Today’s publication of Lord Jim O’Neill’s ground-breaking global Review on Antimicrobial Resistance (AMR) should act as the wake-up call the world desperately needs. Make no doubt about it, antimicrobial resistance is a threat of insurmountable proportions. With potential deaths of 10 million a year by 2050 as the efficacy of antibiotics dwindles, the UK Government has shown global leadership and driven forward much needed momentum on the issue.
The report: “Tackling Drug-Resistant Infections Globally: Final Report and Recommendations” marks the culmination of an 18-month project led by Lord O’Neill, a Treasury Minister and former Goldman Sachs Chief Economist. The Review was established by Prime Minister David Cameron to analyse the future impact of drug-resistant infections and propose solutions to the lack of development of new antimicrobial drugs.
So what does this mean for TB?
The only airborne drug resistant infection, the O’Neill Review estimates that TB has the potential to cause a quarter of all deaths from AMR by 2050, with an estimated 75 million people dying from the disease over the next 35 years at an economic cost of $16.7 trillion. That’s one person dying from multi-drug resistant TB (MDR-TB) every 12 seconds leaving every person in the world $1,700 worse off. The recommendations of the review quite rightly identify tuberculosis as the “cornerstone of the global AMR challenge”. One of the world’s oldest infections, TB has claimed more lives than any other infectious disease in history. Since 2015, TB surpassed HIV as the world’s deadliest infectious disease responsible for 1.5 million deaths every year.
DR-TB occurs when TB becomes unresponsive to standard treatment. Such resistance has developed due to the lengthy treatment needed to fight TB; even standard TB treatment is inherently difficult to treat with long treatment times of at least six months, whilst treatment for drug resistant infections can take up to an arduous two years. Such long treatment, coupled with the lack of new drugs to defeat TB fans the flames of increasing resistance.
We have had no new drugs enter the standard TB treatment in nearly 50 years. Because the disease predominantly affects the world’s poorest people, there is no commercial incentive to invest in developing new treatments.
The review recognises the need for new tools in the fight against TB. Potential solutions suggested include the introduction of a pooled fund which would offer a substantial financial reward for anyone bringing a new antibiotic to market, including a TB regimen. The review also focuses on incentivising new diagnostic developments, an area which is critical to TB patients and proposes a fund to stimulate wide spread roll-out. Finally, the creation of a Global Innovation Fund is proposed to cover basic research including vaccines, an area which poses a significant scientific obstacle in TB research.
Encouragingly, the Review emphasises how important it is to ensure global access to any future and existing products, stating that we must “Put affordability and access at the heart of a solution”. No solution to drug development is complete without getting the drug to the people who need it, including in low and middle income countries, and new TB tools are no exception.
While new tools will be critical in ending the epidemic, the Global Fund to Fight AIDS, TB and Malaria has a vital role to play, as diagnosing and treating people correctly for all forms of TB is integral to preventing the development of drug-resistant strains. A fully funded Global Fund in the upcoming replenishment in Canada in September will be essential in combatting drug resistant TB.
Without action, we risk compounding political and economic instability in some of the world’s most fragile regions. G20 leaders and the global community must act quickly to implement the Review’s recommendations. If drug-resistance takes hold, we could return to an era where treatment becomes practically impossible. In the words of the Review, “The burden of TB is too great, and the need for new treatments too urgent”.
We have to act and we have to act now.