This brief is part of series, The EU’s Global Role: Policy Proposals for a New Era. The series sets out a suite of policy proposals designed to shape the international development agenda of the European Union’s leadership during the 2024-2029 term.
Summary
- Antimicrobial resistance (AMR) is responsible for a large and growing burden of mortality, morbidity, and economic impacts. This is due to three underlying problems: lack of access to essential antimicrobials, insufficient stewardship of these drugs to prevent overuse and misuse, and a dearth of innovation to create new medicines and diagnostics.
- The previous European Commission showed strong leadership on this issue. There is a window of opportunity to continue this momentum, especially following the UN General Assembly High-Level Meeting on AMR.
- The EU should support the development of a sustainable access hub to ensure all countries can access a portfolio of essential antimicrobials and diagnostics.
- The EU should implement a new model to drive innovation of novel antimicrobials. We propose a system whereby the EU would offer an incentive to reward innovation of an antibiotic meeting certain criteria. In return, companies must register and sell the antibiotic in all EU countries at an agreed, affordable price, and provide voluntary licenses to low- and middle-income countries to ensure sustainable access.
Antimicrobial resistance (AMR) occurs when bacteria and other microorganisms develop the ability to survive in the presence of antimicrobial medicines that ordinarily kill them. While this is a natural process, it is being hastened by our overuse and misuse of antimicrobials—resulting in a serious problem whereby many medications are no longer effective. Estimates suggest that AMR is responsible for over 1.15 million deaths every year—mainly in low- and middle-income countries (LMICs), but also including about 58,000 in the European Union (EU). AMR also causes a substantial economic burden, in terms of both the increased health care costs associated with treating resistant infections and productivity losses. We have estimated that resistance causes excess health care costs of USD 66 billion globally and that USD 168 billion is spent treating patients with resistant infections. Within the EU, health systems spend EUR 15 billion each year treating resistant infections. Without concerted action, these numbers will only grow.
Three main problem areas underlie the rise in AMR: a lack of reliable access to essential antimicrobials, insufficient stewardship of these drugs to prevent unnecessary use, and a dearth of innovation to create new drugs. A lack of access directly causes morbidity and mortality, as people are unable to access the treatments they require—it is estimated that more people die from a lack of access to antimicrobials than from resistance itself. But also, lack of access can indirectly lead to worsening resistance, as infections are left to spread unchecked, or inappropriate drugs are used. In some cases, lack of access to first-line drugs means that later-line drugs, which ideally would be kept in reserve, are used, thus allowing resistance to develop to these critical drugs. Lack of access to antimicrobials has long been an issue in developing countries with weaker health systems and in smaller EU countries with insufficient market size to be profitable, but recently we have seen more widespread access problems in the EU. For example, in 2022, many European countries faced acute shortages of the antibiotic medication, amoxicillin.
Ensuring access to necessary medicines is crucial, but at the same time, protecting antimicrobials from unnecessary use is key to ensuring their lasting efficacy. This can be a difficult line for countries to tread, as stewardship measures such as limiting some antimicrobials to hospital-only use can have unacceptable consequences on access. Stewardship, therefore, should not be considered in isolation.
Thirdly, current payment systems do not adequately reimburse developers of antimicrobials for their efforts, especially when new drugs are intentionally used only sparingly to preserve their efficacy. This means pharmaceutical companies are dropping out of the market and the pipeline of new drugs is worryingly dry: the World Health Organization (WHO) found that the pipeline is “insufficient” to tackle rising AMR. The EU is the second largest pharmaceutical market, and yet even here, companies are withdrawing due to difficulties generating sufficient profit for novel antimicrobials. Solving AMR will include developing new purchasing systems which adequately reward innovation, without incentivising companies to oversell their product to increase their profit.
AMR is not a problem that can be solved at the individual country level but is inherently a global issue. Resistance can freely spread across borders—so all countries lose from inappropriate use in one country. Similarly, new innovations spread across borders—so all countries gain from the R&D investments of other countries. Unfortunately, this global nature means AMR, much like climate change, suffers from the collective action problem: while all countries would benefit from working together, each individual country has an incentive to “free ride” or rely on the efforts of others, resulting in insufficient or inefficient action. Therefore, international bodies have a crucial role to play in ensuring the necessary collaboration to tackle AMR. This was recognised in a 2023 resolution of the EU Parliament, which stated that “action at EU level to address AMR can deliver clear added value, since no single Member State alone can provide an adequate solution to this cross-border and global issue.”
by: Katherine Klemperer, Javier Guzman and Anthony McDonnell. CGD Center for Global Development