Antimicrobial Resistance Should Not Overshadow Broader Issue Of Access To Medicines, Some Say

While the issue of antimicrobial resistance has arrived in high-level discussions, and there is a consensus that the problem must be tackled one way or another to avoid slipping back into a pre-antibiotic era, some voices are highlighting the need to remember that other health issues remain unmet, and access to medicines is still an acute problem.

On 25 October, the World Health Organization, World Intellectual Property Organization and the World Trade Organization organised a joint technical symposium on antimicrobial resistance. The symposium sought to achieve a better understanding of the global challenge of antibiotic resistance and examine possible ways forward.

Most speakers invited to the event presented possible solutions to boost research and development for new antibiotics and the need to restrict the use of existing antibiotics to prevent the building up of microbe resistance. However, some speakers insisted on the fact that antimicrobial resistance (AMR) is only a part of the issue of access to medicines.

Brazil: AMR Should Not Be Used as a Barrier to Treatment

Lucas Sversut, from the Brazilian mission in Geneva, underlined the multiple dimensions of the issue of AMR.

Any options in support of access to and stewardship of antimicrobials should balance monitoring [corrected], control and conservation on the one hand, and access and affordability on the other, he said.

From the development perspective, it would seem far too drastic to advocate for stringent measures of control such as limiting consumer access to antimicrobials, or withholding life-saving antibiotics for human use under the concept of conservation, he said.

It is necessary to avoid unnecessarily restrictive policies in particular in developing countries where the lack of access to antibiotics kills more than the resistance itself, he said.

Undue restriction on prescription and use of antibiotics, or the imposition of a ban on sales would result in greater barriers to access and could in practice undermine flexibilities provided for public health objectives in international agreements, said Sversut.

For example, it would go against the WTO Doha Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) and Public Health, the UN 2030 Agenda for Sustainable Development, violating the human right to health, and jeopardising food security and nutrition with significant negative social consequences for many, he explained.

The core objective must be to ensure access to existing and new antimicrobials for all. Further work on appropriate use will be needed.

The alarm on AMR should not be sounded so high that it jeopardises international travel, trade and migration, he added.

The issue of the lack of dynamic research and development (R&D) for AMR is to be considered in a wider concern for lack of R&D for other life-threatening and under-served diseases especially affecting developing countries, he said.

“We fear there is a lack of analysis of the shortcomings of the IP system to induce innovation on antimicrobials based on needs rather than market reward,” Sversut said.

Even taking into account the projected 10 million annual deaths by 2050 caused by AMR, “we must recognise that the public health burden can be also high for other existing diseases that have not gotten the same international attention,” he said.

Nearly half of the world’s population is at risk of malaria, he noted, and in 2015 alone, 214 million cases were registered, leading to almost 440,000 deaths.

This is not to dampen the concerns about AMR, said Sversut, but to underline that the AMR momentum should be used to systemically address the issue of access to medicines.

Much discussion has been going on about the de-linkage of the cost of R&D and the price and volume of sales of microbials [clarified], but a first step would be to better understand what linkages exist between the two, he said. R&D costs urgently need a common workable definition and the UN system is the appropriate body to carry out this task, he added.

“We see with concern that some existing voluntary [clarified] patent pooling mechanisms have been limited in scale by commercial interests and marketing strategies of participating right holders. More often than not they will restrict voluntary licensing of their products by excluding large middle-income countries where the poor and needy live in the largest number,” he said.

AMR is an encompassing agenda, he concluded. Any solution will have to take into account the capacities of states to tackle AMR, and the need for evidence-based R&D, capacity building, technology transfer, technical assistance, and cooperation.

AMR is a new discussion with little multilateral precedent to draw from, said Sversut, and it potentially involves restricting access to antimicrobials under the guise of conservation, and rewarding innovation through innovative mechanisms that could eventually have an “IP plus” effect on market control and prices.

The AMR agenda was conceived in a small group of discussions in the Group of 7 (G-7) and more recently promoted on the basis of the AMR Review and economic financial lenses. To become a matter of global agreement, it will need to respond and be accountable to the social dimensions of the 2030 Agenda for Sustainable Development, its goals and targets, he said.

South Centre: AMR broader Systemic Issue

Viviana Muñoz, coordinator, Development, Innovation and Intellectual Property Programme, at the South Centre, considered the role of public health institutions and other stakeholders, and whether public goals and health goals can be reconciled with business goals.

The issue of AMR is also a broader systemic issue in relation to innovation in other areas, she said. “The right to health is the key basic goal of why we work for innovation that leads to addressing real medical needs around the world,” she said.

There are on the whole less breakthrough innovations, she said, and those that do come are highly priced, such as hepatitis C treatments.

Challenges in AMR are complex and innovation is part of solution but cannot be seen by itself, she said, adding that innovation must come together with pursuing the goal of access, as well as promoting stewardship to make sure that new antibiotics that come about are not misused.

Audience: Need for Research Beyond New Antibiotics

From the audience, a scientist said although the medical issue is microbial resistance, the issue that the initiatives described by the speakers is trying to solve is how to deal with microbial infections.

The approach for the last 80 years to solve this issue of microbial infections has relied on new antibiotics, he said. But it is worth looking how other treatments have evolved, such as cancer treatments, with the implementation of gene manipulation, he said.

“If we continue in the business of discovering new antibiotics, or using old antibiotics,” there will be a lack of incentives and enthusiasm, he said.

The approaches and models proposed by the speakers in the symposium do not leave space for a new paradigm to tackle microbial infection, he said.

In a longer term approach, he told Intellectual Property Watch, there is a need to provide space for other ways of addressing antimicrobial resistance than through antibiotics.

 

Image Credits: Catherine Saez