"Antibiotic resistance is a challenge so complex that it fascinates"

(Image removed) Eva Garmendia, Helle Aagaard, Agneta Richter-Dahlfors, Richard Bergström, Malin Grape

The accelerating antibiotic resistance is presenting research, society and care with numerous acute challenges. In order to secure global public health, new drugs, treatments and knowledge of how to use available tools are required. But who is supposed do the work? And how should it be financed? In late August, Uppsala University gathered representatives of academia, industry, authorities and opinion leaders to panel Antibiotics: Past. Present. Future. It quickly became obvious to the audience that the threat is very real - as well as that opinions differ on what is required to take the next step.

(Image removed) Malin Grape, AMR ambassador

“More or less every medical achievement is based on the premise that we can cure infections. Thus, resistant bacteria are endangering our entire healthcare system, making this challenge so complex that it fascinates. Still, if we are to highlight something positive, Sweden has shown that it is possible to influence for the better, and that what we need now is an international action plan with clear agreements,” stated Malin Grape, Sweden's – and the world's – first AMR Ambassador.

In a study published in journal The Lancet, 1.3 million people are estimated to have died in 2019 as a result of infections caused by resistant bacteria. Thus, making it one of the world's leading causes of death. Nonetheless, four decades have passed since science last identified a new antibiotic class approved for treatment. Inadequate financial incentives for the pharmaceutical industry are often cited as the reason, but is a functional business model really that impossible to achieve?

“Anyone who develops a new antibiotic must be prepared to see their product locked into Fort Knox, to give it away essentially for free and finally to see it lose its effectiveness. As Return On Investment is a decisive factor for any business operation, a new model for interaction between nations and corporations is required, and our experiences from the pandemic and the development of covid vaccines show that this is indeed possible,” notes Richard Bergström, Vice President of European affairs at IQVIA.

On the other hand, it is far from given what should be placed in the driver's seat during the development of medical innovations. On a direct question from moderator Eva Garmendia – of the Uppsala Antibiotic Center – a majority of the audience answered that public health needs must be in focus. Richard Bergström emphasized that profit is an aspect we can hardly overlook, while Agneta Richter-Dahlfors, Professor at KI and Director of operations at Aimes, was of diametrically opposite opinion:

(Image removed) Agneta Richter-Dahlfors, KI/Aimes

“To allow curiosity-driven research is absolutely necessary for scientific progress. Many innovations were created without responding to any obvious needs, but have over time gained decisive importance. Unfortunately, infections are not a scientific status area to explore. Thus, we have to create a structure that attracts both academia, small and medium-sized companies and, finally, Big Pharma to board the train.”

And finally, facing the many aspects of this, to say the least, complex problem: Which of all measures is really the most important? Despite numerous options to choose from, the audience's votes were relatively evenly distributed. Only "Make sure antibiotics are available everywhere" ended up - albeit barely - in the wake. A reasonable, if incorrect assumption, noted Helle Aagaard, Deputy Director at ReAct, an opinion-forming organization with focus on antibiotics.

“In fact, more people die from a lack of antibiotics than from resistant bacteria. We also know that when the right antibiotics are not obtainable, many choose what they think is the next best thing, which can in turn have even more serious consequences. Most importantly, however, the audience response shows that no single effort is sufficient in itself, but also, If I may add, that we must ensure that the paths we choose to prioritize will have the intended effect in all – not just rich – countries.”

FACTS

• The panel discussion Antibiotics • Past. Gift. Future. was held in the Uppsala University Main Auditorium on Friday 18 August.
• The panel was arranged in connection with the NorDoc Summer School 2023: Antibiotics According to a New Generation
• The panel included
• Helle Aagaard, Deputy Director, ReAct
• Richard Bergström, Former National Vaccine coordinator
• Malin Grape, Swedish AMR Ambassador
• Agneta Richter-Dahlfors, Professor, KI
• Moderator: Eva Garmendia, Uppsala Antibiotic Center

LEARN MORE

• Antibiotics • Past. Present. Future.
• NorDoc Summer School 2023

CONTACT

(Image removed) Anders Backlund, Professor
Uppsala University
Anders.Backlund@farmbio.uu.se

text: Magnus Alsne, photo: Mathias Hallberg