20th August 2020

As the COVID-19 pandemic deepens and more patients across the globe enter hospitals with symptoms of the virus and secondary bacterial infections, the appropriate use of antibiotics is now more critical than ever. Concerns over the impact of COVID-19 on antimicrobial resistance (AMR) are mounting. Studies on hospitalised COVID-19 patients have shown that while 72% of patients received antibiotics, only 8% demonstrated superimposed bacterial or fungal co-infections. This overuse of antibiotics could spur another global health crisis — the rise of superbugs...

While the pharmaceutical industry is now working towards new treatments and vaccines targeting COVID-19, this is only one part of the puzzle. It also must ensure a sufficient global supply of essential medicines, including antibiotics — and help achieve fair and equitable access to both new and older products. At the Access to Medicine Foundation, we have been tracking and evaluating the actions of companies in this area for more than ten years, to help stimulate and guide the industry to improve access to medicine.

Drug shortages fuelled by the pandemic

The rising COVID-19 infections in Brazil, India and the US, which together account for nearly USD 40 billion worth of global medicine exports, highlight the risk of supply chain collapse for essential medicines — and in particular antibiotics. The impact of fragile supply chains was already being felt prior to the pandemic, with antibiotic shortages reported on both global and national scales while many formulations of antibiotics for specific populations, including children, still have limited availability.

As the global demand for antibiotics grows, capacity issues caused by rolling lockdowns, trade barriers, and travel restrictions could also lead to severe shortages. Furthermore, the COVID-19 pandemic threatens to halt manufacturing at plants that could lead to supply chain bottlenecks. When such demand spikes and shortages occur, doctors and healthcare professionals often resort to using less optimal treatments. This also brings an increased risk of AMR. To reduce this threat, doctors must ensure that the right antibiotic is used against the right type of infection. Disruptions to prevention and treatment programmes for existing health priorities, such as HIV, malaria and TB are also being threatened by the pandemic, further accentuating the issue of access during this crisis.

Commercial incentives protecting supply chains remain weak

Findings from our second Antimicrobial Resistance Benchmark published earlier this year indicate that commercial incentives underpinning the antibiotic market are weak, with few pharmaceutical companies willing or able to invest in rebuilding supply chains particularly for antibiotics. The independent report, which is published every two years, compares how a cross-section of the pharmaceutical industry is responding to the threat from drug-resistant infections. A white paper using data from the Benchmark identified areas where further action is required to prevent shortages and supply chain issues: 1) pharmaceutical companies must bring a step change in their practices for antibiotic stock and inventory management, improve their agility, e.g., in response to shortages, and communicate information about their plans and stock data earlier and in more detail to more partners: 2) a unified approach – led by governments and supported by regulators and the industry – is needed to ensure there are multiple suppliers competing at critical links in the chain; and 3) the establishment of stronger incentives that can help shape the market and allow pharmaceutical companies to enter and stay in this space. The three areas of action, linking to the pharmaceutical industry and governments, are now more relevant than ever in order to safeguard the supply of essential products during the pandemic.

The role of governments in preventing shortages and stockouts

Pharmaceutical companies must be further incentivised to take action and be transparent about their sourcing, allowing governments to make informed procurement decisions and actively promote diversification of manufacturers to mitigate the risk of service interruptions. Many governments are thinking critically about responsible procurement through initiatives that include measures to ensure supply. For example, the UK Government, along with NICE, NHS England, and NHS Improvement, are creating the world’s first pilot programme to support a fully delinked antibiotic pull incentive. The pilot includes specific stipulations for successful candidates, including performance requirements involving surety of supply and compliance with good manufacturing, among others. Furthermore, the Swedish government commissioned the Public Health Agency of Sweden to propose and pilotnew models for keeping approved antibiotics available on the Swedish market, and PLATINEA, a multisectoral collaboration platform, aims to preserve and enhance the value of existing antibiotics in Sweden. The initiative plans to evaluate and test new methods to promote rational use of antibiotics and investigate supply chains for existing antibiotics. Additionally, national health agencies in Norway, with the support of DRIVE-AB, the Innovative Medicine Initiative-funded project, also designed a potential delinked pilot. What’s more, several global health funding bodies, including the UK, are investing in supply chain strengthening initiatives to safeguard against critical service interruptions for the programmes they support.

Now more than ever, tools like the Antimicrobial Resistance Benchmark are vital to encourage company participation in such activities, increase transparency to inform government decision making, and incentivise companies to remain involved in key priority areas.

Safeguarding supply chains beyond COVID-19

The Access to Medicine Foundation, through its intensive programme on stakeholder consensus building, continues to define the priorities for companies: on the development and equitable delivery of new health products for COVID-19; the prevention of drug shortages and stockouts; limiting the spread of drug resistance; and maintaining access to many other existing essential medicines.These priorities have been distilled into the foundation’s latest analytical framework for the next Access to Medicine Index.

As government priorities are globally shifting towards COVID-19, the Access to Medicine Foundation will work in lockstep to continue to evaluate and incentivise pharmaceutical action pertaining to coronaviruses, as it has been doing since 2017. In the coming months and years, it will be closely monitoring company behaviour, including efforts to improve and strengthen supply chains, not just in relation to COVID-19, but across 82 diseases, conditions and pathogens, including high-burden communicable diseases, non-communicable diseases, neglected tropical diseases, maternal & neonatal health conditions and priority pathogens. While all eyes are on COVID-19, the Access to Medicine Foundation will continue to assess company action to promote access across the board, providing a mechanism for long-term accountability, transparency, and change.

Margo Warren, Government Engagement and Policy Manager, Access to Medicine Foundation


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