Info Service on Health Issues (Aug17/04)
18 August 2017
Third World Network
friends and colleagues,
is a report put out by the South Centre on a side-event at the recent
70th World Health Assembly in May 2017 regarding the urgent
need to address antimicrobial resistance.
With best wishes,
Third World Network
Civil society and South
Centre call for urgent actions to tackle AMR and ensure access and
new innovation models
by Mirza Alas
the side-lines of the 70th World Health Assembly session
in May 2017, the South Centre supported and chaired a multi-stakeholder
dialogue between civil society and governments, with the speakers
calling for urgent global action to tackle antimicrobial resistance.
The side event “Responding to the Challenge of Antimicrobial Resistance
(AMR): Perspectives of Civil Society, Intergovernmental Organizations
and Developing Countries” was held on 22 May 2017 at the Palais des
Nations in Geneva. The event was sponsored by Médecins Sans Frontières
(MSF), Drugs for Neglected Diseases initiative (DNDi), Health Action
International (HAI), and Medicus Mundi International Network (MMI),
and was supported by the South Centre and ReAct Action on Antibiotic
Resistance. Viviana Munoz of the South Centre chaired the event.
The Centre played a key role in organizing the meeting.
Below is a report of the event.
society is becoming increasingly active in advocating for more effective
and coordinated actions to tackle the crisis of antimicrobial resistance
(AMR). Senior representatives of leading global CSOs spoke in
a side event at a packed hall (with many participants having only
standing room) at the World Health Assembly, and stressed the need
not only for urgent action to control the misuse of antibiotics, but
also that the new antimicrobials must be made affordable and accessible
CSO leaders from Médecins Sans Frontières (MSF), Drugs for Neglected
Diseases initiative (DNDi), ReACT and Medicus Mundi International
Network stressed that the poor and the low and middle income countries
(LMICs) suffered the most from AMR. It is imperative that as more
funds are poured into research and development (R&D), the outcome
or new antibiotics, other antimicrobials, vaccines and diagnostic
tools must be affordable to LMICs, especially their poor.
The Chair of the event, Viviana Munoz of the South Centre, also shared
these points in her opening and concluding remarks. Representatives
of the Health Ministries of India and Thailand also made presentations
of their countries’ plans to combat AMR; they brought up issues of
implementing the plans and called for more assistance from WHO.
DNDi, ReACT and MSF emphasized that R&D efforts to counter AMR
should adhere to internationally agreed principles including affordability,
effectiveness, efficiency and equity and de-linkage. Several speakers
stressed the importance of adhering to the principle of de-linkage
– the prices and sales volumes of antibiotics are not linked to the
cost of investment in R&D –, and that therefore new innovation
models based on de-linkage should be put into practice.
The problems of access to medicines and innovation models that are
consistent with access were the main highlights of the CSO presentations,
which said these models were to ensure benefits arising from better
stewardship of new and existing antibiotics.
Viviana Munoz, South Centre, welcomed participants to the event and
noted that the outstanding tournout was an expression of the broad
support for coordinated global action to tackle AMR. She noted that
AMR is a multifaceted problem. For example, AMR is linked to misuse
and excessive use, but there is also the problem of access to antimicrobials.
Moreover, AMR is linked to human use, use in animals and impact on
On the positive side, AMR is now firmly placed on the global agenda,
and increasingly on national health agendas. There is recognition
of the need for a holistic approach to the problem that involves multiple
sectors and actors. With this, she noted great pleasure to moderate
a panel composed of CSOs and people that are working hard to make
a difference and whose engagement on the AMR agenda is essential,
as they have an extraordinary capacity to inspire and mobilize collective
action, and a deep understanding of the root causes of the problems
relating to AMR. She highlighted that the South Centre is convinced
that there is a need to give more voice to civil society to engage
in and help shape the AMR agenda, if we really want change.
Anthony D. So, Director, IDEA (Innovation+Design Enabling Access)
Initiative at the John Hopkins Bloomberg School of Public Health and
Director, ReAct - Action on Antibiotic Resistance Strategic Policy
Program, suggested that the problem of AMR should be approached from
a systems perspective, considering the inter-related elements of (1)
innovation, (2) access and (3) stewardship.
Dr. So highlighted the need to curb the non-therapeutic use of antibiotics
and phase out the use of certain antibiotics in food animal production such
as colistin, which is a last-line treatment in human medicine. He
noted that a larger volume of antibiotics is not used in humans but
in agriculture and aquaculture.
Dr. So further elaborated on issues around prices of antibiotics.
He noted that the idea of rationing antibiotics through higher drug
prices is not an effective way to ensure rational use. Infectious
diseases do not skip the poor and fall more heavily on those who cannot
afford antibiotics. He also noted that if courses of new antibiotics
could cost thousands of dollars, we should begin to wonder how we
will ensure access and stewardship from such an innovation pipeline.
Dr. So also talked about how push incentives for new antibiotic
drugs (e.g., CARB-X, the European Union’s Innovative Medicines Initiative,
NIH, BARDA and the U.S. biodefense program) address the key scientific
bottleneck in the R&D pipeline, but existing efforts
are insufficient and must better address de-linkage as well
as conditions for access and stewardship. However, he explained
that CARB-X has only $350 million dollars in commitments, but
the needed expenditure in incentives is billions of dollars.
In his opinion, the overemphasis on pull incentives (e.g., priority
review vouchers, transferable intellectual property rights, and late
stage market entry rewards) is misplaced. The evidence shows that
first-in-class antibiotics can command first-in-class returns on investment.
He added: “Linezolid and daptomycin are prime examples, two
first-in-class antibiotics, each with sales that place them among
the top 50 drugs in the U.S. These drugs came to market before new
incentives like the GAIN Act that extended the period of monopoly
He underscored the need to focus the incentives and that when policymakers
and industry call for billion dollar market entry rewards “it may
be too much, too late” since those market entry rewards may focus
the public’s resources on the wrong part of the pipeline.
There is a need to delink the return on investment from both prices
and quantities of sales of antibiotics, he said. He thus concluded
that fair returns on public investment in R&D should be ensured
and that it is not just innovation, but affordable access and stewardship
that are needed, stressing that “stewardship should not be an afterthought
at the end of the pharmaceutical value chain.”
On the animal health sector Dr. So talked about the importance of
phasing out non-therapeutic use of antimicrobials, and to invest in
developing alternative sustainable agricultural practices that help
transition farmers and food production away from the intensive use
of antibiotics. He also mentioned the need to change retail and institutional
procurement practices and the need to engage consumers in demanding
products without routine use of antibiotics. In his concluding remarks
Dr. So emphasized the need for an “AMR Watch” of civil society organizations
that could contribute with monitoring governments’ development and
implementation of the National Action Plans as well as the intergovernmental
organizations and other key actors, and making them more accountable.
Michelle Childs, Head of Policy Advocacy, Drugs for Neglected Diseases
initiative – Latin America, highlighted the need to implement and
adhere to internationally agreed R&D Principles to guide innovation
and access for AMR. These include the principle of de-linkage
of prices and sales volume of antibiotics from the cost of R&D.
Ms Childs spoke on the role of guiding principles on research and
development (R&D) and stressed that any initiative should focus
on the public health priorities with an emphasis on global needs.
Ms Childs emphasized the need to ensure the implementation of globally
agreed key norms and principles to ensure innovation and sustainable
access such as: affordability, effectiveness, efficiency and equity
as well as the importance of de-linkage – investments in R&D not
linked to returns from sales volumes or prices.
Ms Childs also pointed out the importance to ensuring sustainable
financing at the national, regional and global level. She stressed
the need to continue exploring new incentives for innovation such
as push and pull mechanisms based on agreed priorities, principle
of de-linkage and conditions to ensure sustainable access. Other important
elements she mentioned were the need to identify R&D needs and
gaps, to have a clear priority setting mechanism, coordination, sustainable
funding and the core principles of: affordability, effectiveness,
Ms Childs also mentioned the recently created Global Antibiotic Research
and Development Partnership (GARDP) which is a not-for-profit R&D
organization that will develop new treatments for bacterial infections.
GARDP is a joint initiative of the World Health Organization (WHO)
and the Drugs for Neglected Diseases initiative (DNDi).
Els Torreele, Executive Director of Médecins Sans Frontières (MSF)’s
Access Campaign, spoke on how MSF, as one of the largest non-government
providers of humanitarian medical care, is now witnessing the growing
burden of AMR. “We see AMR in trauma patients in Jordan, newborns
in Pakistan, malnourished children in Mali and burn victims in Iraq.
We see people with infections that can only be treated with the last
lines of antibiotics, after first, second and even third line no longer
She stressed the importance of an urgent, comprehensive, global and
public health-driven response to this growing problem and to ensure
that the needs of patients and health care providers are at the center
of any response. Ms Torreele also referred to the challenges caused
by drug resistance in patients with TB, malaria, HIV/AIDS and other
infectious diseases. She described how MSF in 2015 treated more than
20,000 patients with TB, of which 2,000 had MDR-TB. This could
just be the tip of the iceberg of an estimated 580,000 people with
DR-TB worldwide since most who are infected are undiagnosed and untreated.
Ms Torreele added that one of the biggest challenges for the medical
teams is the lack of appropriate diagnostics. Thus there is a need
to equip doctors and nurses with the right diagnostics and treatment
tools to help them determine types of infection and whether the standard
drugs still work.
She mentioned other key issues in the AMR response which include:
health system strengthening, improving medical practice and the need
to increase access to vaccines such as the Pneumococcal Conjugate
Vaccine (PCV) and rotavirus vaccines. “Increasing coverage of these
vaccines could dramatically reduce the use of antibiotics. But high
vaccine prices are a key barrier today to increasing vaccination,
especially in middle-income countries,” she remarked.
Ms Torreelle stressed MSF’s mandate to save lives and treat infections
and therefore it took seriously the need to have affordable access
to diagnostics and treatment tools, new and old and future ones. She
said that “medical innovation is only relevant if the resulting products
are available and accessible for those in need.” TB was mentioned
as an example of one disease where new drugs have recently become
available but less than 5% of patients that could benefit from these
new drugs currently have access.
She remarked that the public health challenges caused by AMR are not
exceptional but linked to the global health challenges caused by a
society that relies on high prices and monopolies to pay for innovation,
which causes both a lack of access to existing health technologies
as well as lack of patient-driven innovation. She also mentioned the
importance of the recommendations and findings in the recent UN High
Level Panel on Access to Medicines report and the need to use them.
Garance Upham of Medicus Mundi International Network and Vice-President
of “WAAAR”: World Alliance Against Antibiotic Resistance, stressed
that AMR infections spread like epidemics do. This partly occurs because
of the lack of adequate infection, prevention and control (IPC) systems.
She mentioned that more than 20 countries in Europe do not have good
IPC systems and therefore this is not an issue that only affects low
or middle income countries.
She pointed out that IPC systems would be beneficial in the animal
sector since it would help prevent sick animals from infecting others
animals. Also, hygiene practices in farms are an effective method
to prevent disease in animals more than using meta-prophylaxis antibiotics.
She also observed that untreated or badly treated wastes from the
pharmaceutical industry, fruits and vegetables industry, hospitals
and health care centers are dumped into the environment releasing
antibiotics and exacerbating resistance. She emphasized the need to
invest in clean water, sanitation systems and proper waste treatment
as preventive measures that would reduce the need to use antibiotics
in the first place.
The side event also heard from two discussants: Mr. Lav Agarwal of
the Ministry of Health and Family Welfare in India and Dr. Nihima
Sumpradic of the Ministry of Public Health in Thailand. They presented
on their countries efforts’ in addressing the AMR problem, and the
challenges that remain particularly on implementation of the national
plans. They called on WHO to provide further assistance to developing
Marc Sprenger from the WHO AMR Secretariat noted that civil society
would be invited for dialogue and interaction with the members of
the UN-level Interagency Coordination Group (IACG) that was established
in March 2017.
In the open dialogue, other CSOs made interventions, including International
TB Union, TB Alliance, HAI, Oxfam, Health Care without Harm, Save
the Children and KEI.
Author: Mirza Alas is an Associate Researcher of the South Centre.
This article was edited by Viviana Munoz and Martin Khor. Viviana
Munoz is the Coordinator of the Development, Innovation and Intellectual
Property Programme (DIIP) of the South Centre. Martin Khor is the
Executive Director of the South Centre.