CHALLENGES:

• Large-scale and uncontrolled use of antibiotics results in increased resistance of bacteria to treatment

“With the very wide-spread use of antibiotics around the world, in people and in animals, that has changed the way that bacteria evolved. Now we have antibiotic-resistant bacteria. So that accelerated the change,” said James Anderson, Chair, Association of the British Pharmaceutical Industry (ABPI) Antimicrobial Resistance (AMR) Network.

“What exacerbates the problem further is that antibiotics are almost always sold as a non-prescription medicine,” said Vasily Ignatiev, General Director, R-Pharm JSC.

“Numerous messages about resistance to antibiotics have appeared primarily because of their massive use in the agricultural sector, rather than as a result of wrong medical uses,” said Nikolay Vlasov, Deputy Head, Federal Service for Veterinary and Phytosanitary Surveillance (Rosselkhoznadzor).

• Significant investment in developing new generations of antibiotics is needed, but ROI is low

“There’s a need to secure investment in developing new antibiotics, so that, notwithstanding bacteria becoming resistant, we can have a new generation of drugs to counter them,” said Sergey Shvetsov, First Deputy Governor, Central Bank of the Russian Federation.

“It takes ten minutes for the formation of a new generation of bacteria, right, but it takes us ten years to develop a new antibiotic <…> not many companies invest in antibiotics nowadays, because there is a relatively low return on the investment,” said Steffen Brygger Lund, Vice President, Head of Nordic, Russia and Baltic Region, MSD.

SOLUTIONS:

• Consolidating resources of pharma, government and science to work out a comprehensive approach to the issue

“The issue is of an interagency nature, it has to involve more than three organisations that committed to that effect <...> In September 2016, the General Assembly of the United Nations held its session <…> that adopted a political declaration determining the need to set up an interagency group <…> under the UN auspices to consider such issues as a single set. <…> Each country should elaborate its own national action plan to be of an interdisciplinary, that is of an interagency, nature,” said Lyalya Gabbasova, Member of Interagency Coordination Group on Antimicrobial Resistance, The United Nations Organisation.

“Of course, it is not at the scale of a company or of a state <...> these have to be joint efforts of many countries. <…> About 80 companies [from different backgrounds] have decided to issue a declaration about this issue, and the roadmap has been put in place. <…> It is required to secure that enough resources are allocated to this research. To finance such research <…> there’s a need to make sure that a proper environment is put in place, so that R&D organisations in connection, of course, with academics can move in the right direction,” said Olivier Charmeil, Executive Vice President and General Manager, General Medicines and Emerging Markets, Sanofi.

• A focus on bacteria from the WHO priority list and development of alternative product groups

“The WHO has approved a priority list of pathogens to develop new antibiotics. <...> These priority lists will be a foundation for development of new products around the world,” said Lyalya Gabbasova.

“The microorganisms’ ability to adapt to antibiotics is a part of the problem. <...> The proteins that help bacteria to survive are now considered as targets for developing products which would block the microorganisms’ adaptive potential, so called antiadaptogens,” said Alexey Tutelyan, Member, Russian Academy of Sciences.

“It is essential to develop new innovative ways in search for prevention methods and new treatment approaches <...> not only new antibiotics classes but also alternative products,” said Lyalya Gabbasova.

• Monitoring of production and consumption of medications, their rational use, outreach to community and medical professionals

“Can we impact that? Yes, absolutely. By doing the things that we hear from the political lead, from the UN, from the WHO <...> we need to make sure that we use the antibiotics that we have more carefully, in lower volumes, and only for the patients and animals that really need them. We need to make sure we don’t pollute the environment with antibiotics, whether it’s from agriculture, whether it’s from manufacturing, whether it’s from waste,” said James Anderson.

“[There should be] active prevention measures to raise awareness of the problem <...> specialist training. <...> It is really important to raise immunisation-related prevention matters now,” said Lyalya Gabbasova.

“There should be a certain split of antibiotics into classes <...> the first [class] would be those allowed for human use, the second those allowed for use in veterinary medicine and crop farming <...> and a group of last resort products that should be forbidden for use anywhere but for hospitals that treat infectious diseases. <...> the third group should be financed by the government because these medicines would never be high-margin. <...> Industrial sanitation at farms and processing facilities <...> is not something reallly discussed or regulated,” said Nikolay Vlasov.

“<...> The patients <...> would become pro-active self-carers, and <...> it can alleviate the healthcare costs burden to the healthcare system meaning that the budgets can be used for the real serious diseases and not for diseases which patients could easily treat themselves,” said Niels Hessmann, General Director, Bayer; General Representative, Russia and CIS, Bayer.