From time to time we will use BiologyOnTheBox to aggregate coverage on the same story from a number of different broadcast sources. This is one such post.
In 2014, David Cameron established a Review on Antimicrobial Resistance, under the chairmanship of economist Jim O’Neill (the man previously credited with coining the acronym BRIC to group together the emerging economies in Brazil, Russia, India and China). In December 2014 The review published their first report Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations followed in February 2015 with their second, Tackling a Global Health Crisis: Initial steps.
The press coverage described below comes from 14th May 2015, the day on which the Review published their most important report to date, Securing New Drugs for Future Generations: The pipeline of antibiotics. Publication of the report garnered widespread coverage, including the news items documented here. This is by no means an exhaustive list, but reflects the kinds of issues raised across the day (programmes are listed here in chronological order).
This file is actually a splice of two sections from the programme; a prefilmed package in which Fergus Walsh (1:50) gives background to the situation and includes an interview a woman who is immunocompromised following transplant surgery and therefore reliant on effective antimicrobials. The second part is one of the many interviews conducted with Jim O’Neill over the course of the day. He emphasises that this is a global problem, needing a global solution and that China may play a crucial role in their forthcoming role as chair of the G20. I was struck by his use of the notion of “enlightened self-interest” as a motivator for the pharma industry to become re-engaged in antimicrobial production.
There are a number of frustrations in this file, I am not convinced that the antibiotic shortage at present is due to new medicines being held back for future use – I think the threat of this might have been a disincentive for pharmaceutical companies, but I don’t believe there is a secret medicine cupboard somewhere which has spare antibiotics in it for future use. Secondly, Charlie Stayt unfortunately makes a verbal glitch as he introduces the interview with O’Neill saying that the problem is that “there are more drugs that are resistant to bacteria” to which O’Neill replies “that’s exactly the problem” – this would need to be pointed out if the clip was to be used in teaching.
Today (Radio 4):
This clip features an interview with Professor Laura Piddock, from Antibiotic Action, on the Radio 4 Today programme. Prof Piddock endorses the importance of a global innovation fund to kick-start research into new drugs. She also highlights the need to prevent infection and stop resistance development. This is not going to be a one-off solution – bacterial will continue to evolve resistance to new drugs, but it is vital that something is done now. Piddock also hopes that we will have learnt the lessons from some of our previous misuse of antibiotics, and that we will therefore demonstrate better stewardship with any drugs developed from here on in.
This clip unfortunately starts with an onscreen graphic relating to a previous story, but the early introduction is helpful as it emphasises the prophylatic importance of antibiotics, not just the treatment of established infections. Victoria Derbyshire then interviews Jim O’Neill. She asks him how his committee came up with the estimate of 300 million unnecessary deaths if action to resolve this issue is not forthcoming. O’Neill argues that the figures suggest there will be 100 trillion dollars worth of economic harm if we allow the current situation to develop unchallenged, involving 10 million deaths per year – we might be back to an era where a simple cut, for example shaving or gardening, could result in an untreatable infection.
O’Neill echoes arguments made previously that the current model of investment in antibiotic production doesn’t fit the expectation for pharmaceutical companies. They want to maximise sales for as long as possible, whereas we want people to be taking antibiotics for as little time as possible to avoid resistance development. He flags an interesting point that might serve as a carrot for re-involvement of the pharmaceutical industry in antibiotic research, namely that the monies they are spending on more attractive medicines, such as expensive cancer therapies, will be wasted if we can’t keep patients alive with antibiotics. This is where his notion of “enlightened self-interest” comes in. This represents a change of mindset and business model.
The discussion moves on to the importance of patients and GPs not taking antibiotics unnecessarily. O’Neill floats the idea of a Bollywood movie with a script that reinforces the need to tighten the use of antibiotics in India. Other strategies would be tailored to raising awareness in appropriate ways in different parts of the world.
Newshour (Al Jazeera):
This report also starts with the World Health Organisation estimate of 10 million additional deaths per year by 2050. It illustrates the story with footage from a typhoid outbreak in Zimbabwe (from 2012). The threat of a “post antibiotic era” is noted, with the re-emergence of disease such as TB which people think of as diseases of the past. Following yet another interview with O’Neill looking at economic arguments, the piece then moves on to the importance of tackling agricultural use of antibiotics. Finally, there is another interview with Laura Piddock who notes that we haven’t run out of antibiotics but there is an increase in the number of infections for which the options are very limited. She points to current research into compounds that can inhibit bacterial growth which might potentially be useful therapeutic agents. She also points to the merger of pharmaceutical companies which has caused a reduction in funding for antibiotic resistance by the companies themselves and in universities because there are fewer companies passing on incentives for basic scientific research of that kind.
BBC News at 6:
http://bobnational.net/record/295494 (3:09) This programme features another report by Fergus Walsh, different from the one included on BBC Breakfast. For this item, Walsh visits both India and America. In India he sees life on the “frontline” of resistance development. A combination of poor sanitation and poor management of drug regimes provides ideal circumstances for resistance development. In America, Walsh visits researchers who are looking to soil microbes to find new antimicrobial compounds. He describes this as a “surprising source”, however many of the initial antibiotics discovered in the 1940s and 1050s came from soil microbes and experts in the field (such as my colleague Eric Cundliffe) have been saying for many years that revisiting the soil, and culturing organisms found there under different growth conditions is likely to be more effective than combinatorial chemistry and high-throughput screening. The most promising new drug Teixobactin has been found using a soil-screening strategy.
At the time of writing, some of the Fergus Walsh VTs are also available via the BBC website.
Ian King Live (Sky News):
This is another long interview with Jim O’Neill. The interview was conducted by Ian King as part of his programme which has an emphasis on financial news. In consequence, the emphasis here is primarily on the economic arguments, some of which have been summarised in the earlier clips. There is also a brief interview with Dr Neil Murray, Chief Executive of RedX Pharma who explains why developing antibiotics has not been an attractive prospect for them in existing financial models.
A shorter piece (2:27) with Ian King from Sky News earlier in the day is available via this link.
If there are any other clips relating to this story that add specific content not covered by one of the items above, then please let me know and I’ll see if we can add them. Incidentally, if anyone wants my take on the matter here’s a link to my BBC News interview with Jane Hill from the day that David Cameron announced the current review. I stand by my views both that this is a problem that we’ve known about for ages and that the solution will require a different financial model. However if it has taken “translation” of the biological and medical issues into economic language before governments will take the problem seriously then so be it. Let’s hope that the new initiative can genuinely get pharma back on board developing novel antimicrobials.