A report released Thursday by the Review on Antimicrobial Resistance, commissioned by the UK government and led by Jim O'Neill, called for the development of a "pay-or-play" system to spur antibiotic development by drugmakers. Under the proposal, any drugmaker that does not engage in antimicrobial research would be fined a surcharge of 0.25 percent of annual sales into a pooled fund to support market rewards for other companies that successfully develop treatments. The report also calls for a lump sum payment of as much as $1.3 billion for the successful development of a new antibiotic.
The report estimated that $40 billion in funding is needed over the next decade to stimulate action against antimicrobial resistance, including $16 billion to revamp the antibiotics and tuberculosis R&D pipeline. "We think there's a strong case for the pharmaceutical industry itself to collectively pay given how important antibiotics are for the companies themselves," remarked O'Neill. However, the economist cautioned that additional deliberation is needed on how to make the system "practical, fair and effective."
The report, which forecast that drug-resistant infections could cause as many as 10 million deaths by 2050, additionally urged measures to reduce the use of antibiotics. O'Neill specifically urged the G20 and United Nations to set targets for reducing antibiotic use in agriculture by 2018. The report also suggested that developed countries should be required by 2020 to perform diagnostic tests before antibiotics are prescribed.
"There is no excuse for inaction given what we know about the impact of rising drug resistance,” the report stated. In noting that governments will pay the cost "sooner or later," the report states "[countries] can either do so proactively by taking action now and pay less for better outcomes, or remain unprepared and end up spending much more taxpayer money on far worse outcomes further down the line."
In 2014, UK Prime Minister David Cameron commissioned the independent review to stimulate the discovery and development of novel antibiotics. In a report published last year, the review recommended the creation of a global innovation fund and other measures to spur antibiotic development.
The pharmaceutical industry questioned the recommendation that drugmakers bear the cost for battling antibiotic resistance. "The suggestions that pharmaceutical companies should shoulder the financial burden for global [anti-microbial resistance] -- and must therefore 'pay or play' -- fails to recognise the need for a collaborative response," said Virginia Acha, director of research at the Association of the British Pharmaceutical Industry, adding "putting the onus on any one group will not solve the problem." In January this year, 85 companies asked governments and industry to collaborate to combat the threat of drug-resistant infections.
Meanwhile, Ed Schoonveld of ZS Associates noted that although a bonus would stimulate antibiotic development, such incentives may prove to be "horribly inefficient." Schoonveld commented "it may motivate the wrong parties to get creative to make sure they don't have to pay the tax," adding "you need a carrot rather than a stick."
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