Oxford University have announced the launch of a world-leading institute to fight antimicrobial resistance (AMR), made possible by a £100 million donation from chemical giant INEOS (covered in this BBC News article). This is a hugely positive addition to the armoury in our fight against AMR, but why now?
Comparisons are often drawn between climate change and AMR - both, if left unchecked, are predicted to be economically and societally devastating. However the key difference, at least until recently, has been public awareness.
Climate change’s PR team have done a fantastic job in recent years of raising awareness, but the underlying story being told by the “experts” is not substantially different to that of past decades. It is therefore not experts’ predictions that have caused the change in public perception, but real-world experience. Increasingly frequent hurricanes, wild fires, and ever shrinking glaciers (and even ski-resorts) have hammered the experts’ narrative home, thus increasing awareness and engendering real change.
By comparison, AMR has kept out of the limelight. Methicillin-resistant Staphylococcus aureus (MRSA) is often covered in the press, but rarely outside of medical settings. All the while, in the background, AMR is thought to be accelerating (see our blog AMR - a global threat).
Nonetheless, there is progress in the pipeline. Our recent Forward article Medicine's most wanted looked at a range of potential answers to the post-antibiotic era, including phage therapy and semi-precision antibiotics. The rise in “personalised healthcare” is also promising to prolong the usefulness of existing antibiotics, by ensuring only the most effective antibiotics are picked for a patient’s particular infection (see our Forward article Antimicrobial resistance: moving towards a targeted approach).
Precious new antibiotics are also emerging, such as the worm inspired Darobactin (see our blog Darobactin – worming our way out of antibiotic resistance). However, the economic and regulatory hurdles facing antibiotic development leave little incentive for pharmaceutical companies to go all-in on antibiotics. Traditional volume-of-sales economics doesn’t work for new antibiotics because, in order to prolong their effectiveness (i.e. by staving off resistance), the newest and best antibiotics should be used sparingly and only as a last resort treatment. Alternative funding models like “market entry rewards, alternative and flexible payment models” might help to overcome this issue, and was a hot topic of discussion at the 2020 BioInfect Conference (see our blog 2020 BioInfect Conference - tackling antimicrobial resistance).
But these alternative funding schemes need to be backed - likely by national or international bodies - and for this to happen on the scale necessary AMR needs a significant publicity boost. Experts have been forecasting AMR issues since the 1980s, when the first tranche of antibiotic discoveries started to dry-up. But, as we learnt for climate change, the public can only be swayed so much by expert opinion. What really counts is first-hand experience.
The COVID-19 pandemic has provided a glimpse at the fragility of a world without antimicrobial agents. Experiencing this for ourselves has focussed the mind and made us more receptive to expert guidance. As Professor Louise Richardson, Vice Chancellor of Oxford University said while introducing the new INEOS institute: “the British public cannot get enough of experts”.
Indeed, public opinion of “blue sky research” is also at an all-time high. If asked in 2019 whether 20 years of costly, public funded research into vaccine development was money well spent, public opinion would not be as positive as today. We now know that those 20 years of investment laid the foundation for the Oxford-AstraZeneca COVID-19 vaccine (among others) to be developed in record time; undoubtedly money well spent.
Oxford University’s new institute is just the start. Piggy-backing off the public awareness generated by COVID-19, a global response tackling the economic, social, and scientific issues surrounding AMR is starting to gather momentum (see our blog Antimicrobial resistance – a global response to a global threat).
Looking forward, we are optimistic that 2020 will be an inflection point in the fight against AMR - a year which triggered a wave of awareness, investment and innovation.
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