescription drug sales.
If you look
at sales of new drugs, the US is responsible for 55% of sales. When translated into pharmaceutical company
profits, the US still dominates. Since
these sales are, to a certain extent, rolled back into research and
development, one could conclude that the US has been subsidizing global pharmaceutical
R&D for decades.
So I look
forward to incentives for antibiotic R&D coming, to a large extent, from
Europe!
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