Dr Greg Frank is the director of global public policy at MSD and he spoke with BioPharmaDispatch about the company's focus on the global issue of antimicrobial resistance (AMR).
Dr Frank previously served as the senior director of infectious disease policy at US-based BIO. He currently serves on the US Presidential Advisory Committee on Antibiotic-Resistant Bacteria, the Leadership Council of the National Institute of Antimicrobial Resistant Research and Education, and the expert advisory committee for the Partnership to Fight Infectious Diseases.
Dr Frank told BioPharmaDispatch one of the real challenges with AMR is that "people do not perceive it as an acute issue."
"It is seen as an issue for 'down the road'. I think it is very challenging when the solution is expensive and tough to do," he said, adding governments tend not to fix problems "until the house is burning down around them, then they call the fire department."
"People are not appreciating the magnitude of the problem. Of course, COVID has gripped political attention for very good reason."
Dr Frank said the pandemic has necessarily dominated the recent discussion on infectious diseases but this has also "illustrated the need to be less blasé about and thinking it is a problem for another day."
"When it comes to AMR, we use the term 'silent tsunami' in that it builds gradually. People go to the hospital for something else, they get sick, it turns out to be resistant, they may die, they may get better. There is not a coalescing of an appreciation that this is a significant issue.
"I firmly disagree with the idea that this is 'a problem in the future'. This is a problem now and it is being wildly underestimated.
"In the US, there is a 2017 study that landed on 163,000 Americans dying every year from AMR infections. This would place AMR as a third leading cause of death," said Dr Frank.
He pointed to another report that found that without action AMR will be the cause of 10 million deaths globally each year by 2050.
"We need to think about what that means for every time someone goes to a hospital for any kind of procedure. How we take certain things for granted when it comes to safety and the treatment of infection.
"The risk of infection will become so high that procedures are no longer simply clinical decisions. Something like a caesarean birth will become a potentially life or death situation because of the risk of infection. Cancer treatments and transplants will also be impacted and that would be absolutely catastrophic to modern medicine.
"Something that illustrates this is the experience in India. It is a very different country from the US and Australia when it comes to its health system. In one of its tier-one hospitals, I think it was a cancer ward, their rate of resistant infections was so high they stopped treating patients.
"This was a learning that might be a case of 'when and not if' for countries like the US and Australia unless there is action."
Dr Frank said the reasons for the significant global variability in the prevalence of AMR is "multifaceted" but that "you can boil it down" to the fact some countries have less effective stewardship and appropriate use controls.
"An example is India and some other developing countries where you do not even need a prescription to get antibiotics. I know countries are taking steps to address these issues but at this point, they have higher rates of AMR and that is being exported to other countries."
He said countries cannot "simply stewardship" their way out of AMR and that significant government support for research into new antimicrobials is welcome.
"This has been critical to keeping the pipeline alive but unfortunately what is really needed is a market reform and that is not cheap or easy to do.
"Political momentum is needed to really drive action. That is a policy challenge we have not quite surmounted but I feel like we are turning a corner on that. I think the subscription models that are emerging with the PASTEUR Act in the US and similar approaches in the UK and Sweden, we might actually be getting closer."
Under the PASTEUR Act, the US government will create market incentives for the development of antimicrobial medicines. Companies would be paid agreed amounts annually, for a duration ranging from five years up to the antimicrobial’s patent life.
"I think there will be many lessons learned from the models. The hope is that they are successful and can evolve so that other countries, including Australia, look at developing models that suit the particular circumstances of their health systems."
He continued, "I think if I had my magic wand, I would like to see many countries adopting subscription-based models. I do think we need to be honest that not every country is going to be able to put together a PASTEUR Act but they do not need to. I think they need to provide their collective support to that innovation. I think the key role is they have to be aligned.
"I think they actually need to be collectively aligned around the unmet need. That is a challenge, back to the fact this is really hard to do, but my hope would be that multiple countries, especially in the developed world, really take the plunge and implement incentives.
"This would put us, I think, on the right course to create a sustainable pipeline that we all need and a durable arsenal."
Dr Frank said the current pandemic has very clearly illustrated the "devastating and disruptive" of infectious diseases.
"I think you can argue AMR could rival COVID if we wait and sit on it long enough. I think when we have the conversation about how we want to do better next time, how all countries want to be better prepared for the next pandemic, that AMR needs to be on that list."
He said "no one is proposing a COVID response to AMR" but that there are "a lot of antimicrobial innovations" and "all sorts of new technologies that could provide more durable solutions."
"Honestly, if we solve these problems with the market the investors will return and the pipeline will emerge. It will probably take us ten years to get this pipeline and, in the meantime, AMR is only going to get worse."
