U.N. High-Level Meeting on AMR: Market-shaping tools like PASTEUR Act needed, leaders say
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Innovative financing mechanisms that spur the development of new antimicrobials are needed to achieve the goals adopted by world leaders at the Sept. 26 United Nations High-Level Meeting on antimicrobial resistance, including reducing drug resistance-related deaths by 10% by 2030, global health leaders said at a related event on the sidelines of the U.N. meeting.
Passing the PASTEUR Act, in particular, “is the single most important thing our government can do this year to transform antibiotic research and development and help meet the global goal of reducing AMR deaths by 10%,” IDSA President-Elect Tina Tan, MD, FIDSA, FPIDS, FAAP, said at the event, which was cohosted by One Health Trust, IDSA and other partners on Sept. 22. (Watch the event recording.)
While investments in U.S. programs like the Biomedical Advanced Research and Development Authority are critical for innovation, Dr. Tan said, “companies that have successfully brought new antibiotics to market with the help of BARDA continue to face bankruptcy because the antibiotic market is really fundamentally broken.”
“When you think about the way that businesses work, normally the more you sell and the more that is used, the more money they make — but for antibiotics, it doesn’t work that way,” Dr. Tan said, noting that antibiotics must be used judiciously to prevent the development of drug resistance and ensure their efficacy for as long as possible.
“We take antibiotics for how long? Seven days, 14 days,” Prime Minister Mia Mottley of Barbados said. “Pharmaceutical companies make their money from drugs that people take for years, and therefore the disparity between the economics of antibiotics and economics of normal pharmaceuticals is something that is going to continue to challenge us,” she said.
Addressing market failures
The PASTEUR Act would spur antimicrobial development by establishing a subscription program where the federal government would enter into contracts with antibiotic and antifungal developers for critically needed, novel products, with payments delinked from sales volume to provide a predictable return on investments.
Market-shaping mechanisms like these are critical for addressing failures in the market to address a global challenge like antimicrobial resistance, which is “critical to the economic stability of the world yet doesn’t have return on investment,” Mottley said.
“We had 20 companies doing research on antibiotics in the year 2000, and we have four now,” Mottley said. “If we fund a mechanism where pharma is getting research done and making money, we ensure they won’t make decisions based on their returns.”
Greater investments are urgently needed to strengthen existing efforts to prevent the development and spread of antimicrobial resistance, experts said, including accelerating the development new vaccines and ensuring universal access to pediatric immunization, improved infection prevention and control, and uptake of high-quality water, sanitation and hygiene practices in health care facilities, experts said at the event.
Importance of immunization highlighted
Of the 108 national action plans to address antimicrobial resistance that exist globally today, only 18 mention immunization as a tool to tackle the problem, according to Dr. Sania Nishtar, CEO of GAVI, the Vaccine Alliance. “Clearly, there is a policy disconnect in recognizing that immunization plays a very important role in tackling antimicrobial resistance” by reducing the prevalence of infections that require antimicrobial use in the first place, Dr. Nishtar said.
Scaling up immunization in conflict zones is of particular importance, especially in the Sudan and Gaza, where millions of people have now been displaced due to conflict, said Dr. Hanan Balkhy, the World Health Organization’s regional director for the Eastern Mediterranean region and former assistant director-general for antimicrobial resistance at WHO.
Displaced populations, destroyed health care infrastructure and inadequate sanitation — resulting in open, running sewage in parts of Gaza — are all contributing to rising rates of antimicrobial resistance, Dr. Balkhy said.
While antimicrobial resistance monitoring in the region is challenging as it requires sophisticated diagnostics and laboratory systems in place where health care infrastructure has been destroyed, WHO has seen that among people who have left Gaza, over 80% already carry multidrug resistance, Dr. Balkhy said.
Several cases of polio have been reported in Gaza — the first cases of wild polio to emerge in 25 years — due to disruptions in immunization efforts, highlighting that conflicts in the Eastern Mediterranean region can potentially impact global efforts to address antimicrobial resistance, Dr. Balkhy said.
“There needs to be an understanding that this is one global community, and what’s happening in the Eastern Mediterranean region will affect the rest of the globe, as bugs know no borders.”
What You Can Do: Contact your U.S. Senate and House members today and ask them to pass the PASTEUR Act this year.
Photo: IDSA President-Elect Tina Tan, MD, FIDSA, FPIDS, FAAP (third from left), emphasized the importance of innovative financing mechanisms like the PASTEUR Act to spur the development of new antimicrobials. She spoke at a Sept. 22 event in New York City cohosted by One Health Trust, IDSA and other partners on the sidelines of the U.N. High-Level Meeting on AMR.
