Weak Systems And Lack Of Investment In New Antibiotics Are Key Global Health Threats

Health systems must work together with populations, communities, and patients in addressing the COVID-19 response and other health risks

Russia’s war in Ukraine is draining resources to build better health systems, while Sino-American rivalry is undermining the global solidarity needed to address future pandemics.

But the massive under-investment in new antibiotics to combat drug-resistant “superbugs” and weak primary health systems might be the biggest enemies of global health.

This was according to global health leaders who were discussing how to attract better investment in health at an event organized by European Investment Bank (EIB) and the World Health Organization (WHO) on Monday.

One of the biggest investments needed is in research and development (R&D) for new antibiotic drugs in the face of rising drug resistance – but this field attracts less than 5% of venture capital investment in pharmaceutical R&D.

A key reason for this is the “high risk of failure”, according to Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission.

Barbara Kerstiens, head of the Combatting Diseases unit in the Directorate-General for Research and Innovation at the European Commission.

“Under the innovative medicines initiative, we’ve been funding a large program to support the development of new antibiotics, and after 10 or more years, still, there’s nothing on the horizon so it’s just high risk,” said Kerstiens.

The European Commission was working with the EIB to provide “push and pull incentives to stimulate the development of these new antimicrobials”, she added.

John Ryan, the acting Deputy Director-General of the Health and Food Safety Directorate at the European Commission, supported innovative financing to develop new antibiotics.

“We see that this [field] isn’t really fitting with the current model of Big Pharma to do this, as there is a very long time before realizing profits against quite high investment,” said Ryan.

“We really need to be thinking of alternative models and one of the things that I’ve been very impressed with over the last decade has been the rise of product development partnerships, which have been focusing on diseases which have no market – many of the neglected tropical diseases– and yet being able to form partnerships which drive production of new therapeutics,” he said.

He gave the example of how a drug for sleeping sickness had received approval from the US Food and Drug Administration (FDA) in 2021 after being developed through such product development partnerships.

the drug Fexinidazole, was developed as part of an innovative partnership between the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi) and drug company Sanofi.

“We need to think about the model and how we involve pharma but not just rely on them,” said Ryan.

He also stressed the immediate need to ensure that countries introduce “better stewardship’ about the use of antibiotics to slow down the development of drug resistance.

“It tends to be the higher income countries that have been using more intensively antibiotics and using the more recent antibiotics at much higher volumes that are now facing these big problems,” said Ryan.

“Like most biological organisms, [pathogens] are really quite clever and quite complex and they’ve been pushed towards an evolutionary state of dodging around the tools we have in front of us,” said Ryan.

Jeremy Farrar, Wellcome Trust

“Without antibiotics, you can’t conduct safe surgery, you can’t have safe childbirth. You can’t prevent infections in people needing intensive care, or dying after trauma or after surgery. So we’re talking about the whole of modern medicine here, and yet, as a world, we’re not prepared to invest,” said Jeremy Farrar, Director of the Wellcome Trust.

“We must not underestimate the long-term nature of research and innovation, and we need to appreciate that the private sector has got a crucial role to play. But if we want vaccines, therapeutics, tests for which there’s no commercial model, or indeed antibiotics to treat new infections, then we’ve got to appreciate that the public sector and philanthropy, have got to be willing to invest and pay for those products for which at the moment that may be no commercial driver.”

Farrar added that the world has not valued antibiotics or vaccines highly enough.

“We’ve regarded antibiotics as something that is as cheap as chips. Like Smarties, you can buy them very cheaply in many parts of the world. We haven’t looked after them as well as we could and should have done, which means drug resistance is going to come sooner.

“If we lose this class of drugs, or tuberculosis becomes more resistant or indeed malaria becomes more resistant, then we will have a growing pandemics of these diseases which we really should be able to combat.”

Farrar also favors “a different model between the public and the private sector”, with companies being incentivized to develop these essential drugs for the future and this would also ensure that they were more accessible to all parts of the world”.

Dr Tedros

Primary health as the foundation

WHO Director-General Dr Tedos Adhanom Ghebreyusus appealed for investment in primary healthcare, praising the EIB for its commitment of €500 million to support primary health care in sub-Saharan countries.

“When health is protected and promoted individuals, families, communities, economies and nations can thrive. The best way to do this is to invest in and reorient health systems towards primary health care as the foundation of universal health coverage,” said Tedros.

“More than 90% of essential services can be delivered through primary health care, including many services to promote health and prevent disease and avoid or delay the need for more costly secondary and tertiary care.”

Meanwhile, Thomas Östros, EIB vice president, warned that “long-term investment in health and life sciences may be further put on hold because of the current geopolitical situation”.

“National budgets are being stretched by food and energy price shocks triggered by the Russian invasion of Ukraine,” said Östros. “Fiscal pressures are increasing, yet long-term health care challenges remain. What is clear is that we must prioritize investments in healthcare before the next crisis strikes.”

Former Prime Minister of New Zealand, Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response, said that “building more resilient national health systems, which can adjust rapidly to deal with crises while also maintaining all services” was key to pandemic-proof countries.

“The new pandemic fund at the World Bank, in coordination with WHO, requires a minimum of $10.5 billion every year, mostly to invest in safeguards in low and middle-income countries. But so far, this fund has commitments totaling just over a 10th of that amount. That’s not sustainable funding.”

Image Credits: Flickr: Rumi Consultancy/World Bank.

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