Without new antibiotics, antimicrobial resistance (AMR) represents a bigger threat to people's health than COVID-19. If this seems surprising, consider the facts: 700 000 people die every year from AMR. By 2050, this number is expected to rise to 10 million per year.

Antibiotics are losing their power, as bacteria develop defence mechanisms to resist their effects, becoming so-called ‘superbugs’ that cannot be treated with existing medicines. A world without effective antibiotics is one where surgery, cancer care and organ transplantation become too risky for millions of patients. This comes at enormous cost to individuals and society.

AMR also costs an estimated €1.5 billion in healthcare spending in Europe – a figure that will surely rise unless action is taken.

Despite the urgency of the problem, finding solutions has proven a major challenge. Discovering new antibiotics is challenging, from a scientific point of view, and the economic incentives are low: any new drug would be used only as a last resort.

Action needed

Solving this complex problem requires a holistic approach that includes collaboration across the health, food and environmental sectors and stakeholders, that includes prevention of infections, hygiene, stewardship measures, as well as a sound push and pull incentives ecosystem.

Over the past decade, the Innovative Medicines Initiative (IMI) has been a pioneer on the front of push incentives with collaborative research efforts between public and private partners. IMI has invested €1 billion in 14 innovative AMR projects.

Experts are drafting roadmaps for faster diagnosis of infectious diseases, supporting the appropriate, timely and tailored use of the antibiotics we have today. Companies and academics are working together to deepen understanding of the causes of resistance and stimulate the discovery of novel treatments. As a result, seven potential new drugs are being developed. Some of these may be the antibiotics of tomorrow.

For example, New Drugs for Bad Bugs (ND4BB) covers eight projects addressing diagnostics (TRANSLOCATION), accelerating drug discovery (ENABLE), and advancing clinical trials and disease surveillance (COMBACTE). Taken together, these projects illustrate the 360° approach IMI can bring to tackling all aspects of AMR.

These initiatives also support an ecosystem of researchers that will deliver long-term benefits to Europe. COMBACTE has built a network which connects over 1,600 hospitals and labs in more than 40 European countries. This diverse group is working on 11 clinical trials with six antibacterial molecules, while advancing epidemiological capacity.

AMR research also benefits from other IMI projects, including vaccine research programmes and the AMR Accelerator – a €145m initiative designed to speed-up the discovery of new medicines to treat patients with resistant bacterial infections such as tuberculosis.

Public-Private Partnership

IMI’s impact on AMR showcases the value of leveraging public and private R&D efforts. Many of the biggest public health challenges we face today cannot be solved by one company, one institute or one country: only collaborations have the financial firepower, technical expertise and knowhow required.

Drug discovery is invariably expensive, costing an estimated $1 billion to bring a drug to market. It is also risky and time consuming – most drug candidates do not make it to market and those that do take a decade to develop. Add to that the need to use any new antibiotic sparingly, and it is clear that traditional business models are ill-suited to the AMR crisis.

The DRIVE-AB project has developed recommendations for possible economic models that look to address the financial challenges of developing new antibiotics. IMI has provided a platform to identify new business models with the potential to ensure more companies invest in antibiotic research and advanced diagnostics.

A platform for the future

IMI has delivered significant investment and built valuable collaborations in AMR research. The initiative has provided a unique environment where clinical trial networks and science platforms have been created and used to better understand the science of resistance and to make progress towards the development of new medicines. This brings additional benefits by making Europe more attractive to investment and in supporting preparedness for future outbreaks of disease – including COVID-19. While the scale of the crisis is daunting, the IMI shows what is possible when we work together.

Broader market reforms are however essential if we wish enable long-term sustainable and continued investment to sustain this progress and deliver innovative solutions to the complex challenge of AMR.