It has been 8 years since the Review on Antimicrobial Resistance “Tackling Drug-Resistant Infections Globally” was published. This is often referred to more colloquially as “The O’Neill report on antimicrobial resistance”. The report presents AMR as a critical global health threat that could lead to 10 million deaths per year by 2050, with a $100 trillion economic cost. It highlights the growing crisis of drug-resistant infections, driven by overuse and misuse of antibiotics in humans and animals, lack of new drugs, and poor global health infrastructure.
Cost of tackling AMR
The report estimates that the cost of a global strategy to address AMR would be around $40 billion over 10 years. It compares this to the significantly higher costs of inaction, both in human lives and economic loss. The report highlights that much of this funding could come from reallocating resources from existing health and economic development budgets or creating new funding streams such as taxes on antibiotics.
Key takeaways
The report underscores the urgent need for a coordinated global effort to combat AMR. It proposes actionable solutions to reduce unnecessary antibiotic use, including through use of rapid antimicrobial susceptibility testing, promote new drug/vaccine development, and improve infection control measures. If left unaddressed, AMR could reverse decades of medical progress, making routine surgeries, cancer treatments, and infectious disease management much more dangerous. It proposes that Governments, industries, and international organiations must work together to ensure a sustainable future with effective antimicrobial treatments
The report also pointed to the importance of being proactive rather than reactive in terms of seeking to address global AMR issued. Of course, the world has since had to deal with a global COVID pandemic and the pandemic has offered new perspectives on several key issues raised in the report, particularly around preparedness, global coordination, and the importance of rapid diagnostics. Here’s how the pandemic has reinforced or recontextualised the issues:
1. Global Health Preparedness and Surveillance
The COVID-19 pandemic exposed the vulnerabilities in global health systems and demonstrated the critical need for robust preparedness and surveillance—one of the main pillars of the report. Just as with AMR, COVID-19 highlighted how the interconnectedness of our world can accelerate the spread of diseases, emphasising that no single country can tackle global health threats alone. The development of early warning systems and better global health surveillance for infectious diseases (as proposed in the report) has gained new urgency. As mentioned above, surveillance systems, like the WHO's GLASS for AMR, have seen some expansion during the pandemic, but significant gaps remain in low- and middle-income countries.
2. Rapid diagnostics
During the COVID-19 pandemic, rapid diagnostic tests were developed at an unprecedented pace, showing the world what is possible when innovation is prioritised. However, while COVID-19 diagnostics advanced, the same urgency has not been applied to rapid tests for bacterial infections. The pandemic underlined how crucial these tools are not just for reducing antibiotic misuse, but also for quickly identifying the nature of infections and responding accordingly.
3. Investment in R&D and innovation
The success of COVID-19 vaccines and treatments has demonstrated the impact that coordinated global investment can have on drug and vaccine development. This aligns with the report's call for greater incentives for antibiotic research and development. The quick mobilisation of funds for COVID-19 vaccine development (e.g., initiatives like COVAX) could serve as a model for future AMR-focused global initiatives. The pandemic has shown that when the threat is high enough, large-scale public-private partnerships can drive innovation swiftly—a principle that can be applied to tackling AMR.
4. Reducing unnecessary antimicrobial use
The pandemic has placed additional strain on healthcare systems, leading to increased antibiotic use, particularly in the early stages when bacterial co-infections were suspected in COVID-19 patients. Studies during the pandemic showed a high rate of unnecessary antibiotic prescriptions, despite COVID-19 being a viral infection. This exacerbated concerns about the potential for accelerating AMR as a secondary impact of the pandemic. The issue reinforces the report's call to reduce the unnecessary use of antimicrobials in healthcare, particularly through better diagnostics and stewardship programs.
5. Global collaboration and political will
The COVID-19 pandemic highlighted the need for international cooperation, which was a major point in the report. While the global response to COVID-19 was uneven, it also showed how global governance bodies, such as the WHO, can be mobilised to coordinate responses to public health emergencies. However, the uneven access to vaccines and treatments during the pandemic also underscored the challenge of equitable distribution—an issue that is equally relevant to the fight against AMR, where poorer nations often lack access to essential antibiotics and new treatments.
Conclusion
In light of the COVID-19 pandemic, the issues raised in the report are more relevant than ever. The pandemic has underscored the need for better global health preparedness, innovation in diagnostics and treatments, and coordinated global action—exactly the areas that the report emphasised. COVID-19 serves as both a warning and a blueprint for how the world can and must address the looming AMR crisis.
What has been done since the publication of the 2016 report, in terms of developing new antimicrobials, vaccines and diagnostics? It would appear from published literature, that there has been some progress in developing new antimicrobials, vaccines, and rapid diagnostic tools, although challenges remain.
1. Antimicrobials: There has been a modest increase in the development of new antibiotics, with the number of drugs in the pipeline growing from around 80 in 2021 to 97 in 2023. However, the rate of true innovation remains slow, as most new antibiotics are variations of existing classes, which limits their long-term effectiveness against resistant strains. Only a few truly novel antibiotics have emerged since 2016, and the economic incentives for developing these drugs remain insufficient, particularly due to the high costs and low financial returns in the antimicrobial market.
2. Vaccines: There has been a notable increase in the recognition of vaccines as a critical tool to combat antimicrobial resistance. Vaccination reduces the need for antibiotics by preventing infections in the first place, which can help slow down resistance. While vaccines targeting specific bacterial pathogens have been in development, their impact is still limited by issues like slow approval processes and lack of widespread deployment in low-income countries.
3. Rapid diagnostics: The development of rapid antimicrobial susceptibility tests (AST) has advanced significantly, with innovations like nucleic acid amplification, biosensors, and microfluidic devices showing promise. These technologies are crucial for quickly identifying resistant bacteria and ensuring appropriate antibiotic use. However, widespread adoption of these diagnostic tools remains slow, particularly in outpatient settings, despite the technology being more widely available in hospital laboratories.
Overall, while innovation activities in these areas appears to have increased since 2016, there is still a need for greater financial incentives, more global collaboration, and faster adoption of new technologies to fully address antimicrobial resistance.
A recent paper assessed the state of antibacterial drug discovery through patent analysis and made some interesting observations. The paper acknowledged that there has been an increase in antibacterial drug patent applications filed since 1990. However, the paper observed that larger pharmaceutical companies were filing less antibacterial patent applications and in fact, many large pharmaceutical companies had exited antibacterial research and development. Whilst this is clearly a worrying observation, the reduction in patent filings by large pharmaceutical companies, was being offset by other organisations.
The paper warns against using patent analytics as the sole measure of innovation and suggests that a broader set of metrics is needed. However, in the therapeutics field, the value of patents cannot be underestimated and looking at patent filing data can be highly reflective of what trends may be observed in particular therapeutic fields.
Almost 10 years ago now, we looked at patent filings in relation to new antibiotics (Marks & Clerk Life Sciences Report 2015). We found that new antibiotic patent families remained relatively constant over the period 2004 – 2013. We were interested to know if any change has happened since then, in view of the increased concerns and publicity surrounding AMR. We have carried out further patent further patent searching analysis, in order to see what changes, it any, have occurred since our previous analysis.
The graph below shows the number antibiotic related patent families that have been filed between 2015 and 2024. Due to the 18-month delay in patent publication, the results for 2023 and 2024 are not yet finalised and so the data from these years should not yet be taken into account.
Apart from a dip observed between 2019 and 2020, presumably due to the COVID pandemic, it can be seen that there has been an increase, year on year, of antibiotic patent filings, from 2015 - 2022. Whilst the increase in numbers is certainly encouraging, there does appear to be a recent slowing down in terms of the numbers of antibiotic patents being filed each year. It will be interesting to see, once the full 2023 and 2024 data is available, if the filing numbers are actually plateauing. Most critical of course is the actual commercialisation of new antibiotics, but given the attrition observed between identifying a new pharmaceutical product and actually bringing a new pharmaceutical product to market, the more new antibiotic patent filings there are, the better the likelihood of some new antibiotics making it to market.
We propose analysing our new antibiotic patent filing data in much more detail and providing further insight in due course. As well as looking at new antimicrobial patent filings, we also intend looking at vaccines and rapid diagnostics patent filings, in order to see if the concerns reflected in O’Neil’s report and/or the COVID-19 pandemic have resulted in an increased focus in AMR directed research and development.
