Keeping healthcare sustainable: Let’s start by challenging the assumptions

As the US essayist HL Mencken once wrote: “For every complex problem, there is an answer that is clear, simple and wrong.”

It’s an insight that all of us in the global healthcare community should bear in mind as we search for the “silver bullet” to end antimicrobial resistance (AMR), identified by the World Health Organization (WHO) as one of the major global healthcare threats of our time.

Antibiotics are the cornerstone of modern medicine: in addition to treating and preventing infections, they are critical to a broad range of treatments including surgery and chemotherapy.

However, as the WHO and others warn, without harmonized global action to combat AMR, we risk entering a “post-antibiotic era” in which common infections once again kill and other routine treatments become too dangerous to perform.

As the CEO of the leading global supplier of generic antibiotics, I feel a clear commitment to be part of that global effort. That’s why, a year ago, we published our AMR Statement of Intent.

Framing the debate correctly

I believe part of that role is to help frame the public debate. Unfortunately, there seems to be a growing perception that, while all four pillars of the global anti-AMR strategy (Research & science, Appropriate use, Access, Environment) are equally important, the need to promote R&D for novel antibiotics is somehow “first among equals”. It’s a perception worth challenging.

There is no doubt that we desperately need new medicines, but antibacterial therapy as we know it is changing fast, with future medicines likely to be reserved for those who need them most. 

Which means that new therapies will only have the chance to be truly effective if we do everything in our power to safeguard and maximize the efficacy of the medicines we have today.

It’s similar to the theory of vaccines: much of the protection comes not from receiving the vaccination yourself but from the fact that the majority of the population also receives it, which prevents you even being exposed to the illness in the first place.

Learning to work with what we have

Hence the considerable potential of the WHO’s new AWaRe tool, which classifies antibiotics into three groups – Access, Watch and Reserve – with clear targets for which to use when.

In other words, we need to learn to work with what we have – and that also means recognizing the role played by growing pricing pressure in increasing shortages of essential generic medicines (which in turn promote the spread of resistance).

However, what matters most is to find the right balance between all four components of this complex “eco-system”. Paradoxically, focusing too exclusively on the Research & science part could prove to be the quickest way of limiting its ultimate potential.

To take the pricing example again, if we fail to fix today’s issues today, future “push and pull” initiatives for new medicines may arrive too late to be much use.

As we approach annual Antibiotics Awareness Week, it will be interesting to see if the global debate recognizes this complex balance.