What to do when the drugs don’t work? Health messaging and the world’s silent pandemic

Chris Hulme, Director

Fear and shock have a place in public health campaigns seeking to change behaviour – think drink-driving awareness or stop smoking – but otherwise most of us dislike being targeted with scare tactics.

At the moments of highest anxiety during the Covid pandemic, the messaging acknowledged as much by putting a positive emphasis on ‘Stay Home, Protect the NHS, Save Lives.’ Yet what can you do when the health crisis is potentially even more deadly than Covid – which claimed around seven million lives – and continues to be largely ignored by everyone, including the world’s largest pharma companies?

According to the World Health Organisation, about 4.5 million people each year die from an anti-microbial resistant (AMR) infection. This is happening because we are running out of effective antibiotics. Bacteria have become resistant to the drugs that we routinely use to treat the risk of infections from medical procedures as straightforward as dental work through to major surgery. Dame Sally Davies, Chief Scientific Adviser at the Department of Health from 2004 to 2016, put it simply in the title of her much-admired book: The Drugs Don’t Work: A Global Threat.

It is well understood that the dwindling supply of effective antibiotics is about market failure – pharma companies avoiding the financial risks associated with classes of drugs that are extremely costly to develop, but only used sparingly, to focus instead on medicines where volume and therefore sales and profits can be maximised.

The UK has periodically led efforts to get us all off this slippery slope into a pre-antibiotic era. One of the most important pieces of work was commissioned by then Prime Minister David Cameron.  He asked an internationally renowned economist, Lord Jim O’Neill, to explore the implications of unchecked AMR infections. The O’Neill Review was published in May 2016 and concluded that the global cost in lives will be 10,000,000 a year by 2050 – about the same as the current death rate from cancer – and produce a $100 trillion cumulative loss in global production.

The O’Neill Review is one of several important studies that pose fundamental questions about approaches to public health and perhaps even how institutional investors should view the sector.  To continue the comparison with oncology: imagine receiving a cancer diagnosis and being kept alive by new drugs developed as a result of vast R&D expenditure and the tireless work of our best scientists and medical teams, only to die from an associated infection for which there is no treatment.

The scale of the challenge is acknowledged by everyone from the UN down but there is still a seemingly fathomless void in terms of public demand for action or behaviour change around the overuse of antibiotics in animal and human health. Where is the Greta Thunberg to speak up about what this will mean for all of us? Where are the calls for ethical investment?

Never one to shirk a challenge, Lord O’Neill was among the scientists and industry stakeholders who gathered in Liverpool at The Spine in February this year to rally themselves once again to the AMR cause. They were taking part in the Bioinfect Conference, which is produced by the north of England life science industry group Bionow.

Influential was part of the team that collaborated with Bionow to establish the first Bioinfect conference back in 2014. Ten years on, one of our clients Renewvax, which is working on a vaccine to tackle AMR-resistant infections, helped curate the programme.

For the original conference we structured the day into two parts – challenges in the morning and solutions in the afternoon sessions. This time, that order seemed to spontaneously reverse itself.  The opening keynotes featured researchers from around the world highlighting progress. These included Professor Janet Hemingway, one of the UK’s most distinguished scientists.  In 2020 she founded iiCON, a consortium of industry and academia with a major focus on speeding up development of antimicrobial products and treatments. iiCON has got off to a flying start, getting contracts in place with 345 companies to support R&D and helping get 36 new products to market. 

Professor Janet Hemingway, founding director of iiCON

Professor Hemingway is also one of the leaders seeking to establish Liverpool City Region as a supercluster of innovation focused on infectious diseases; hence the choice of location for the event. From the U.S, there was John Rex, a vastly experienced drug developer with more than 40 years of big pharma behind him, whose insights carry weight in the global AMR community. John Rex asked everyone to zoom out a little and see the big picture: over a 20-year period, progress has been made and the kind of change that’s required was never going to happen overnight.

On the day I had the opportunity to ask Lord O’Neill about the fate of his recommendations since his landmark report was published. Given that he managed to get AMR on the agenda at the G20 summit, I am comfortable saying that I hung on his every word. Unlike the keynotes in the morning, Lord O’Neill’s presentation was somewhat pessimistic about the future. He sounded weary of big pharma and the way it ‘talks and talks and talks’ without apparently doing much on AMR. The Pasteur Act, a much-vaunted piece of legislation to incentivise research in the U.S, fared little better – a sceptical wince at its seemingly interminable and byzantine journey, never quite making it through the Congress.

Lord O’Neill did flag one encouraging sign: concerns about the over-use of antibiotics in livestock farming potentially changing consumer behaviour in the U.S consumer market. Two fast food chains, Shake Shack and BurgerFi, have prospered by making a point of stressing that the beef they use is antibiotic-free. There’s a feeling they may spook much bigger industry names into changing practices.

Lord O’Neill wondered out loud if it might take a wild card, someone like Elon Musk, to come from outside the pharma space and get to grips with the reality of millions of people dying for lack of an effective response.

One of his other brutal conclusions also stayed in my mind: nothing is going to change until this story is on the evening news, every night of the week.

There’s a short clip of the interview here: