By Chistrofer Fjellner, Marisa Matias, Antoniya Parvanova, Marina Yannakoudakis - 7th April 2011
Seventy years after the introduction of antibiotics, the rise of bacterial resistance has become a major threat to global public health.
We now face the possibility of a future without effective antibiotics for several types of bacteria that cause life-threatening infection.
While infectious agents are becoming more and more resistant to the medicines that are currently in use, not enough drugs are being developed to combat them.
In the EU, drug-resistant bacteria cause about 400,000 infections a year and at least 25,000 deaths annually. Besides the tremendous impact on people, bacterial resistance to antibiotics also leads to healthcare costs and productivity losses of €1.5bn.
Antimicrobial resistance (AMR) is a naturally occurring phenomenon. Bacteria have always possessed the ability to protect themselves from naturally occurring antibiotics by acquiring resistance through the exchange of genetic material with other bacteria. However, the widespread use of antibiotics has further accelerated the development of antimicrobial resistance. As a result, even the most recently approved and most effective drugs will gradually decline in efficacy.
Antimicrobial resistance has become such a critical issue, that the World Health Organisation has made it the theme of this year's world health day on 7 April. The response of the EU builds on the Swedish presidency conclusions on innovative incentives for effective antibiotics in 2009 and several initiatives launched at European and member state level to raise awareness for increasing antimicrobial resistance, including the work of the European commission on the EU-US taskforce on antimicrobial resistance (Tatfar). Tatfar has put AMR prominently on the European agenda and the Commission will provide its recommendations in a report to be released at the EU-US Summit in 2011. Tatfar's goal is to ensure appropriate therapeutic use of antimicrobial drugs in the medical and veterinary communities, to prevent both healthcare, and community-associated drug-resistant infections, and develop strategies aimed at improving the pipeline of new antimicrobial drugs.
Stakeholders such as the office of health economics (OHE) and ReAct – an independent global network for concerted action on antibiotic resistance based within Uppsala university, Sweden – have also contributed key policy recommendations aimed at supporting the EU's response to the issue. Both the OHE and ReAct stress the importance of visualising the consequences of inaction in terms of public health and financial consequences. According to the OHE, financial support is necessary to enable market power and to stimulate R&D investment in antibiotics. At EU level this means member states need to reach consensus on the issue of growing costs of antimicrobial resistance and offset this against required financial support. The OHE advises to financially support drug research and the development of point of care diagnostics to ensure appropriate and effective usage of antibiotics.
Significantly, the European centre for disease prevention and control (ECDC) and the WHO regional office for Europe have made antimicrobial resistance a high priority for the European region and continue raise awareness of the threat, to support the development of relevant policies and to call for innovation in the development of new antibiotics.
The growth in antimicrobial resistance has been accompanied by a sharp decline in the development of new antibiotics due to scientific and financial challenges. To avoid the crisis of growing antimicrobial resistance, the challenges holding back the discovery of new antibiotics need to be overcome and cooperation between the public and private sector needs to be improved.
Financial incentives in the research and development phase are a way to stimulate development of new antibiotics. But we could also discuss whether research incentives could be accompanied with commercial incentives, as the return on investment on antibiotics can be sometimes relatively low compared to other drugs because they are taken for a short period of time and cure their target disease. Delinking the commercial incentives from volume of use could be further assessed as a potential option to reward the launch of an effective drug and bring the goals of policy makers and the industry closer together.
The global community needs to recognise existing market mechanisms do not work and that more incentives and ideas are needed to increase the pipeline of new antibiotics. The European parliament is committed to coordinating EU wide action to raise awareness of antimicrobial resistance and to foster and support innovation of new antibiotics.
This is one of the faces of this huge challenge we are facing in order to protect and to promote public health. We, thus, all consider that an entire and innovative strategy is needed to tackle this problem, including other dimensions beyond the development of new drugs as well. In that sense, the European parliament recognises its role in contributing to the solutions to this growing problem and will host a high-level roundtable discussion on world health day aimed at tackling antimicrobial resistance and ensuring effective and innovative strategies for future generations. The roundtable will be attended by MEPs, commission officials, WHO Europe, ECDC, the OHE and representatives from the pharmaceutical industry. This roundtable will also present an opportunity to emphasise that antimicrobial resistance poses a great threat to public health and to move forward in measuring the extent of the problem in the member states.