Coronavirus has driven millions of people
out of work and into lockdown.
And at home many of us have turned
to online streaming services like Netflix
for our entertainment.
We're happy to pay a monthly subscription,
no matter how much we watch.
But a subscription model like this
could also be applied to tackling a major global health
threat - antibiotic resistance.
Covid-19 is a reminder of the threat
from new infectious diseases.
But it's also intensified a growing problem -
the overuse of antibiotics.
This fosters microbial resistance
and could render the antibiotics useless.
It's almost a century since the discovery of penicillin.
This wonder drug introduced a new medical era.
But antibiotic resistance means the supply
of effective antibiotics is under threat.
At least 700,000 people already die each year
from drug resistant diseases, which include
types of pneumonia and sepsis.
Health systems have been unwilling to pay as much
for new antibiotics as for treatments of other diseases,
such as cancer.
They've rightly tried to restrict usage,
but that means both the price paid and the volume used is
modest, meaning there's little money to be made.
As a result, even the small number
of drug companies which have successfully
developed new antibiotics have often struggled to survive.
Part of the solution is to offer push incentives,
funding for research into new antibiotics.
But that still leaves a funding gap.
Few companies are willing to cover
the high costs of developing and testing prototypes in patients,
seeking approval from regulators, and manufacturing,
distributing, and monitoring their use.
A reformed system may also need pull factors -
a large pot of money that works as an incentive for drug
companies to invest in antibiotic development.
And it could mean shaking up the usual way the pharmaceuticals
market works by de-linking payment
from the volume of usage and sales.
US policymakers are discussing two ambitious plans.
The Pasteur Fund would create a multibillion fund
to successful antibiotic developers.
Disarm would ease reimbursement from hospitals,
reducing the incentive to save costs
by opting for the cheapest drug.
The most innovative products sell at a higher price
and do wonderful volumes, if they're
really amazing new products.
For antibiotics it is the opposite.
The most innovative new antibiotics
are put on the shelf.
And we try to pay as little as possible for them.
Pasteur, I think, would dramatically alter the market.
It sets high targets for amazing drugs.
And suddenly, every drug developer is going to want
to modify their programme so they can hit a Pasteur target.
It's a subscription model, so they get paid whether or not
we use much of it, which I think also
has benefits for stewardship.
In Europe, three countries are taking similar approaches.
Germany is offering to pay companies
high prices for innovative antibiotics
when prescribed by doctors.
Sweden is offering regular guaranteed payments
to companies with valuable new drugs,
even if no one uses them.
That's where the Netflix comparison comes in.
It would be like a subscription service or an insurance
premium.
And it would involve a different understanding
of the value of antibiotics.
The UK and Sweden are both trialling de-linked
reimbursement.
So they're both going to pay in order
to have access to important antibiotics, which is not
linked to their sales volume.
Germany has implemented a process
where they will award higher prices for particularly
important antibiotics.
Even if pull incentives help create new drugs,
that still leaves another pivotal question -
how to ensure that both existing and new antibiotics get
to patients in middle and lower income countries.
Failure to improve access to the right medicines
anywhere will limit efforts to tackle resistance everywhere.
MANICA BALASEGARAM: It really does require countries
to take initiative at country level,
so I fully support the idea that the US and the EU
should be looking at incentive mechanisms,
because that also encourages other countries to take
the right steps.
But I think there has to be a level of where there's also
a sufficient critical mass that both the incentive makes sense
globally and creates a great sufficient, I would say,
interest, but also that you meet the public health response.
There might be a better analogy to Netflix
- the fire extinguisher.
It's something you buy and pay to regularly maintain,
but hope never to use.
Until more countries support new incentives
the flames of antibiotic resistance
will only continue to spread.