As the Obama administration chalks out a plan to combat the growing menace of antibiotic resistance, Jim ‘o’ Neill who was appointed by Prime Minister David Cameron to lead the review on Antimicrobial resistance talks to Shalini Gupta on his visit to India and how he plans to tackle this mammoth task
How would you describe your role as the head of the AMR review?
I was formally appointed in July 2014, but took up the position only by September 2014. Our goal is for all United Nations members to sign up an agreement on policies to deal with antimicrobial resistance by September 2016. We seek expert inputs from pharmaceutical companies including large pharma, boutique firms, specialist pharma, research specialists and policy makers from all over the globe on AMR which is what brings me to India. We are also in discussion to come up with a global innovation fund to stimulate more research. Going forward, the aim is to spend more time thinking about how better information to help us control the need for antibiotics which is very much consistent with the dramatic focus of the Modi government on sanitation.
What work has been done so far?
We spent the first two months researching and publishing an article in early December about the economic consequences the world will have to deal with if anti-microbial resistance goes unchecked. It revealed that if we do not find a solution by 2050, there’ll be 10 million deaths with approximately more than a million in India. The biggest causes for death and decrease in productivity were attributed to malaria more than TB, least of all HIV. E.coli would cost the highest in terms of superbugs.In a second article published in January this year, we wrote about the easy wins or straightforward ideas that’d be difficult to argue with, like trying to get more people to study microbiology in universities and offering doctors more rewards for research in microbiology and antibiotics for instance.
What has been the focus of your visit to India?
We believe a much bigger role should be played in improving diagnostics particularly in India which was one of the topics discussed on our visit to a diagnostic company in Gurgaon. We are also looking at how to incentivise and motivate pharmaceutical companies to produce more antibiotics. So our trip to India is to help familiarise us with the initiatives here and understand how we can synergise our ideas with them and encourage them to be even bolder to help create a global solution. This will be followed by a visit to China, then US, Brussels and EU. All of these efforts are targeted to get policymakers to agree on a common agenda.
What is the current status of antimicrobial resistance? Is there some data to support it?
First of all to get accurate and comparable data on antimicrobial resistance globally is actually very very difficult. The WHO should play a stronger leadership role in trying to promote greater commitment to better data. For e.g. in the European database on resistance to some antibiotics, we discovered that some countries including some developed countries such as Germany don’t report accurate data.
Its not that easy to say with confidence where India sits relative to other countries. However, importantly based on research done based on evidence that we have, India is probably amongst the most vulnerable among developing nations alongwith China, Indonesia and some of the African countreis like Nigeria, primarily countries which have had a lot of infectious diseases or have challenges with them today.
If there is no concrete data on AMR, how did you arrive at the figure on the economic costs?
It was not easy, we made clear in our paper that we need to make some basic assumptions, we warned people not to overestimate the exact figures that we quoted, for we believe that these numbers are very conservative. If anything the true vulnerability will be larger than the numbers that we reached at. What we did we asked two consultants to come up with projections for the world economy in the future assuming that there was no anti microbial resistance. Then as a second model we came up with projections based on resistance rates and infection rates, as to how productivity and employment and life will be affected looking at three possible pathogens and hospital superbugs. We also looked at three major infectious diseases- TB, malaria and HIV.
Too few pharma companies are developing new antibiotics. Your views.
Its a key question which is worrying. Its not expensive and risky to devote resources to AMR, especially since they can’t charge high prices and cannot sell them in huge quantities. In pharmaceuticals, companies are fashionably focussed on cancer research and we are trying to persuade, incentify them to have a different view. At a conference in London I said, “At the end of the day everyone is going to live in the same world, so one would need to think beyond the immediate profitability.” It is the truth.
So what is the solution?
What I am about to say are not agreed formal policies. One idea that we have is about an innovation fund, the size of which we estimate at $2 dollars. Initially, I was of the view that it needs to be financed by global multinationals such as IFC, World Bank, BRICS development Bank etc. To be honest with you, the more time I spent thinking about it, the more I want pharma companies to change their thinking and focus on social good rather than looking out for their own profits. I am interested in the idea of the top 25 pharma companies contributing to that fund, whether they are interested in AMR or not. My appeal to the pharma companies is that you live in an industry that requires regulatory support from governments and in many countries, favourable tax incentives are a part of it. If you only focus on the areas you want to focus upon and not focus on society’s needs, then it may well be that governments will eventually be less favourable in the support that they provide you. With my own background in banking, I have seen how banks have been forced to think about the broader social good of people and so I am trying to persuade pharma companies to think differently. The recent example of AstraZeneca setting up a standalone company towards antibiotic research adds to my confidence, the fact that they set up a small specialist company which they’re financing shows me that all pharma can do that. If this can be done by Top 25 companies in the world, it’d be great. It is a reality now that small specialist research companies are usually where the greatest findings take place.