The event was themed around the risk of drug resistance being critical with a recent study in the lancet finding that in 2019 over 1.25mm deaths were attributable to AMR which is more than either HIV or Malaria. Globally, this issue must be managed to reduce the impact.
The UK has been a world leader with a strategy and action plan since 2000 and AMR was added to the national Risk register in 2015.
DHSC shared (in strict confidence) the commitments from the draft AMR action plan with attendees to enable the roundtable discussion. These included AMR countermeasures, Support for the subscription models for new anti-microbials, over-coming market barriers and improvement and adoption.
The conversation centred around the use of vaccines, the adoption of IVDs to avoid un-necessary antibiotic use and a collaborative approach to AMR across the system. Lessons from the Sars-COV2 pandemic in terms of cross-government working and public health messaging.
AMR is a well-known concept, if not yet well understood, it was referred to as an ignored pandemic rather than “silent”. UK doesn’t need to look far to see the issues we could be facing with carriage rates and the need to strengthen programmes abroad. The Pandemic caused the trajectory of AMR strategy to be altered, for example the reduction in E-Coli. E-coli has not increased since the pandemic, but CDI is at a 10 year high.
AMR management includes Stewardship, Surveillance, Diagnostics and Incentives. Antibiotics are the only drugs given without a diagnosis. This needs to change.
In terms of vaccines for AMR there are 3 types.
- Already licensed.
- Targeted for hospital acquired infections.
- Targeted for community acquired infections.
Vaccines need to be considered globally and not just domestically.
MHRA have many opportunities for industry engagement and feel that companies do not engage enough to enable them to support.
In the UK, uptake of childhood vaccines is high, but adult take up lower but the pandemic has caused more of an understanding on how to reach under-served communities.
The lack of funding available to pull vaccines through was discussed which is a similar issue for pharma as it is for diagnostics where the benefit occurs outwith the budget holding entity. This seems to be an issue with anything preventative rather than a treatment.
Similarly, this has an effect on surveillance as there is lower presentation of symptomatic patients, and this causes epidemiological challenges.
Education of the public is a method of AMR stewardship that is under-utilised. More learnings from the pandemic, show the (general) capability of the public to socially address a public health issue is reasonable. More education could be beneficial. Direct to patient advertising was discussed. Only NZL and US currently have this. Would advertising change behaviour?
The subscription model was discussed, and what the measurement of success is, how is this to be measured to stimulate the pipeline?
In conclusion, it was acknowledged that diagnostic tests are available – but are they the right pathogens and how are they available. Eg. GP’s don’t have the capacity to manage diagnostic testing machines and lack time and competency to use some technologies.
Community settings are the most appropriate and would arguably identify, triage and enable treatment and surveillance.
Currently the system feasibility and funding availability are the prohibitive issues. Whether cost should be a priority consideration by the system over the outcome and necessity to deal with AMR was also raised.
The issue of CRP (although referred to in a recent NHS England meeting as “crude”) being under-utilised was discussed to bring the meeting to a close and further discussion was welcomed. Some attendees will be invited to BIVDA’s upcoming roundtable.