What will it take to truly bring AMR under control?

Rex Clements, CEO, Centrient?

When I think about antimicrobial resistance (AMR), I always come back to one central truth: I want my kids to grow up in a world where antibiotics work. Because a world without antibiotics would be a much more dangerous and deadly place. Antibiotics are critical to saving lives, helping people recover from infections, and enabling treatments and procedures such as chemotherapy and surgery to be carried out with much lower risk –?which is why they’re a foundational medicine – a medicine on which all of what we do in healthcare is built.

AMR is on the rise as bacteria and other microbes increasingly develop resistance to the drugs we have available. An estimated 4.95 million human deaths were associated with bacterial AMR in 2019, and a landmark GRAM study recently published in The Lancet predicts a sharp rise in mortality from bacterial AMR, with 39 million deaths between now and 2050. That’s an average of three deaths per minute.?

World AMR Awareness Week, which runs from 18 November, is a good moment to stop and think about how to truly tackle this major threat to human health and safeguard the effectiveness of antibiotics and antifungals for future generations. How do we – collectively – put on the brakes on the train that is AMR?

Putting the brakes on AMR

Centrient manufactures key ingredients for antibiotics and antifungals, enabling billions of patient treatments worldwide each year. As both a CEO and a father, I have absolutely no interest in running a company where we contribute to AMR –?and it’s an issue we take seriously across the whole company. That’s why we’ve been industry frontrunners in responsible manufacturing of antimicrobials and in collaborative efforts to curb AMR, as I’ll explain a little below.

It’s also why I’m speaking out about what needs to happen on a global scale to curb AMR. Critically, we need to reduce overuse and misuse of antimicrobials, so they’re only prescribed and used when necessary. We need to expand access, so that appropriate treatments are available to people wherever they live. We need R&D-based pharmaceutical companies to invest in developing new antibiotics and antifungals and bringing them to market. And we need to control antimicrobial emissions, such as antibiotic waste discharges, which can contribute to AMR when they enter the environment –?if not properly controlled.

AMR from manufacturing

In our approach to minimizing the risk of AMR from manufacturing, I can confidently say that Centrient is a leader in the battle against AMR. For many years we’ve had wastewater treatment plants at our manufacturing sites, and we ensure our emissions are carefully and independently tested. We are also a founding member of the AMR Industry Alliance, which has broken new ground by setting the Antibiotic Manufacturing Standard, and we have achieved 100% compliance with safe discharge limits.

But there are certain costs involved in responsible manufacturing, and in a price-sensitive market where there are currently few regulations, some companies will be reluctant to step up with voluntary efforts unless their competitors do so, too.

That’s partly why the AMR Industry Alliance has called on the UN and its Member States to adopt the Antibiotic Manufacturing Standard as part of tendering and reimbursement policies, and to incentivise antibiotic manufacturers and suppliers to be certified per the Standard through third-party certification. When positive behaviour is incentivised, we should see a significant shift across the whole industry as complying with discharge limits becomes the norm.

A broken ecosystem

Unfortunately, the ecosystem surrounding antimicrobial medicines is not in good health. After the antibiotic ‘golden age’ of the 1950s and 1960s, the pipeline of new antibiotics slowed to a trickle, and today it is totally insufficient to meet the challenge of evolving resistance. At the same time, we’ve seen shortages of antibiotics in large parts of the world, even though existing antibiotics are urgently required worldwide.

Why is this? Much of it is down to the fact that, in a catch-22, antibiotics –?old and new – must be used sparingly to hold back the development of AMR. In addition, antibiotics are generally procured at low prices. These factors come together to break the typical pharma model, disincentivising both R&D to develop tomorrow’s antibiotics and manufacturing of today’s antibiotics.

In the G7 2023 Leaders Communique, there was a commitment to exploring and implementing push and pull incentives, which are widely seen as levers that could help create a more sustainable antibiotics market. Having said that, we did see some productive discussions at the UN General Assembly High-Level Meeting on AMR about how to transform the antimicrobials ecosystem, and the are some promising commitments in the political declaration that emerged. If Member States follow through as planned, we could see real progress.

One important thing we can do as an individual pharmaceutical company is keep producing the antibiotic ingredients the world needs, and we’ve already pledged to do so. In fact, we are one of the last remaining manufacturers of certain compounds, including base penicillin G, in the Western Hemisphere. Centrient Americas is the only penicillin G producer outside China.

From overuse & misuse, to stewardship & appropriate use

It's really important that we at Centrient remain committed to our roles in combating AMR, but it's also important that governments and healthcare providers recognize the threat and look at what needs to be done in the supply chains and antibiotic market overall.

Ultimately, we’d like to see all the different stakeholders coming together to ensure antibiotics are prescribed and used appropriately. As well as leading to better outcomes for patients, this preserves the effectiveness of these foundational drugs for longer and is vital for stemming the emergence of AMR. To ensure people around the world have access to the right antibiotic or antifungal for their specific infection, there also needs to be an expansion of access to antimicrobials, especially in low- and middle-income countries (LMICs), and increased focus on making diagnostic tests faster and more widely available.

It's easy to be gloomy about AMR, and there are good reasons to be worried. But there are also reasons to be hopeful –?because there are practical, tangible things that can be done. By acting together to stop fueling AMR, we can ensure the runaway train runs out of steam.