Three reasons why investors should care about antimicrobial resistance

Warnings of disaster have never been popular. We often can’t handle the truth.

Firstly, the global economy remains vulnerable. The COVID pandemic demonstrated the economic disaster of ongoing inadequate biosecurity. Death, debt and disruption has cast a long shadow into the third decade of this century, but we still don’t have a convincing response to a global pandemic. Lockdowns are reactionary. School closures stunt our future potential. The threat of future pandemics is even worse when you consider the what’s coming around the corner. For it was those who anticipated the poly-crisis who realised our former ways needed to change. Moderna’s development of pioneering RNA therapeutics is impressive, but the operational efficiency to scale their vaccine was just as important. Both asset and logistics were needed to salvage global recovery plans, but next time we may not have an equivalent solution.

Secondly, antimicrobial resistance (AMR) directly threatens revenue. AMR, when microbes resist drugs to treat them, is a catastrophe playing out before our eyes, to the tune of 10 million deaths annually by 2050 without effective action. A top ten health problem of the World Health Organisation, this ‘silent pandemic’ is far more insidious than the real dangers faced in 2020. The AMR fallout includes higher healthcare costs, lower employment rates, and reduced productivity. The World Bank estimates that AMR could increase healthcare costs by $1 trillion by 2050. AMR makes infections more expensive to treat due to longer hospital stays and more intensive medical care. The World Bank also estimates that AMR could cause GDP losses of $1–$3.4 trillion per year by 2030. These losses could be as severe as the 2008 global financial crisis, but could last much longer. AMR will lower employment rates and reduce productivity at work; in 2015, chicken sales in Norway dropped by 20% after news that a resistant strain of E. coli was found in chicken meat. The World Bank projects a 3.8%. loss of global GDP in 2050 in a high-AMR scenario. Higher tax burdens to pay for reactionary health systems and economic depression will suffocate revenue.

Thirdly, pre-emptive defence is needed now. Communicable disease is an acute challenge in a globalised, interdependent and diverse world. Immigration and trade are central to our assumptions for ongoing growth in our living standards. The extent of operational disruption posed by multi-resistant bacteria ravaging densely populated urban centres will eclipse any risk profile, revenue or market capitalisation forecast. Theoretical dominance in retail, consumer, hospitality, energy or transport are pitiful if no one dare leave their bedroom for fear of infection. Funds with committed positions in these industries had better defend themselves by investing in the fight against AMR.

More investors need to follow the example of GSK’s ￡45M drive to fight AMR through a partnership with Imperial’s Fleming Initiative. As a duty of stewardship and prudent act of self-preservation, novel incentive frameworks to strengthen the investment case for new antimicrobials are needed to direct capital to this vulnerable frontier. Bioinformatics AMR-AI models are an exciting opportunity to combine epidemiology, pharmacology and genomic data to deliver operationally efficient diagnostic and antimicrobial prescribing decisions. The deployment of fluorescence microscopy to detect AMR is promising for diagnostics, whilst the use of AI in drug development enhances possibilities for polymyxins and antimicrobial peptides as new weapons in our armoury. Peptide design and synthesis, identifying biosynthetic gene clusters, drug repurposing and drug target prediction are all augmented by deep learning.

Barbarians are at the gate; we must reward those who will defend us.