News and Opinions  –  2019

We need public health principles for sustainable access to novel antibiotics – Policy brief by ReAct

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Governments, philanthropies and public health institutions increasingly recognize that new antibiotics will not emerge from the pharmaceutical pipeline if things are just "left to the market". Over the last five years, numerous investments have emerged to address the lack of novel antibiotics that are urgently needed to address drug-resistant infections.

ReAct has welcomed these efforts to address this market failure. Yet we are concerned that these efforts may not achieve the desired outcome of creating a sustainable new approach to antibiotic research and development. In a new policy paper, we outline the public health principles that should govern any public funding spent, to secure equitable and sustainable access to new antibiotics.

Photo: Rohan Basak, India. This is a cropped version.

We need to create an “end-to-end” model for sustainable development of new antibiotics, to secure access for those that should be at the center – patients. This means we need to consider how access to and stewardship of these drugs will be handled, already when money is being invested in developing them.

Three key points why we need public health principles for sustainable access to novel antibiotics

1. An effective end to end model should not focus on the multinational pharmaceutical industry as the solution to a crisis that it played a role in causing.

Instead policy makers and donors must support a novel, alternative ecosystem which includes emerging biotechnology companies, generics companies, product development partnerships and the public sector.

2. As public sector funding is needed both to pay for the development of new antibiotics and for reimbursement once such products are approved, public health principles should govern the development of new antibiotics to safeguard public interest.

3. These public health principles include:

  • Setting target product profiles for new products through scientific consensus.
  • Ensuring full transparency across the pharmaceutical value chain.
  • Promoting full delinkage to facilitate equitable and affordable access to new medicines.

Full delinkage: delinking the cost of investment in research and development from the price and volume of sales.

Achieving these in practice is difficult, but they should be principles all policy makers and donors set as achievable aspirations over time.

Need for substantial new resources from governments

It is clear that there is a need for substantial, new resources from governments (beyond what has already been committed), but we also caution that such resources could be wasted unless they are guided by public health principles. It needs to be made much clearer that investments made should not focus on large pharmaceutical companies, but ensure that research and development produces novel antibiotics that are affordable and accessible worldwide.

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