Without action, AMR costs go from $66b to $159b/yr by 2050

Dear All,

A new paper from Anthony McDonnell and a team led by the Center for Global Development extends estimates of the health-related impact of AMR (e.g., death) to a consideration of the economic ($) cost of AMR. To follow the plot, here are the links you will need:

  • The new paper: “Forecasting the Fallout from AMR: Economic Impacts of Antimicrobial Resistance in Humans”
  • Antimicrobial resistance is dangerous in more ways than one“, a 26 Sep 2024 editorial in the Financial Times on the new report.
  • And then some background material
    • Below my signature you will find an expanded list of prior newsletter covering
      • The health-related impact (mostly mortality) of AMR
      • The economics of AMR
    • Of these papers, the two that I think are most helpful if you are new to the area are:
      • 29 Apr 2024 newsletter: “R&D Implications: Global Burden of Disease is 28% Infectious!” that discusses the important idea of DALYs (Disability-Adjusted Life Years)
      • 20 Nov 2022 newsletter: “Impact of PASTEUR: 9.9m lives saved, ROI of 125:1” that shows how DALYs can be converted to $.

You’ll need to do your own review of the new report, but the key point is that it seeks to further broaden our perspectives on the economic costs of AMR by going beyond just mortality and morbidity to compute value as the sum of reduction in health costs, GDP-based health value computed from DALYs, and macroeconomic factors such as population and workforce changes.

Let’s look at the key messages from this new report:

  1. The authors estimate that AMR currently increases the global cost of health care by US$ 66 billion/year
  2. With no new action: This is predicted to rise to US$ 159 billion/year  by 2050 in a business as usual (BAU) scenario if no action is taken and resistance rates follow historical trends.
  3. It could be worse: If resistance increases at the rate of the bottom 15% of countries, AMR health costs would rise to US$ 325 billion in 2050 and the global economy would be US$ 1.7 trillion smaller in 2050 (vs. the BAU scenario).
  4. If we act: The authors predict that if (i) high-quality treatment is provided to everyone with bacterial infections and (ii) we fund innovative new antibiotics, this would mean that by 2050:
    1. Global health costs could be US$ 97 billion/year cheaper.
    2. The global economy could be US$ 990 billion larger.
    3. Generated global health benefits could be worth US$ 680 billion per year.
  5. In short, it’s a LOT cheaper to act than not act: Improving innovation and along with ensuring access to high-quality treatment would cost about US$ 63 billion/year.
    1. That’s a global return on investment of 28:1.

As note above, this report goes beyond just mortality and morbidity to compute value as the sum of health costs, health value computed from DALYs, and macroeconomic factors. Visually, the key messages above reduce to this figure:


Yup … the tiny yellow bar at the bottom is the cost of all of these interventions combined:

  1. Access: Providing better treatment of bacterial infections by improving access to available treatments
  2. Innovation: Funding both creation of new therapies as well as providing the Pull needed to keep them in the market
  3. General measures: Vaccination, WaSH (Water, Sanitation, and Hygiene), etc.


And it’s important that this new estimate converges with prior work. Prior reports use different approaches to estimate overall costs and returns, but the overall flavor of all prior reports is similar. The best comparison is with the Bonnifield and Towse reports from 2022 (see the 20 Nov and 8 Dec 2022 “impact of PASTEUR” newsletters cited below my signature) in which we have estimates of ROI (return on investment) from PASTEUR that can be compared with the returns estimated in the new report. It’s hard to do a strict apple-to-apples comparison, but the long-term benefits are within ~2- to 3-fold of each other (see Table 4.1 at the bottom of page 49 of the new report).

Yow! These are the kind of data that drive change! As the report notes, “Making an economic case for investment in the fight against AMR has been a challenge across the world, partly due to competing priorities at all levels.” Exactly … there are LOTS of problem to solve … and it needs to be clear that action now on AMR is much cheaper than inaction.

Well done, Team CGD! We all need to roll up our sleeves and face this crisis together! All best wishes, –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://amr.solutions/blog/. All opinions are my own.

REFERENCE MATERIAL

  • Prior papers on health-related impact (mostly mortality) of AMR
    • 20 Jan 2022 newsletter: “#AMRSOS! GRAM report: “at least 1.27m deaths/year directly attributable to AMR” discussing the first big paper on the GBD for AMR.
    • 29 Apr 2024 newsletter: “R&D Implications: Global Burden of Disease is 28% Infectious!” discussing a further analysis showing that 28% of GBD is infectious and14% is bacterial!
    • 17 Sep 2024 newsletter: “#AMRSOS! AMR could worsen, killing 39m during 2025-2050” discussing an extension of the GRAM report.
    • Commentary: These papers are based on the global burden of disease (GBD) project that has been running since 1991. The 29 Apr 2024 newsletter provides an extended discussion of the project and its metrics.
  • Prior papers on the economics of AMR

Current funding opportunities

  • ENABLE-2 has continuously open calls for both its Hit-to-Lead program as well as its Hit Identification/Validation incubator. Applicants must be academics and non-profits in Europe due to restrictions from the funders. Applications are evaluated in cycles … see the website for details on current timing for reviews. 
  • CARB-X has open calls at intervals that span four areas: (i) Therapeutics for Gram-Negatives, (ii) Prevention for Invasive Disease, (iii) Diagnostics for Neonatal Sepsis, and (iv) Proof-Of-Concept for Diagnosing Lower-Respiratory-Tract Infections. See this 6 Mar 2024 newsletter for a discussion of the call and go here for the CARB-X webpage on the call. There are multiple opportunities to submit — see the CARB-X webpage for details.
  • BARDA’s long-running BAA (Broad Agency Announcement) for medical countermeasures (MCMs) for chemical, biological, radiological, and nuclear (CBRN) threats, pandemic influenza, and emerging infectious diseases is now BAA-23-100-SOL-00004 and offers support for both antibacterial and antifungal agents (as well as antivirals, antitoxins, diagnostics, and more). Note especially these Areas of Interest: Area 3.1 (MDR Bacteria and Biothreat Pathogens), Area 3.2 (MDR Fungal Infections), and Area 7.2 (Antibiotic Resistance Diagnostics for Priority Bacterial Pathogens). Although prior BAAs used a rolling cycle of 4 deadlines/year, the updated BAA released 26 Sep 2023 has a 5-year application period that ends 25 Sep 2028 and is open to applicants regardless of location: BARDA seeks the best science from anywhere in the world! See also this newsletter for further comments on the BAA and its areas of interest.
  • HERA Invest was launched August 2023 with €100 million to support innovative EU-based SMEs in the early and late phases of clinical trials. Part of the InvestEU program supporting sustainable investment, innovation, and job creation in Europe, HERA Invest is open for application to companies developing medical countermeasures that address one of the following cross-border health threats: (i) Pathogens with pandemic or epidemic potential, (ii) Chemical, biological, radiological and nuclear (CBRN) threats originating from accidental or deliberate release, and (iii) Antimicrobial resistance (AMR). Non-dilutive venture loans covering up to 50% of investment costs are available. A closing date is not posted insofar as I can see — applications are accepted on a rolling basis; go here for more details.
  • The AMR Action Fund is open on an ongoing basis to proposals for funding of Phase 2 / Phase 3 antibacterial therapeutics. Per its charter, the fund prioritizes investment in treatments that address a pathogen prioritized by the WHO, the CDC and/or other public health entities that: (i) are novel (e.g., absence of known cross-resistance, novel targets, new chemical classes, or new mechanisms of action); and/or (ii) have significant differentiated clinical utility (e.g., differentiated innovation that provides clinical value versus standard of care to prescribers and patients, such as safety/tolerability, oral formulation, different spectrum of activity); and (iii) reduce patient mortality. It is also expected that such agents would have the potential to strongly address the likely requirements for delinked Pull incentives such as the UK (NHS England) subscription pilot and the PASTEUR Act in the US. Submit queries to contact@amractionfund.com.
  • INCATE (Incubator for Antibacterial Therapies in Europe) is an early-stage funding vehicle supporting innovation vs. drug-resistant bacterial infections. The fund provides advice, community, and non-dilutive funding (€10k in Stage I and up to €250k in Stage II) to support early-stage ventures in creating the evidence and building the team needed to get next-level funding. Details and contacts on their website (https://www.incate.net/).
  • These things aren’t sources of funds but would help you develop funding applications
    • AiCuris’ AiCubator offers incubator support to very early stage projects. Read more about it here.
    • The Global AMR R&D Hub’s dynamic dashboard (link) summarizes the global clinical development pipeline, incentives for AMR R&D, and investors/investments in AMR R&D.
    • Diagnostic developers would find valuable guidance in this 6-part series on in vitro diagnostic (IVD) development. Sponsored by CARB-XC-CAMP, and FIND, it pulls together real-life insights into a succinct set of tutorials.
  • In addition to the lists provided by the Global AMR R&D Hub, you might also be interested in my most current lists of R&D incentives (link) and priority pathogens (link).

John’s Top Recurring Meetings
Virtual meetings are easy to attend, but regular attendance at annual in-person events is the key to building your network and gaining deeper insight. My personal favorites for such in-person meetings are below. Of particular value for developers are the AMR Conference and the ASM-ESCMID conference. Hope to see you there!

  • 17-20 Sep 2024 (Porto, Portugal; virtual attendance is possible): ASM/ESCMID Joint Conference on Drug Development to Meet the Challenge of Antimicrobial Resistance. Go here to register!
  • 16-20 Oct 2024 (Los Angeles, USA): IDWeek 2024, the annual meeting of the Infectious Diseases Society of America. Go here for details.
  • 25-26 February 2025 (Basel, Switzerland): The 9th AMR Conference 2025. Go here to register
  • 11-15 April 2025 (Vienna, Austria): ESCMID Global 2025, the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases. Go here for details. 

  Upcoming meetings of interest to the AMR community:

  • [LAST SHOW THIS SATURDAY 28 SEP – DON’T MISS IT] 28 Aug to 28 Sep (Off-Broadway, New York City, the Alice Griffin Jewel Box Theatre): Lifeline, the musical story of Sir Alexander Fleming’s discovery of penicillin. Previously entitled The Mould that Changed the World, the musical is a two-time Edinburgh Festival Fringe sell-out (2018 and 2022) and has toured to London, Glasgow, Atlanta and Washington DC (2022). This 5-week run in NYC is timed to be in support of the High-Level Meeting on AMR (HLM AMR) during UNGA 2024. Go here for a blurb and here to book your tickets!
  • 16-20 Oct 2024 (Los Angeles, USA): IDWeek 2024, the annual meeting of the Infectious Diseases Society of America. See Recurring Meetings list, above. 
  • 16 Oct 2024 (virtual and in-person, 10a-1p ET): FDA’s Rare Disease Innovation Hub, in collaboration with the Reagan-Udall Foundation will discuss how the recently announced Rare Disease Innovation Hub can engage and prioritize its work. This may seem somewhat remote, but could this have implications for rare infections? Hmm! Attend if you can! Go here for the meeting’s webpage.
  • 19-27 Oct 2024 (Annecy, France, residential in-person program): ICARe (Interdisciplinary Course on Antibiotics and Resistance). Now in its 8th year, Patrice Courvalin directs the program with the support of an all-star scientific committee and faculty. The resulting soup-to-nuts training covers all aspects of antimicrobials, is very intense, and routinely gets rave reviews! Seating is limited, so mark your calendars now if you are interested. Applications open in March 2024 — go here for more details.
  • 22-24 Oct 2024 (Belgrade, Serbia): Ecraid/ESCMID postgraduate course “Better methods for clinical studies in infectious diseases and clinical microbiology”. Go here to register by 29 Sep 2024.
  • 4-5 Dec 2024 (in person, Washington, DC): “Fungal Dx 2024: Fungal Diagnostics in Clinical Practice” is a 2-day in-person workshop organized by ISHAM‘s Fungal Diagnostics Working Group. The program and registration links are available at https://fungaldx.com/; the agenda is comprehensive and features an all-star global list of speakers.
  • 4-5 Feb 2025 (online, 1-5p GMT timing on both days): Antimicrobial Chemotherapy Conference by GARDP and BSAC in collaboration with CEPID-ARIES and Fiocruz. Now in its 6th year, the free program offers a good review of antimicrobial R&D, ranging from drug discovery to preclinical and clinical activities. Go here to register; the abstract deadline is 15 Nov 2024.
  • 11-15 April 2025 (Vienna, Austria): ESCMID Global 2025, the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases. See Recurring Meetings list, above.

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