How can the economy deal with the issue of antimicrobial resistance?

Applying the economics of climate change to antimicrobial resistance can help avoid the 10 million deaths expected by 2050 if urgent action is not taken

As the use of antibiotics grows, bacteria are becoming increasingly resistant to treatment. Antimicrobial resistance (AMR) compromises modern health care, which relies on access to antibiotics to prevent and treat infections associated with routine medical procedures.

Economic analyzes have successfully informed the recommendations of the Intergovernmental Panel on Climate Change and decisions taken by the international community, such as the Paris Accord. Using economic analysis to inform the action on RAM can help accelerate change.

Recent reports commissioned by the UK government estimate that if no action is taken, by 2050 the AMR will cause up to 10 million annual deaths worldwide. The substantial effect on the health and productivity of the workforce can also reduce gross domestic product (GDP) by 2 to 3.5 percent. A review published in Science argues that a number of economic levers can help address the challenges AMR presents, including assessing the total social cost of using antibiotics when the impact of health and GDP levels of resistance is taken into account .

The development of new antibiotics is rarely profitable and most major pharmaceutical companies have left the field. The review argues that new ways are needed to make antibiotic development profitable by dissociating profits from volumes sold, a recommendation that is in line with the UK's five-year national action plan published in January.1 Incentives should also be offered for the development of interventions that reduce the use of antibiotics.

Today, in high-income countries, people assume the relative safety of procedures such as hip arthroplasty and cesarean sections, but before the discovery of penicillin, infection with a small scratch can be fatal.

Lack of access to antibiotics still results in more deaths worldwide than antibiotic resistance.

Lead author Dr. Laurence Roope of the Center for Health Economics Research (HERC) at the Department of Health Population of Nuffield, University of Oxford, said:

"In low- and middle-income countries, inadequate access to antibiotics among the poor is often associated with excessive consumption of antibiotics by the middle classes. It is estimated that the universal provision of antibiotics can prevent 75% of pneumonia deaths in children under five in these countries.

"Balancing the need to reduce the overall use of antibiotics with the expansion of essential access is a difficult but important challenge."

The review draws parallels between the challenges posed by AMR and climate change. Consumption of antibiotics and carbon may provide valuable short-term benefits, but it does impose long-term costs.

People often feel little incentive to change their behavior because the adverse consequences may occur in the future. In addition, future adverse consequences are unlikely to be avoided, unless many other people also decide to reduce their carbon footprint and antibiotics.

In countries where prescription and dispensing of medicines are not separated, doctors may have financial incentives to prescribe antibiotics. A system in which GP practices are taxed on each antibiotic they prescribe or a tax is applied locally or nationally can provide an effective incentive to reduce prescriptions and the revenue collected could be invested in the development of antibiotics.

An alternative may be to establish a regulatory body that grants allowances or quotas to prescribers, and then allows the market to determine the price.

The widespread use of antibiotics in agriculture also contributes to ADR. 80% of the use of antibiotics in the US is in agriculture and aquaculture where they are used to promote animal husbandry growth or as low-cost substitutes for hygiene measures to prevent infections. Taxes and quotas could be used to discourage unnecessary use of antibiotics in animals and reinvested in research and development.

Co-author Sarah Wordsworth, also from HERC, said:

"The development of new antibiotics needs to be profitable regardless of prices and sales volume. We need better incentives to encourage pharmaceutical companies to engage in the development of antibiotics.

"We demand" incentive "incentives, such as research grants and tax credits, to reduce R & D costs and" pull "mechanisms to provide investment returns that are sufficiently attractive to developers."

Co-author Professor Richard Smith of the University of Exeter added:

"If the cost of antibiotics increases, through taxes or quotas, it will be vital to develop mechanisms to reduce the risk that they will be taken only by those who can afford them. Future research should consider ways to reduce overall antibiotic use without restricting essential access.

"There is an opportunity for economists from many fields to get involved with this urgent global problem."

This research was funded by the National Institutes of Health Research Health Protection Research Unit (NIHR HPRU) in Infections Associated with Health and Antimicrobial Resistance at Oxford University and in partnership with Public Health England (PHE).