While more countries are concerned about antimicrobial resistance (AMR) than a decade ago, many are reluctant to commit to a specific target to reduce the overuse of animal antibiotics as they negotiate a political declaration ahead of the United Nations high-level meeting on AMR.

The zero draft of the declaration issued on 20 May proposed a target of “at least 30%” reduction in “the quantity of antimicrobials used in the agri-food system globally” by 2030.

But “a lot of countries still seem keen to water down very concrete commitments on things like reducing animal use of antibiotics”, Jeremy Knox, head of infectious disease policy at Wellcome Trust, told a media briefing on Monday.

However, Knox said he was “cautiously optimistic” about the outcomes of the UN high-level meeting set for 26 September – eight years after the only other HLM on the issue in 2016.

Wellcome has proposed three key strategies to address AMR  – a political “rallying cry” (such as the climate sector’s target of no more than a 2ºC temperature increase), a global scientific evidence panel on AMR, and sustained political follow-up, said Knox.

“I don’t think we’ll end up with the kind of very clear and ambitious rallying cry that we might have hoped for, but I do think we will see some commitments which are steps in the right direction,” said Knox.

“We will most likely have something like an ambition for a 10% reduction in mortality [on the 2019 baseline figure of 1.27 million annual deaths] but that’s narrower and less ambitious than some of us might have hoped for.”

Investors call for action

The Investor Action on AMR (IAAMR) initiative, supported by 80 investors who represent $13 trillion in assets, issued a call on Tuesday for global policymakers to take “critical action against the escalating AMR crisis”.

AMR claimed 1.27 million lives in 2019, surpassing deaths from HIV and malaria, with this figure set to rise to 10 million annually by 2050.

“With the global economic costs associated with AMR likely to reach $100 trillion and lead to a 3.8% decrease in global GDP by 2050, the investor community is increasingly concerned with the negative impact AMR will have on global financial markets, economic stability and long-term value generation,” said IAAMR in a statement. 

IAAMR was founded by the Access to Medicine Foundation, the $75 trillion FAIRR investor network and the UK Department of Health and Social Care,

“Companies – from pharma to pork producers – take advantage of lax regulations allowing the routine use of antibiotics in animals enabling them to cut corners in animal welfare, while diminishing antibiotic effectiveness in humans,” said Jeremy Coller, Founder and Chair, of FAIRR, which works on building a more sustainable and equitable food system.

“An estimated 80% of antibiotics are administered to livestock rather than people in the United States alone. Investors recognise that AMR is not only a threat to the health of our people and planet, but to the financial well-being of those who rely on investment returns to fund their retirements.” 

IAAMR has seven proposals, three of which dovetail with Wellcome’s three strategies. Like Wellcome, they want a “rallying” aim, political will and an independent global scientific panel on AMR along the lines of the Intergovernmental Panel on Climate Change (IPCC).

This proposal has the support of the governments of the UK and Saudi Arabia, according to IAAMR.

‘Crisis of innovation, talent and market’

There is a “crisis of innovation” in the development of new antibiotics, says Damiano de Felice, chief of external affairs at CARB-X, a public-private partnership that supports the development of new antibiotics.

Even the AMR Action Fund, which was given $1 billion from big pharmaceutical companies, the European Investment Bank and Wellcome, “struggled to find investment opportunities in clinical development exactly because the pipeline is insufficient”, he added.

In the early stages of development, there is a lot of innovation – but most of the product developers are vulnerable because they “tend to be very small”, often coming from academia.

“The few companies that have been scientifically successful in bringing a new product to the market, have done very poorly financially,” he told the Wellcome media briefing.

“At least seven of the small biotech companies that brought a new antibiotic on the market in the past five to 10 years all had significant financial problems, and most of them actually went bankrupt.”

De Felice describes the market conditions for new antibiotics as “broken”. Large pharma companies are not that interested in antibiotics as they are short courses, face competition from generics – and clinicians tend not to prescribe them “to prevent the development of resistance”.

This lack of investment and interest also means that researchers don’t stay in antibiotic R&D – resulting in a “crisis of talent”.

But, says de Felice, there are “push” and “pull” incentives to address these problems. Push incentives provide financial, technical and business support to developers for R&D. Meanwhile, 

A pull incentive meanwhile rewards a new antibiotic which has already been brought to the market, and at least $300 million a year for 10 years should be available for this, he estimates.

‘Best time for bugs’

Anand Anandjumar, co-founder and CEO of Bugworks, a small biotech company based in Bangalore, wants the UN political declaration on AMR to include a commitment to support innovation.

“We are looking at a long, dark, dangerous battle, so at least setting some very basic goals like five new antimicrobials by 2030 – that gives us about six years to work with – would be good,” said Anandjumar, whose company gets support from CARB-X.

“The bugs that we are seeing today, which are resistant to most antibiotics, are not going to wait for humanity to figure out solutions in our own timelines,” Anandjumar told the Wellcome briefing.

“If you’re a bacteria, there’s no better time than today,” he added. “You have heavy abuse of antibiotics on the one side. Therefore the bacteria are becoming much smarter and are developing mutations and other skills to avoid it. 

“On the other side, you have no R& D because the big pharmaceutical companies don’t find this exciting.”

India has one of the “toughest problems with AMR because of the easy availability of antibiotics and population density, he added,

“It’s a great honour to work on creating a new class of antibiotics from India, because the worst bugs are here.”

He added that AMR was being exacerbated by climate change and war: “Rising temperatures are making bugs much more pathogenic and virulent”, while the wars in Ukraine and Gaza are creating conditions for “superbugs”.