Still too little progress on antibiotic resistance, says O’Neill report update

The O’Neill report on antimicrobial resistance in 2016 generated headlines around the world warning that once-trivial infections may become death sentences without drastic action.

Now, three years on, an update on progress has been published and concludes that there has been a worrying lack of progress on some of the critical recommendations from the original document, including the development of incentives for researching new antibiotics, vaccines and diagnostics.

The review’s main findings – 10 million deaths due to AMR per year by 2050 and an accumulated cost to the global economy of $100 trillion – continue to be widely cited.

It recommended global awareness campaigns, improved hygiene and infection control, a reduction in the use of antibiotics in agriculture, more vaccine use and R&D incentives.

In a foreword to the update, the 2016 report author – ex-Goldman Sachs economist Lord Jim O’Neill – writes that there has been encouraging progress in some areas such as a raised profile for AMR, funding for early-stage antibiotics research and the number of scientists working in this area.

What is missing however, “despite endless words”, is a firm commitment of money from governments or pharmaceutical companies, as well as the introduction of market entry rewards to encourage companies to develop new drugs.

He suspects governments may be waiting for the crisis to escalate to the point that they can justify giving large amounts of money to companies to develop drugs, and that drugmakers – despite assertions to the contrary – “find the antibiotics business increasingly unattractive [and] are simply adhering to their own risk-return calculations.”

The new update, is written by Charles Clift, senior consulting fellow at Chatham House’s Centre on Global Health Security, who writes: “it appears that the threat, in spite of many warnings, is not perceived to be sufficient to merit the exceptional policy action many consider necessary.”

He points to significant advances in reducing antibiotic use in agriculture in high-income countries, but notes this hasn’t been mirrored in less affluent countries, which have also struggled to restrict access to over-the-counter antibiotics – another key recommendation in the 2016 report.

There has been greater investment in awareness raising, but questions remain about its impact and effectiveness in changing behaviour, and poor hygiene controls in low- and mid-income countries continues to undermine messages about infection prevention and control.

On the issue of new drug development, the update welcomes recent announcements by governments that suggest a willingness to reform the way antibiotics are paid for. For example, the UK is planning a new payment system that would see the NHS pay an upfront subscription for access to drugs – whether they are used or not – rather than paying by volume.

In the foreword, O’Neill makes additional recommendations based on developments since the original review was published.

One example is for the World Health organisation and other groups such as the United Nations to tap into social media around the world to spread the message about AMR. He also says governments should allow AMR to be cited as a cause of death on national registers.