Pharma Firms Must Come Together, Ensure Access to Antibiotics in Poor Countries to Take on Superbugs

In an era marked by remarkable medical advancements, a disquieting paradox is staring at us. While many parts of the world face a growing threat of antimicrobial resistance (AMR) owing to overuse of antibiotics, several low and middle income countries (LMICs) grappling with limited access to these drugs are also compounding the problem. A 2022 report by Access to Medicine Foundation suggested that in regions which experience both the highest rates of infectious diseases and highest incidence of AMR, lack of access to antibiotics is a major contributory factor, especially in poor countries. But this pressing concern is largely overlooked with economic considerations like low profit margins and limitations like weak supply chains getting in the way, as witnessed during the Covid-19 pandemic when LMICs struggled to get access to the vaccines.

The global challenge of ensuring widespread access to antibiotics is a critical issue in the developing world, where factors like inadequate healthcare infrastructure, limited resources and socio-economic disparities are obstructing the availability of these life-saving drugs. The lack of access to the right antibiotics at the right time has made bacterial infections lethal, leading to fatalities that could otherwise have been easily prevented. The problem is compounded by the fact that newer antibiotics which cater to resistant bugs are not launched in LMICs even years after they are approved in regulated markets. In fact, a paper published by University of Oslo and the Centre for Disease Dynamics, Economics and Policy (now One Health Trust) on the geographic availability of new chemical entity (NCE) antibiotics approved between 1999 and 2014 reported that the availability of NCE antibiotics is significantly delayed in LMICs even after 10 years of drug launch in high-income countries. The data reflected the affordability challenge in LMIC countries, where the problem stems from the lack of a market to drive commercial antibiotic development.

Alarmingly, AMR claims more lives than malaria and HIV/AIDS put together. Thriving on inequality and poverty, the African continent, especially Sub-Saharan Africa, bears the heaviest burden of AMR. A 2019 study published in Lancet reported 114 AMR associated-deaths per 1 lakh population in Africa as against 56 in high-income countries.

The African nation of Ethiopia, for instance, grapples with lack of access to crucial medications as it struggles to meet the demands of its growing population. Lower respiratory tract infections, including pneumonia and bronchitis, account for a significant portion of Ethiopia's disease burden. These infections continue to claim lives with barriers to access to antibiotics preventing timely and effective treatment.

The 2021 AMR benchmark report of Access to Medicine Foundation has found that though 80% antibiotics are off-patent, access to these drugs in LMICs continues to be a distant dream. While inappropriate antibiotic use remains a primary driver of resistance, poor access to antibiotics can allow bacterial infections to propagate unchecked, triggering conditions where resistance can develop through natural selection. In the absence of access to the right drugs, doctors have no other option but to resort to suboptimal treatments, which kill only some susceptible bacteria and allow the ones with resistant genes to spread unchecked. This worrisome situation underscores the importance of equitable access to antibiotics.

Addressing this crisis requires a multifaceted approach and a sense of deep commitment from the global pharma industry. Pharmaceutical companies can play a crucial role in bridging long-standing gaps in access to antibiotics in LMICs by making conscious efforts to strengthen their global supply chains and ensuring equity of pricing strategies to reach the most vulnerable populations.

They can also make a big difference by following an innovative approach involving initiatives like technology transfers, strategic partnerships, voluntary licensing agreements and participation in institutional tenders through competitive bidding. Government tenders can go a long way in improving access to antibiotics and making them more affordable in resource-poor settings. There is no reason why these initiatives will not serve the intended purpose if governments of the day back them by prioritising stewardship measures and preventing the influx of inferior drugs. Simultaneously, healthcare professionals should be entrusted with the responsibility of collecting and sharing data on a case-to-case basis on the kind of antibiotics needed in different LMICs. This will not only help in creating a sustainable market for these medicines, but will also streamline the registration procedures for generic antibiotics.

As we strive to advocate a future where antibiotics are used judiciously, the world leadership has a moral obligation to facilitate global access to affordable medicines by addressing disparities within and between countries, navigating pharmaceutical industry dynamics and fostering international cooperation through coordinated efforts. By prioritising antibiotic accessibility, the global community can contribute to a healthier, more equitable world.