The Next Pandemic: Applying the Lessons of COVID-19 to AMR | Brunswick

The Next Pandemic: Applying the Lessons of COVID-19 to AMR

The COVID-19 pandemic has shown we must be better prepared for health threats right across the global healthcare architecture – spanning governments, civil society, philanthropy and industry.

That means all stakeholders, including healthcare and life sciences companies, will be judged on their response to future crises, putting a premium on their ability to learn the lessons of COVID-19 and to communicate effectively how they will address these challenges.

The list of emerging pathogens that could overwhelm humankind is long and worrying. But one threat is predictable – and, indeed, already here.

Antimicrobial resistance (AMR) today kills more people globally than malaria and HIV combined, according to the most comprehensive analysis to date published in January. In total, antibiotic-resistant infections caused 1.3 million deaths in 2019, while nearly 5 million people died with such “superbugs” in their bodies, the Lancet study found.

Sadly, it will get worse. The more resistant that pathogens become, the more they will spread. The COVID-19 pandemic may actually have added fuel to the fire because of the large number of sick people prescribed antibiotics for secondary infections while in hospital.

However, on the plus side, the experience and insights gained from fighting a previously unknown coronavirus has left behind a valuable toolkit that can be applied to future health crises – from advances in technology and improved public-health protocols to new models for drug and vaccine development.

Pharma and biotech can lean into the lessons of COVID-19 by leveraging that toolkit and using what has been shown to work, whether that is through greater public-private cooperation, calibrated access schemes in lower-income markets or a readiness to tear up standard business models to ensure the rapid deployment of life-saving interventions.

At the same time, health systems can use insights from COVID-19 about the most effective public health messaging to prevent infections in the first place – from general hygiene and mask-wearing to the containment of contagion within medical settings.

It will not necessarily be easy. Getting the balance right when it comes to preparing for AMR is a challenge.

One risk is that the infectious diseases agenda in the wake of COVID-19 may shift too far towards tackling viral threats and away from bacterial hazards, which could deprive AMR of both attention and investment. Countering this risk will take a holistic approach by public-sector research funders, private sector investors and the boards of healthcare companies.

Importantly, the balance between antiviral and antibacterial strategies does not have to be a zero-sum game. In fact, many of the changes in mindsets among healthcare professionals and the general public triggered by COVID-19 could also help control antibiotic resistance. 

Immunisation, for example, can prevent diseases requiring antibiotic treatment just as much as it can tackle viral infections. The dramatic advances in vaccinology driven by the current pandemic could therefore be a boon in addressing AMR. What is more, the fact that over 10 billion doses of COVID-19 vaccine have been administered worldwide suggests that vaccination may be more widely accepted in future – despite the vocal protests of a small group of antivaxxers.

Similarly, the revolution in mass diagnostic testing unleashed by the pandemic may pave the way for significant advances in detecting antibiotic-resistant infections. Fast and efficient point-of-care diagnostics will be key in the superbug fight, both to identify pathogens and then test their susceptibility to different antibiotics. To date, the development of AMR diagnostics has been limited, reflecting both market barriers and technological challenges. But the speed of innovation seen in coronavirus testing and the widespread acceptance of such tests among the public shows what is possible.

When it comes to developing new medicines, one thing is clear: the current pipeline of new antibiotics is thin and the level of investment inadequate. Many large companies have withdrawn from the field in the face of meagre financial returns, leaving small drugmakers accounting for 75% of all late-stage antibiotics in development.

Increased funding is needed to discover more antibiotics and to bring them to market quickly. The new data on the global burden of AMR should therefore be a wake-up call, providing momentum for action and potentially an opportunity to leverage the models used in the pandemic to fast-track COVID-19 drugs and vaccines.

There are some encouraging platforms to build on. The $1 billion AMR Action Fund, for example, is backed by 23 pharma companies and aims to bring two to four new antibiotics to market this decade. And the Trinity Challenge partnership underscores the potential of collaboration between universities, foundations and companies in preparing for future health emergencies.

But the lack of a viable market for antibiotics – which are complicated to develop yet are used sparingly to preserve effectiveness once approved – remains a major challenge for both industry and wider society.

Without a stepped-up response and action to address these structural market issues, the danger is that large tracts of modern medicine from abdominal surgery to chemotherapy could become untenable as resistant pathogens gain the upper hand, taking a terrible toll on lives and livelihoods.

Some healthcare investors are already sounding the alarm in response to the landmark Lancet study, reflecting their fears for the sustainability of global healthcare delivery – and the wider economy – if AMR is left unchecked.

In the words of Jim O’Neill, the former UK minister who chaired a 2016 review into antimicrobial resistance, the scale of the problem suggests that COVID-19 is “just a warm-up for what could happen if we don’t sort out AMR”.