Antimicrobial Resistance and the Circular Economy

On 24 January, BBC Radio 4 addressed the issue of antimicrobial resistance (AMR) in an interview with UK Health Secretary Matt Hancock. Over-use and under-development of antibiotics has the potential to seriously affect our ability to tackle infections and bacterial diseases. Reducing over-use calls for action from the public to use antibiotics more wisely. Under-development is a separate matter altogether. In the last 25 years there have been no new antibiotics produced. Take a moment to think about that. No new incarnations of the cornerstone of modern medicine since the 1980s. So why is this?

Mr. Hancock explained the drivers and barriers around antibiotics in more detail at the World Economic Forum on 24 January. At the highest level, there is not enough incentive for change. Antibiotics used today broadly work and thus new research is not at the top of list for many companies. Commercially, new drugs designed to combat heart issues and cancer are much more lucrative, buoyed by their uniqueness. On the other hand, antibiotics are much more common and hence, sold more cheaply. Regardless of their less weighty price tag, the annual NHS expenditure on antibiotics is £1 billion. All this on treatments which are becoming progressively less effective, while the new contenders cry out for investment. The NHS Welcome Trust revealed that there are around 40 new drugs waiting in the wings, but require costly clinical trials to bring to the front-lines. So how can research be encouraged, antibiotic supply continued, and the future of healthcare secured?

The government’s answer: via a key principle of the circular economy. I’ll explain.

The AMR Vision and national action plan, presented by Mr. Hancock at the World Economic Forum, laid out the 20-year plan for the UK. Its targets include cutting resistant infections by 10% in 5 years, cutting antibiotic use by 15% in 5 years and, within 6 months, changing the procurement method of the NHS. The final point there is the one that piqued our interest. But why?

The NHS will no longer buy the antibiotic pill, rather, the service of effective antibiotics.

In effect, only the drugs that are effective will be paid for. Transitioning from purchasing a product to purchasing a provided service is key to the circular economy. This places efficiency and effectiveness above bulk and over-consumption. Companies producing antibiotics will have much more incentive to develop new drugs, with the financial support of the government to do so. Furthermore, this new procurement method will operate within the current antibiotics budget, so money will be better spent (or possibly even saved).

In other words, this method will focus on improving resource efficiency, encouraging product quality advancements and collaboration with industry. These are all key pillars of the circular economy and we welcome this evolution for the likely benefit it will bring the NHS, the UK as a whole, and as a case study for future procurement.

Jake Harding