We are great at generating reports; on solving global collective action problems, not so good
The House of Commons Science and Technology Committee report is out (ungated but no pdf yet), calling for more dramatic action to preserve antibiotic effectiveness. The Report focuses on stewardship, prevention and new treatments for bacteria (including vaccines & diagnostics). This comes on the heels of the Prime Minister’s announcement last week of a 2 year study commission on antibiotic incentives (TIE post here).
Several research gaps were identified, particularly etiology from the agricultural and environmental sectors (pars. 45 & 51) and the need for basic data on use and resistance (par. 56).* I was disappointed that the research gaps did not discuss long-term human capital investments to retain and build capacity to perform basic science in antibiotic resistance.
The Report correctly noted the influence of health system structure and reimbursement in affecting stewardship and infection control. Health systems researchers should take note.
The most uneven work was in economic incentives. The best section was on “decoupling” (or delinking) company rewards from sales volume (pars. 68-70). This is the focus of a Chatham House process started last year that I serve on (interim report here; next report due in October).
The conclusion at par. 82 is undoubtedly correct that a menu of incentives will be needed, but the Report does very little to describe what those might be. In several places, this devolves into just a listing of various opinions without analysis of which ones are better supported by the evidence (par. 73 on patent extensions is an egregious example). While the Report notes the Prime Minister’s study commission, it hopes that action on incentives won’t have to wait for 2 years. Duly noted.
The most puzzling omission in this section on incentives was the €6.2 million grant from the EU Innovative Medicines Initiative to study economic incentives in antibiotic use and creation (disclosure: I have a role on that grant). That effort (DRIVE-AB), involves a wide array of stakeholders across Europe, including many in England.
* As bad as UK data are, data in the US are much worse, hamstrung by industry efforts to prevent public dissemination of fully transparent data on antibiotic use in agriculture. US resistance data in hospitals are good (NARMS) and will soon get better (ARM), but not in animals.