September 2023 • PharmaTimes Magazine • 18-19
// PHARMA //
Pharma’s dramatic global battle against antimicrobial resistance intensifies
Antimicrobial resistance (AMR) is one of the top ten most serious global public health threats according to the World Health Organization.
It was directly to blame for at least 1.27 million deaths across the globe in 2019, whilst a further 5 million deaths were indirectly associated with resistance.
In the battle against AMR, a large focus continues to be on the R&D pipeline and the development of new treatments for infections. Recently, the UK Government announced an allocation of £39m in support of this research.
While R&D, however, is essential, there are other practical ways for stakeholders to manage and reduce this ever-growing threat to the global population.
Pharma has a vital role to play in the fight against AMR, but what are the main priorities and latest progress in minimising AMR infections?
Viruses, bacteria, fungi and parasites are ever changing and evolving organisms that have the ability to, over time, develop resistance towards traditional medicines that are used to kill them.
Known as antimicrobial resistance, this presents a significant challenge for medical experts who require new drugs to treat patients presenting with AMR infections. It’s also vital to protect the effectiveness of existing antimicrobial drugs in killing microbes.
The term antimicrobial includes antibiotic, antiprotozoal, antiviral and antifungal medicines.
While it is part of the natural cycle of viruses, bacteria, fungi and parasites to evolve and develop resistance, there are many ways in which human action exacerbates and speeds up this process.
Socio-economic factors have a large role to play in driving AMR, including poor infection and disease control in healthcare systems and livestock agriculture, poor access to sanitation, clean water and hygiene, and inequality in access to high-quality and affordable treatments and vaccines.
The misuse and overprescription of antimicrobial drugs, together with weak legislation are also significant drivers of AMR.
The social and economic costs of AMR are shared globally. The biggest costs result from the need for extended hospital stays often requiring costly and intensive care. And, of course, there is the widespread and preventable loss of human life.
‘Antibiotics released into the environment across the supply chain, from manufacture to disposal, are also fuelling the problem’
Considering that each year more antimicrobial drugs are rendered less effective or obsolete, one might ask: why aren’t new ones developed? The answer is not so simple.
Manufacturers of these drugs know all too well that the research and development of next-generation antimicrobials is expensive and high risk.
Secondly, time is not on their side, requiring manufacturers to commit to long-term R&D investment to develop novel antimicrobials, taking 10-15 years only to get them into clinical testing stages.
This multifaceted issue requires a dynamic approach to overcome the current barriers. This cannot be achieved through the public sector alone but requires collaboration between private and public sectors, working together to expand the pipeline for novel antibiotics, antiprotozoal, antiviral and antifungal medicines.
Funding is the pinnacle of the problem deterring manufacturers. However, organisations such as the Antimicrobial Resistance Multi Partner Trust Fund, the Global Antibiotic Research & Development Partnership and the AMR Action Fund have been forging the way ahead and are committed to closing this funding gap.
Governments in advanced economies across the globe are recognising the urgency of addressing AMR, including the UK government who has recently ring-fenced funding with particular focus on manufacturing new antimicrobials.
In an ideal world, this should be the case across the globe if we are to prevent simple common infections from developing into deadly diseases but financial constraints on governments in the least-developed countries make this difficult.
It may seem counterintuitive, but over-prescribing antimicrobial drugs has a direct role in driving AMR. In fact, there is a direct link between antimicrobial drug prescribing and the spread of AMR.
In the UK, reform in diagnostic coding and more precise prescribing guidelines are essential in tackling this problem against the backdrop of a period of reduced resources and a tendency to stick to the status quo.
Automation in digital prescribing can be partially to blame, diminishing the need for regular authorisation and reviews. The result is unnecessary and excessive long-term prescribing for conditions that are likely to resolve naturally.
Fortunately, in the UK, recent changes have granted additional powers to community pharmacists, enabling them to prescribe medication for certain illness. This enhanced opportunity for review and authorisation will relieve some of the burden on GPs and reduce reliance on online pharmacies.
Focusing on patient adherence is crucial because of its ability to affect treatment outcomes and slow the spread of AMR.
Often, patient non-adherence is a symptom of forgetfulness, a lack of education, negative side effects and resolution of symptoms before the course of medication has been completed.
This is an ongoing problem that requires continual attention, ensuring all patients have the information to empower them to correctly use prescribed medicines.
The UN warns that a large percentage of antibiotics are excreted unmetabolised into waste water, along with the resistant bacteria.
Treatment facilities cannot remove all traces, and there is evidence that multi-drug-resistant bacteria are prevalent in marine waters and sediments close to aquaculture, industrial and municipal discharges. This highlights to the urgency in tackling the over-prescription of antimicrobials.
Antibiotics released into the environment across the supply chain, from manufacture to disposal, are also fuelling the problem, together with poor-quality or counterfeit drugs.
Sizeable amounts of waste can also be generated due to a mismatch between dose amounts and course lengths being mandated by drug manufacturers and prescribers.
It is in this respect that pharma packaging has an important role to play in ensuring antibiotics are delivered and administered as intended. The application of ‘quality by Design’ principles will mean more antimicrobial packaging is fit for purpose.
High-quality and well-designed packaging can ensure that the information on medicine labels corresponds correctly to the latest guidelines. For example, the continued rise in adult and child obesity is very quickly leaving recommended dosages outdated.
More recently, digital and smart packaging solutions are frontline soldiers in the battle, many of which have the ability to identify poor quality counterfeit drugs and send reminders to patients to ensure prescription completion.
Smart blister packs can now gather data about patient-adherence, providing insights into a patient’s medicine taking and creating a global data set that illuminates adherence trends
Ultimately, it will take a joined-up approach to defeat to a problem that ‘won’t just go away’.
Steve Brownett-Gale is Marketing Lead at Origin. Go to originltd.com