Countries' Shortcomings in Tackling Antibiotic Resistance Spotlighted

The countries with the highest overall scores were the United Kingdom (76) and the United States (68), followed by Germany (64) and France (61). But those scores revealed major shortcomings even in countries that were at the top of the list.

For example, analysis of national expenditures showed that, of the 11 countries, only the United States and the United Kingdom have committed material investments to address AMR. But experts agree that even those investments aren’t sufficient.

Similarly, the report lauded efforts in both countries to address the broken marketplace for new antibiotics and stimulate antibiotic development—the United Kingdom with its pilot pull-incentive program to pay drug companies for antibiotics based on their expected value to society, and the United States with recently introduced legislation (the PASTEUR Act) that would implement decoupled subscription payments for new antibiotics.

But whether those efforts will be successful is unclear, and few other countries have shown a commitment to policies that could boost antibiotic development. In fact, the report notes that many policymakers interviewed didn’t fully understand the incentive proposals that experts agree are needed to restore the antibiotic pipeline.

The report also found that, across most countries, public awareness of AMR and antibiotic misuse is poor. A review of recent survey shows that only 46% of the public in Brazil, 51% in the United States, 63% in China, and 68% in India recognize AMR as a term.

“The awareness of the relationship between the use of antimicrobials and the development and spread of AMR is still unfortunately very low,” Tiemo Wölken, a member of the European Parliament from Germany, said during a webinar discussion held yesterday to launch the report.

Most countries also received low scores on innovation, AMR and the environment, and collaborative engagement.

“There’s tremendous progress in many of the key areas in almost all countries, but it also really highlights that more needs to be done on all the key areas in every country,” James Anderson of the International Federation of Pharmaceutical Manufacturers & Associations, which sponsored the report, said during the webinar.

Anand Anandkumar, PhD, CEO of the biopharmaceutical company Bugworks and another participant in the webinar, noted that the three countries with the lowest overall index scores—Brazil (34), China (37), and India (37)—could provide regional leadership on AMR because of their size and economic strength. But they have to commit to funding to their national AMR action plans, developing push and pull incentives that will encourage and reward antibiotic development, and promoting responsible use of antibiotics.

“There is a big opportunity for these countries to step up,” he said. “Clearly, no one wants to come to these countries and launch their drugs if there is no market and no stewardship plan.”

Priorities Going Forward
Based on the findings, the report concludes that the 11 countries need to strengthen and fully implement their AMR national action plans, raise public awareness of AMR and its consequences, bolster AMR surveillance efforts, and fundamentally restructure the antibiotic marketplace to stimulate innovation.

Other priorities include promoting appropriate use of antibiotics, enabling consistent and reliable access to antibiotics, integrating a One Health approach into national AMR strategies, and engaging with other governments and advocacy groups.

The hope is that the index will serve as a benchmark against which future progress in these countries can be measured. Neil Clancy, MD, an infectious diseases expert at the University of Pittsburgh School of Medicine and member of IDSA’s AMR Committee, said he believes understanding what countries’ strengths and weaknesses are, and how they can improve, will help governments be better prepared for the future.

“It’s imperative to seize the moment now,” Clancy said. “As COVID has taught us, advanced preparation puts you in a place where, when problems hit a threshold, you’re ready to deal with them. And the time to be dealing with AMR is now.”

Chris Dall is news reporter at CIDRAP. This article  is published courtesy of the University of Minnesota’s Center for Infectious Diseases Research and Policy (CIDRAP).