The other global threat to life that governments must now face

I have been involved in efforts to boost policy initiatives to address the problem of antimicrobial resistance (AMR). I have been involved ever since I was asked to lead an independent Review into AMR by David Cameron, in 2014. The remit of our review was to identify the scale of the challenge and to come up with global solutions. In our initial report in late 2014, we estimated a model of the world economy up to 2050. In that model, we considered different rates of growth of antimicrobial resistance for various affected illnesses. We concluded that there could be around 10 million people a year dying globally by 2050, up from around 700,000 in 2014.

We also suggested that, linked to the deaths and reduced productivity more broadly, the accumulated loss of economic activity between 2014 and 2050 could be around $100 trillion. In our final report, published in May 2016, we proposed 29 specific interventions around the world, which would require around $42 billion of investment.

leading that Review was the most interesting job I have ever had, and it was probably the most important. I have also often described the 29 interventions as covering ten general areas, which I have also often described as the 10 Commandments of Solving AMR.

There has been progress, but some countries have made more progress than others. Amongst the areas where progress was the best has been in support from some governments (notably the US) and various NGOs such as the Wellcome Trust to finance early stage research for new drugs. Relatedly, there has been an acceleration in the number of Universities setting up AMR research departments, notably in the UK, and to my surprise, there is evidence of progress in the use of antibiotics in a number of so-called developed countries, including the US, UK and elsewhere in the EU.

But is further progress likely to be helped or hindered by the battle against Covid-19? I am not sure of the answer.

One part of me thinks that, given the staggering scale of disruption to our lives caused by Covid-19, everything else is so much on hold. This might indeed apply to some parts of the battle against AMR.

Sadly, it is only when we see the threat to us personally that the political attention follows. This was evident with Ebola, which broke out in parts of Africa early on during our review, and the powerful forces of international policy and those of the pharmaceutical industry swung into action. Ebola is estimated to have accounted for less than 20,000 lives, but it drew in more financial support than the $42 billion we suggested was needed to solve AMR. This was because it created a sense of considerable panic across news media, and the policy response followed.

In our review we examined data on 700,000 global deaths, of which the data suggested around 25,000 were in each of the US and the EU. Worryingly, by 2019, these had risen to around 35-37,000, a faster increase than we had set out in our 2050 projections. What is less clear is whether this was due to: improved data analysis; the historic number of lives lost being higher than originally estimated; increasing resistance to antibiotics.

While Covid-19 is causing greater mortality in the EU and US, what is clear is that polices to deal with AMR in the developed world are clearly getting nothing like the attention that Covid-19 is rightly getting. And when it comes to the rest of the world, particularly in lower income countries, the battle against AMR is possibly causing more challenges than Covid-19. Left unattended, those challenges will become more acute, due to the rise of drug-resistant TB in particular, and also other sources of infection that require antibiotics.

The dramatic speed with which the world’s greatest scientific research centres are pressing ahead with Covid-19 vaccine development is very encouraging to see. Perhaps the same will happen when we suddenly discover that certain infections have become resistant to antibiotics, meaning that various forms of routine surgery cannot be undertaken. When that happens, the fact will dominate every radio and TV programme, which will in turn cause the development of new antibiotics to flourish. But do we really want to wait for that extremely risky moment before acting?

Not only does this crisis raise issues about the preparedness of country health systems for the gravest of challenges, but it also raises issues about the shareholder versus stakeholder model of capitalism through which my generation has lived. In this regard, I hope that the initiatives being considered by the International Federation of Pharmaceutical Manufacturers and Associations, the international organisation that links the big pharmaceutical companies, soon become real, and that the global pharmaceuticals industry does indeed begin to act “as one team“.

And I also hope that our governments don’t let their attention on AMR drop off the international policy agenda because of Covid-19. They need to start backing up their words with investment in new drug development, vaccines and diagnostics — just as they need to do for Covid-19.