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Skip to 0 minutes and 7 secondsToday, we're going to talk about antibiotic resistance from a business perspective. A company typically organises activities, resources, and investments to develop a new product-- let's say, a new generation of smartphones. With the prospective of selling many of them so they could recap the cost of R&D, manufacturing and marketing, and at the end of the day making a profit. Now, companies present in the antibiotic field are facing a big economic problem. As you already know by now, society needs new antibiotics. But at the same time, we need to reduce overall consumption and misuse to avoid the increasing resistance problem.

Skip to 0 minutes and 46 secondsIn economic terms, this means we are asking companies to invest more in R&D, but at the same time to sell much less of what they come up with.

Skip to 0 minutes and 58 secondsBottom line: companies do not see these as attractive or profitable business. They limit their investments and even decide to leave this market. Now, how can we tackle this rather critical situation? How can we increase on one side the antibiotics R&D, and improving responsible use and excess worldwide on the other? This is a complicated question that does not have a single straightforward answer. First of all, we need to better understand the value of antibiotics from the perspective of physicians, patients, payers, and society as a whole. Then we need to consider on one side the specificities of the different stages required to develop a new antibiotic.

Skip to 1 minute and 48 secondsAnd on the other, we need to consider the specificities of the countries and markets around the world. Many changes and initiatives have been discussed recently, and not only in Europe, but also worldwide. And I'm very optimistic! See, for instance, the Global Action Plan proposed by the WHA or the White House plan or the WHO and the UK reports on these matters. Also, IMI offers different initiatives and reports which you can consult in this course session. There are also several ongoing projects that you can refer to. For instance, look at the report from the Uppsala Health Summit 2015 and at the Drive-AB website, where a lot of information is about possible solutions to this big problem.

Skip to 2 minutes and 35 secondsFrom the work done so far, some core ideas are clearly coming out and lead the way. Now, I want to focus particularly on three of those. De-linkage, corporation, and a systemic approach. So first of all, many advocate the necessity to adopt a de-linkage model as a solution. For instance, see the Chatham House report also on this session of the course, which illustrate a lot of information about the possible de-linkage methods. De-linkage means introducing mechanisms that separate the sales from the profits. Now, what this means is that you could introduce, for instance, reimbursement for companies that are engaging R&D in antibiotics. And then they reach a certain success along the path.

Skip to 3 minutes and 28 secondsIt could also be done by providing prizes to the successful projects. Obviously, also, there could be some subcontracting or tender made by the agencies of the government bodies, which would take away the pressure of sales from those that are involved in R&D efforts. These and other de-linking mechanisms aim at sharing risk among different stakeholders and provide in a return for those that actually are getting out R&D, which is not linked to sales. The second aspect is cooperation. Specifically, I mean the necessity to increase sharing of R&D efforts between differing organisations-- both private, small or large companies, but also public entities, such as universities or agencies and governments. New private-public partnerships are to be explored.

Skip to 4 minutes and 24 secondsSo to share the risk, an economic burden of the new investments. Platform for providing cooperation and sharing of knowledge needs to be created as well. No company or organisation alone can reach breakthrough within the current market situation. Most important, initiatives need to be coordinated internationally as much as possible, and particularly so if we want to improve not only innovation, but also stewardship level. The third and last aspect is the necessity to adopt a systemic approach to the antibiotic resistance problem. On one side, the development of new antibiotic already presents many steps. Along its value chain that necessitates different interventions by different actors and the use of different pull or push mechanisms.

Skip to 5 minutes and 17 secondsHave a look, for instance, at the publication provided from the American Journal of Law and Medicine, which does such type of analysis. On the other side, we cannot only focus on developing new antibiotics, but we need also to intervene and better regulate a controlled use and access. This means a huge effort in coordinating and matching proper interventions together, in order to manage in an optimal way what is at the end of the day a very complicated economic equation. Thank you very much.

How can we tackle this rather critical situation?

Watch professor Francesco Ciabuschi talk about the need to increase development and innovation within the field of antibiotics research.

Find out more

In the See also section of this step, you can access links to the Uppsala Health Summit 2015: ‘A World Without Antibiotics’ website and the DRIVE-AB website.

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This video is from the free online course:

Antibiotic Resistance: the Silent Tsunami

Uppsala University