Drs Till Boularte and Ulrik Schilze of BCG stated in February 2022 that “when market forces fail to motivate adequate innovation, other incentives are necessary”. In our article on AMR we explored the risks involved in a highly volatile and expensive market. Shelley McLendon suggested that AMR would rage ahead without waiting for investors to respond to the challenges it raises.  

The pharmaceutical industry has been pushing incentives with “limited initial success” without changing the “underlying economics” of AMR. Thus, the authors demand a “new incentive model” to “support continuous innovation of truly novel antibiotics”. They identify investor willingness to accept high risks for the potential high reward. How can we capitalise on this in a sustainable way?

They suggest that “clear targets and reliable instruments” are critical, as well as an “aligned vision”. These terms are great in theory, but what do “aligned vision” and “clear targets” look like in practice? 

Addressing the private sector, which Boularte and Schulze believe to be capable of achieving the “volume and variety of innovation”, they identify a need for a “sustainable ecosystem” with both “push and pull incentives” to reward successful ventures. Additionally, a “set of agreed-on high-impact target pathogens” should unite public and private efforts. 

There are 6 success factors that they require: 

  1. A more viable ecosystem that aligns the interests of all participants, fostering investment and attracting talent to crucial R&D efforts.  
  2. Continuous innovation of novel antibiotics to counter the continuous decay of the existing antibiotic reserve and stay ahead of AMR.  
  3. Portfolio diversity with global relevance, targeting globally relevant pathogens and product profiles with a range of approaches and mechanisms of action 
  4. Supply surety and availability of novel products: sufficient infrastructure, ensuring product availability as needed and regional and local decentralised production 
  5. Appropriate stewardship through reliable diagnostics and surveillance, global antibiotic use guidelines, and active support for diagnostic solutions, including rapid point-of-care diagnostics for LMICs 
  6. Global access to novel antibiotics, including easy and inexpensive registration in markets with unmet needs, equitable global access, and public-private partnerships for LMICs 

They analyse a series of incentives in their article. Their conclusion was that the “subscription model” of fixed payments in return for sufficient antimicrobial product supply guarantee, delinked from volumes sold, would be imperfect but invigorating. They call on G7 countries, the EU, and China, to unite with the following goals: 

  • Collective understanding that the parties agree with the principle: paying for access as opposed to volume. 
  • Consider the advantages of a subscription model: it increases product availability and is ideal for stakeholders. 
  • Define and align a position regarding the size of the overall pull incentives. 
  • Collaborate with the WHO to establish a mechanism to prioritise TPPS. Form a “joint international scientific committee”. 
  • Get this committee to create a framework for an enhanced Health Technology Assessment to determine the value of a novel antibiotic.  
  • Achieve multilateral agreement on a fair-share methodology that identifies the resources each country contributes. 
  • Acknowledge that mechanisms will differ by country and work in parallel to identify feasible mechanisms.  
  • Urge G20 nations to determine how to handle access and stewardship of novel antibiotics to ensure the efficacy is protected.  
  • Set a clear time frame for implementation and align on the process with contributing countries.  

Their final words resound like McLendon’s warning – AMR will not wait for a unified international approach. So, how will this look in practice, and how much progress has been made 6 months after their call for action?  

For a day of AMR discussion at the World Vaccine Congress in Europe in October follow the link for tickets.