18 - 19 mai 2017
Sustainable use policies within a new multi-sectoral framework for antibiotics
- Morel Chantal
The global health community is well aware that antibiotics are a vital resource for human existence. Antibiotics are not only needed to treat common infections that could otherwise become life-threatening, they also make many everyday interventions such as surgeries and chemotherapy possible in their role as adjunct therapy. Despite the major need for these drugs the pipeline has largely dried up, especially for antibiotics to treat multidrug resistant infections. For the past decade the international community has started to take note of this increasingly frightening situation and begun to explore ways to help spur innovation in this area and –acknowledging the scientific difficulties--to develop better strategies to conserve both existing antibiotics as well as those we hope will be developed in future.
These two endeavours --spurring innovation in new antibiotic development and encouraging conservation of all antibiotics—have historically been at odds with one another, with different sectors of the economy choosing one or the other. On the one hand, public health leaders, public payors, pharmaceutical policy academicians, and health economists, have sought the preservation of these precious resources through the exhaustion of efficacy through stepwise treatment approaches (first line, second line when first line fails, third line when second line fails, etc.), the shelving of new products, and reimbursement decisions based on short-term cost-effectiveness grounds. On the other hand, the pharmaceutical industry, the health insurance industry, and the medical law profession, have sought the habitual use of the most novel products and created both legal and social expectation of immediate cure with little regard for future antibiotic effectiveness but with the assumption of sustained replacement of obsolete products with new ones.
With increasing attention now being paid to the antibiotics problem and its potential threat to human existence (e.g. the 2015 WHO Global Action Plan on Antimicrobial Resistance) the divergence in approach is becoming increasingly hard to ignore. It is also becoming increasingly clear that the two approaches can no longer co-exist. Any approach to solving the antibiotics problem – including the disentangling of perverse incentives that lead to inappropriate use and the dismantling of short-termist public policies that both discourage innovation and encourage potential sub-optimal antibiotic use with regard to long-term resistance patterns – will require coordination across sectors. As such, far greater coherence is needed—especially surrounding the very concept of “sustainable use”.
The new cross-sectoral framework for antibiotics – currently under development by a consortium made up of 16 public and 7 private partners from 12 countries (see http://drive-ab.eu/), amongst others worldwide, is in the process of formulating new financial incentive designs, legal documentation, regulatory levers, and public health methodologies to address this issue. By spring 2017 the policy recommendations—the product of many years of work -- will need to be translated into concrete steps for implementation. A harmonized definition and coordinated approach to “sustainable use” across sectors is vital for the success of this implementation. The proposed Brocher Foundation-hosted workshop will bring together key actors from the fields of clinical care, health economics, innovation policy (representatives from both public and private sector), insurance and medical law, and ethics to present, debate, draw up mutually acceptable definitions, and lay out pathways to reform that can guide the successful implementation of the new cross-sectoral framework.