The joint symposium on antimicrobial resistance (AMR), held by the WTO, the World Intellectual Property Organization (WIPO) and the World Health Organization (WHO), highlighted the importance of global cooperation in fostering innovation of, and access to, new antibiotics as well as the appropriate use of antibiotics.
WIPO Director-General Francis Gurry opened the joint symposium and recalled that the trilateral cooperation was timely and pertinent and had provided the policy debate with tangible outcomes.
He noted that AMR was a problem that crossed many disciplines and involved political awareness. Innovation in its broadest sense was part of the solution, in terms of both science and governing structures. He stated that the microbes had a very instructive innovation model: their cost structures were inexpensive and efficient; they borrowed laboratories and premises free-of-charge and the cycle for bringing on new products was very short. Intellectual property mainly focused on a private innovation model at the intersection of science and the economy. He asked why the private market incentive model had not produced good results in antibiotic research in the last several decades, noting that the United Kingdom's Review on Antimicrobial Resistance had suggested some market-related impediments to innovation.
WTO Director-General Roberto Azevêdo said: “In dealing with a complex global health challenge such as that of antimicrobial resistance, the response must be joined-up. It must rely on a wide range of empirical data and sound policy analysis. And it must be global.” His full speech is here.
DG Azevêdo stressed the WTO has an important role to play in helping face the challenges of antimicrobial resistance.
First, trade ensures that more people have access to affordable medicines. In particular, DG Azevêdo noted that the WTO's Trade Facilitation Agreement would tackle red tape and cumbersome border procedures, helping to expedite the clearance of perishable and refrigerated goods, including medicines. He also cited the amendment to the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which will give legal certainty that generic medicines can be produced and exported under compulsory licence for the benefit of countries with no or limited pharmaceutical production capacity.
Second, the WTO agreements allow members to take necessary measures to protect human health or the environment — even if these restrict the trade of certain products. Governments may set rules to encourage the responsible use of antibiotics in order to address antimicrobial resistance. In doing so, WTO members are encouraged in the WTO Agreement on Sanitary and Phytosanitary Measures (SPS) and the Technical Barriers to Trade (TBT) Agreement to base any restrictive measures on international standards, guidelines or recommendations where they are applicable. This could in turn support the implementation of international standards and good practices for appropriate use of antibiotics.
The Special Representative for Antimicrobial Resistance of the WHO, Keiji Fukuda, stated that antimicrobial resistance had been undergoing a major transition. Instead of being considered as a complex technical issue for a limited audience, it is now understood as a fundamental social threat like climate change. He underlined a strong need to find better and more sustainable approaches to research, development and access to new products and technologies. He said that most people and many organizations are still not familiar with AMR. A broad and functional level of multisectoral cooperation and coordination is essential to tackle AMR. Mr Fukuda stressed the concept of “one health” has to become a daily working reality with harmonized work across sectors, agencies, civil society and industry. A global development and stewardship framework would facilitate and help harmonize appropriate use in both the health and agricultural sectors and would be a major step forward. Yet, for many countries and communities, lack of access is a dominant issue, he said.
Ms Hala Audi, of the United Kingdom's Review on Antimicrobial Resistance, delivered the keynote speech. She said that according to the team's estimation, if no action is taken to address AMR, 10 million more people would die annually and 100 trillion dollars of GDP would be lost by 2050. She stated that the antibiotics pipeline remains too weak and there is a need to stimulate development and for new market mechanisms to incentivise innovation. The solution, however, is not only in new drugs but also in behaviour changes. Preventive measures, such as vaccines or better sanitation, and better diagnostics are essential. Looking forward, Ms Audi stressed that recent international commitments, such as one by G20 leaders in September 2016 and initiatives by the OECD, WHO, the UN General Assembly and others, would help to address the issues.
Participants from governments, academics and international agencies underlined the need to engage all stakeholders in fostering the appropriate use of antibiotics.
In a panel on new approaches to fostering access and appropriate use of antibiotics, Professor Evelina Tacconelli of Tübingen University introduced research on drug resistance and proposed a global mechanism to monitor resistance. Ms Eveline Wesangula, coordinator of the Global Antibiotic Resistance Partnership of Kenya, stressed that the AMR agenda is a great opportunity for countries to strengthen their national health systems. Mr Rob Ahern of the Inter-American Institute for Cooperation in Agriculture (IICA) underlined that AMR is a global issue as resistance could spread across borders through global value chains, and a solution to the problem needs to involve the private sector as well as international organizations.
In another panel on business models for antibiotic innovation, Mr Jean-Pierre Paccaud from the Global Antibiotic Research and Development Partnership (GARDP) explained the vision to develop sustainable finance tools that allow new drugs to be put on the market and to build strong partnerships for this purpose. Ms Viviana Muñoz Tellez from The South Centre reviewed current innovation models from a business and public health perspective and addressed some specific challenges in developing new innovation systems, such as those related to intellectual property barriers and the idea of de-linking research and development (R&D) costs from product prices. Mr Brian Woolhouse from the pharmaceutical company MSD stressed the need for having a mixture of incentives for innovation that are predictable and sustainable because the innovation cycle is long. He suggested working out the tension between cost, access and stewardship and stressed the importance of collaboration across government, industry and society.
In a panel discussion on trade policy in support of antimicrobial access and stewardship, Ms Monique Eloit, Director General of the World Organisation for Animal Health (OIE), highlighted the role of international standards to ensure safe trade in animal products. Mr Lucas Sversut of Brazil's Permanent Mission to the United Nations introduced his country’s experience in international cooperation to promote better access to medicines and tackle antimicrobial resistance. In particular, he warned that antimicrobial resistance should not become a smokescreen to disguise measures restricting trade and travel. He also emphasized the need to agree on a definition of what is understood as appropriate use of antibiotics. Professor Jørgen Schlundt of Nanyang Technological University pointed out that the overuse of antibiotics, in particular as an animal growth promoter, poses great challenges to human health. He foreshadowed an increased use of trade restrictions by major importing countries, in particular those prohibiting antibiotics as an animal growth promoter, as a tool to encourage responsible use of antibiotics.
This symposium is the sixth in a series of joint technical symposia convened by WHO, WIPO and WTO. It builds on the collaborative work undertaken by the three agencies to enhance capacity, including the trilateral study Promoting Access to Medical Technologies and Innovation.
The issue of antimicrobial resistance has attracted growing global attention in the global community. In September 2016, world leaders committed to curb the spread of infections that are resistant to antimicrobial medicines at the United Nations High-Level Meeting on Antimicrobial Resistance.