Lower- and middle-income countries stand to gain the most from policies that combat AMR but resources and implementation are difficult to put into place. What are the findings from the report which policy makers from such countries should take note of?
The economic gains from tackling AMR are greatest in lower-middle-income countries like India, as resistance rates tend to be higher in these countries than in high-income countries. We estimate that improving access to good healthcare treatment and a sufficient pipeline of new antibiotics for gram negative bacteria will improve middle-income-countries’ GDP by an estimated US$260 billion (Rs 2,172 crores).
Moreover, increasing AMR rates are likely to impact tourism, as some people—particularly the vulnerable—will avoid travelling to high-risk countries. We expect that this impact will be greater in countries that are perceived to have less good healthcare systems, which tends to be middle-income countries.
However, these negative trends can be avoided through improved access to, and innovation of new antibiotics, presenting a real opportunity for countries like India to reduce their healthcare costs and increase economic output.
What are some of the recommendations from the report in terms of steps to be taken by pharma companies and governments to mitigate AMR?
We need much greater financial investment to develop the new antibiotics and better healthcare treatments that the world desperately needs. We estimate that this will cost about US$63 billion (Rs 534 crore ). But the return on this investment will be far greater; by 2050, we expect healthcare costs to be US$97 billion cheaper, suggesting that this will be a cost-saving intervention. It will also increase global GDP by US$ 960 billion and provide health benefits worth US$ 680 billion, meaning that for every dollar or rupee we spend by 2050, we will have a return of 28 dollars/Rupees in 2050.
While US$63 billion might sound like a very high number, in reality it is less than the world spends on cosmetic surgery and less than video gamers spend on in-game purchases, each year— and it’s about an eighth of what the world spends on takeout coffee.
What is the role of vaccination campaigns in reducing the impact of AMR, in terms of investment and ROI?
Vaccines have an essential role to play in combatting AMR. Anything that stops people getting sick in the first place is unambiguously a good thing—not only for the patient, but also for society more generally, as it stops them passing the infection on to other people, meaning individuals will not need antibiotics and thus resistance won’t form.
While we do not look at vaccines in our new report, we do look at a package of preventative interventions which include improving access to clean water, sanitation and hygiene, and we found that the economic returns from prevention are very high. We estimate that to achieve universal vaccination for five vaccines that will significantly reduce resistant infections would cost US$4.6 billion a year. If AMR rates were to continue at their current pace, we expect that by 2050, vaccination rates will reach almost half the people not getting vaccinated today—so in reality we probably need an investment of US$2.6 billion to reach everyone else.
Low- and middle-income countries like India and Africa have limited resources to provide access to affordable antibiotics for a majority of their populations. What are the access strategies or models, recommended by the report, that could be followed to improve access so that AMR can be tackled, by reducing health care costs?
In this report we focus specifically on the benefits of access rather than how to achieve it. But at the Center for Global Development, we have done a lot of work on how to improve access to antibiotics. We believe there needs to be some kind of pooled procurement system that ensures a reliable supply of antibiotics into low- and middle-income countries. This could be built into an existing programme like the Global Fund to Fight Aids, Tuberculosis and Malaria or the Global Drugs Facility, which would ensure a reliable supply of both generic first-line antibiotics and low-volume reserve drugs.
Thankfully for India, it leads the world on pharmaceutical manufacturing, which means it already has good access to most antibiotics, but we need to ensure any new drugs approved are made available in India.
We also cannot underestimate the importance of improving access to and investing in basic healthcare. We need to ensure that people who are sick can reach a doctor and that there are good diagnostic tools available to ensure people receive a high quality of care.
viveka.r@expressindia.com
viveka.roy3@gmail.com