The emergency on the horizon

Lord Jim O’Neill, chair of Chatham House and vice-chair of the Northern Powerhouse Partnership, calls on the G20 to take the lead on health and prioritise anti-microbial resistance at the Osaka Summit

When I led the independent Review on Anti-microbial Resistance for British prime minister David Cameron from 2014 to 2016, one of the most pleasing aspects of the review was that the topic appeared on the agenda of the G20. Initially there was a very brief mention of anti-microbial resistance under Turkey’s presidency in 2015, then most agreeably in some detail under the Chinese G20 hosting in 2016, and then additional references under both the stewardship of Germany in 2017 and Argentina in 2018. I occasionally said after China’s Hangzhou Summit that this was a more satisfying achievement than even the high-level agreement that was signed on AMR at the United Nations in September 2016.

But despite all the warm words, especially in Hamburg in 2017, I am now worried that is all this is – words. I once believed that when a topic arrived on the G20 agenda, it did not disappear until some significant policy action followed and some solutions started to arrive. I now worry that I was being far too charitable, based on my recollections of the achievements of G7 leaders (and finance ministers) in the 1980s and ’90s, and, of course, the powerful success of the G20 in 2009 under British stewardship after the global financial crisis. I now call on the Japanese leadership to prove me wrong, and to prove that the G20 is serious about health issues, especially AMR.

The AMR review highlighted 10 different areas where changes were needed, with 27 specific recommendations. China’s Hangzhou and Germany’s Hamburg declarations gave considerable attention to many of the areas. But here we are, nearly three years since the review’s final recommendations, and very little action has actually taken place, especially in crucial areas such as the market for new antibiotic drugs, affordable and state-of-the-art diagnostics, and new vaccines.

In a Financial Times article on 22 April this year, Jeremy Farrar, CEO of the Wellcome Trust, highlighted the extremely worrying recent developments concerning the early-stage biotech companies working on AMR. This comment followed the news that Achaogen, one of the few notable biopharmaceutical companies, had filed for bankruptcy, having run out of cash to support further advancement of its promising drugs.

In fact, its share price, together with that of the other five leading publicly quoted biotech specialists for new drugs, is around $500 million at the time of writing.

This is a pretty damning sign of the confidence that markets have in the actions of the G20 policymakers, as well as the genuine interest of large pharmaceutical companies in finding new useful antibiotics and bringing them to market. What is especially worrying is, since the AMR review’s final recommendations in May 2016, one of the few encouraging signs was the rise in new researchers, and the interest of some of these early stage biotech firms. This is now at serious risk. It accompanies the rather more sombre slow exit from the antibiotics business by more large pharmaceutical companies.

In the review’s final recommendations, we specifically designed ‘push incentives’ to help early-stage research and, critically, ‘pull incentives’ to support the efforts of big pharma. We described our recommendation incentive as market entry rewards, suggesting a prize of $1 billion or more for the desired new drugs, especially so-called gram-negative bacteria.

Helpfully, before the 2017 Hamburg Summit, the World Health Organization published a list of suggested urgently needed new drugs. Those would clearly be the ones that beneficiaries would receive the prize if they were successfully developed.

The little academic research published since then has essentially endorsed our market entry reward idea. The leaders at Hamburg appeared to focus on this part of the puzzle by stating they would set up a new drug collaboration centre in Berlin. We had designed our recommendations to support both the ambitions of the biotech world and the costs of the generally reluctant pharmaceutical companies, in order to bring these new drugs to market. Sadly, little has actually happened: no money has followed the words, either from governments or from the pharma companies. The market failure becomes more and more apparent.

G20 leaders and other interested policymakers would do well to remember that the AMR review suggested that if nothing is done about reducing over-usage of antibiotics and about finding new useful drugs, by 2050 there could be as many as 10 million people dying every year from AMR-related illnesses, and a huge economic cost would go with it.

So, please G20 leaders, gathering in Osaka for the fifth summit since the AMR Review started and the third since its final recommendations were published, do something!