The UK vs. superbugs: Combatting AMR on the homefront

AMR, or antimicrobial resistance, is never far from the conversation these days. According to the World Health Organization (WHO), the growing resistance to the world’s existing antibiotics is one of the largest threats facing public health, with 1.27 million deaths attributed to bacterial AMR worldwide in 2019 alone – more than HIV and malaria combined.

While academics might have developed a means to reinvent the old, today, the industry faces a weak pipeline for new antibiotics, as there is no commercial payoff to act as an incentive for the resource-intensive development of AMR drugs. Though smaller companies are exploring new treatment possibilities with the likes of CRISPR technology, for example, others are turning to AI to better identify the appropriate antibiotics for the appropriate bacterial infections.

In February this year, Deep Dive headed up to Liverpool, UK, for the BioInfect Conference on AMR. Held at the top of The Spine for the first time, the location of Liverpool’s Royal College of Physicians, as well as the Pandemic Institute, the day sought to bring to light – via discourse and insights from scientists and politicians, researchers and practicing clinicians – the state of affairs when it comes to AMR in the United Kingdom and beyond.

Life sciences in the North West

The BioInfect agenda – an event now in its 10th year – covered a range of topics, kicking off with a welcome address from Mayor of the Liverpool City Region, Steve Rotherham, sharing investment plans for the life sciences sector, before the official launch of the Liverpool City Region Investment Zone in Health and Life Sciences.

Liverpool is a “cultural powerhouse,” he said. With the right level of funding, £42 billion can be generated in gross-value-added (GVA) when pulling together all the “wonderful projects”, he said, to become a “scientific superpower”.

However, achieving this status will require an expansion in laboratory capacity facilities, an expansion that Rotherham argued Liverpool is primed to accommodate – “There are a dearth of labs throughout the UK, so why not Liverpool City?” he posited. To follow, Professor Janet Hemingway CBE, director of iiCON and a senior technical advisor on neglected tropical diseases for the Bill and Melinda Gates Foundation, announced the launch of the Liverpool City Region Investment Zone in Health and Life Sciences and spoke further about opportunities for the North West: a “levelling up”.

What relevance to AMR, though?

The majority of the UK Government’s £80 million investment will go into infrastructure, and tax free zones, boosting economy in Liverpool, Runcorn, St Helens Magull, and Prescot, plus Freeport. Much of this building will surround The Spine. Therein, streamlining organoids with Cat 3 robotics, AI, and machine learning. At this level, the area will be set apart from Europe.

This, of course, means more jobs, more talent, and iiCON itself, in its mere three plus years of existence, has created over 360 jobs in that time. A consortium led by the School of Tropical Medicine, bridging the gap in the infection innovation ecosystem between industry, academia, and the NHS – remember those academics seeking industry’s uptake of their latest research into antibiotics – iiCON’s portfolio programme is now worth >£250 million, with contracts with 345 companies to assist in product development. Indeed, 36 new products have been brought to market in three years (that is a product for every month of existence), and over five billion units of those products are in patients, in populations, in the US, Canada, and Europe.

At the time of BioInfect, LifeArc was a new iiCON partner, offering a humanised antibody platform for infection therapeutics. The other organisation that had joined iiCON was CELT (the Centre for Long-acting Therapeutics), which aims to broaden the understanding of long-acting medicines. However, iiCON is not just interested in the clinical side and developing new antibiotics, but in tackling AMR itself, and “looking at surfaces”.

State of AMR on national levels

To address these points, an opening panel chaired by Beverley Isherwood, strategy leader & PACE programme director at the Medicines Discovery Catapult, discussed the state of AMR in different nations. Panellists included: Nicholas Feasey; Sir James Black, chair of Infection Medicine at the University of St Andrews; Nichola Jones, teaching fellow at the University of Leeds; Pia Thommes, VP of anti-infectives at Evotec; and Seamus O’Brien, director of research & development at the Global Antibiotic Research & Development Partnership (GARDP).

Opening the discussion, the panel cut straight to the point: AMR deaths are escalating.

It’s been almost a decade since the O’Neill Report was published in 2016. This review on Antimicrobial Resistance (AMR), commissioned in July 2014 by the UK Prime Minister, saw economist Jim O’Neill tasked with analysing the global problem of rising drug resistance and proposing concrete actions to tackle it internationally. Jointly supported by the UK Government and Wellcome Trust, it was established as a two-year, time-limited process, engaging widely with international stakeholders to understand and propose solutions to the problem of drug-resistant infections from an economic and social perspective.

Commenting on the main successes since the report’s publication, Feasey, highlighted that the burden of AMR remains huge, and to quantify the size of the problem is an important contribution, so as to place AMR in context with other health problems. He noted the Christopher J Murray paper (PDF) and, on the O’Neill Report, O’Brien commented that it focused minds on the risk of market failure, very much in the pharma sector, kickstarting incentive and initiatives. It was, he said, propositional, talking about certain models that could be looked at, but that there were significant gaps in the data.

Jones, who works primarily in Nepal and Bangladesh, meanwhile, stated that policymakers have an impetus for change, positioned in those countries where AMR is seen on par with other health issues in those settings. Thommes is also an optimist, noting Roche’s research on new antibiotics, and that many attendees of BioInfect  in the audience had new entities, drugs, and approaches to AMR.

Progress, in short, has been made.

O’Brien agreed, stating that the regulatory framework for development of antibiotics has improved, but only in limited indications, and not approved beyond major industries and countries. Indeed, whilst national action plans have been helpful, they have followed a very templated approach. Feasey, who has been working in East Africa, where neonatal sepsis is common, concurred that focus needs to be where the greatest problem of burden falls: the unsexy but important health systems innovations, which need to be driven by the countries from the ground up.

A connected commitment to AMR research

As AMR returns to the limelight in New York this September, at a high-level meeting during the 2024 UN General Assembly, there will be new opportunities for countries to commit to clear and bold new targets and practical steps for tackling the issue. One audience member asked what the panellists hope to see achieved by then and the commitments to be made after that.

Feasey said there’s an emerging narrative on accountability allied to that and that it would be a shame if LMICs are held accountable for AMR if no funds are invested in them. In 2018, he said, someone compared AMR to HIV/AIDs and that the missing piece of the puzzle was, it was agreed, money. Therefore, what he would like to see is action from the Global North to invest in the problem where the need is.

However, Thommes – on tangible solutions – posited a point of care rapid diagnostic, rather than antibiotics. Jones, from the perspective of demand, urged funding of better surveillance, but from a community citizen-scientist perspective, mentioning that the access route differs by seasons, for example, in some countries. So, there is also the supply chain issue. And O’Brien completely agreed: it’s about sustainable solutions and future proofing. One approach GARDP has been discussing with partners is an integrated access programme, he said.

AMR is a cross-cutting thing that aligns with a number of sustainable development goals, agreed Feasey. There is a need for protection, prevention, and control. On surveillance, the UK Government, he said, has invested half a billion in Fleming Fund. Jones noted the UK’s individualised perspective on health, rather than a community approach. To which, O’Brien mentioned the gonorrhoea community and that it’s clear for such a population that AMR impacts their choices: it is a community of direct understanding of the impact of AMR.

While there were lessons learned from population responses to testing during the COVID-19 pandemic, O’Brien reiterated the need for more data on antibiotic use in certain countries. But, he said, he’s excited to see how AI and ML can use AMR datasets for predictions and decisions; small datasets looking at efficacy and safety of antibiotics for resistance to particular phenotypes and genotypes. The missing piece, Feasey caveated, is coordination between primary and secondary care data. The global AMR hub data set is a 50/40 split in terms of funding versus discovery – and it needs to be better joined up, he said. A compartmentalised and fragmented approach is not best going forwards.

O’Brien suggested that what is needed is a greater connection of the FDA and the EMA, together with national agencies and pathways to enable faster discussion and registration with member states. Another attendee raised the topic of tuberculosis, which hasn’t seen a new antibiotic developed since 2013 (though O’Brien commented here that some antibiotics are in existence which are not being approved for use). Indeed, Thommes added that innovation in TB is being driven by the Bill and Melinda Gates Foundation, bringing together companies working in that area.

Thommes commented that a One World approach is needed, and that – despite the day’s ethos of the BioInfect event – the bubble of the North West of the UK cannot solve this issue alone. Solutions can come from there, but need to be applied in the right context in order to work for humankind.

About the author

Nicole Raleigh

Nicole Raleigh, Web Editor

Nicole Raleigh is pharmaphorum’s web editor. Transitioning to the healthcare sector in the last few years, she is an experienced media and communications professional who has worked in print and digital for over 18 years.

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