The pharmaceutical industry plays an essential role in advancing antimicrobial stewardship and addressing the growing threat of resistant pathogens.
Resistant pathogens are becoming ever more widespread and difficult to treat, with some reports1 suggesting we have already entered a post-antibiotic era. The effects on patients, their families, and societies are devastating: antimicrobial resistance (AMR) threatens our ability to treat common infections in both humans and animals and to benefit from many other achievements of modern medicine.
The importance of access to effective antimicrobials and the need for responsible antimicrobial use, or antimicrobial stewardship (AMS), has been highlighted by the recent coronavirus 2019 (COVID-19) pandemic.
Clinicians around the world are dealing with vulnerable populations suffering from the viral illness and secondary bacterial and/or fungal, and potentially antimicrobial-resistant, infections. As we move through the peri-pandemic stages, AMS is likely to take on increasing importance as a global public health priority.
AMR action plans are being implemented on global2 and national3 levels. In recognition of the interdependence of human, animal, and environmental health (the “One Health” perspective, Fig. 1), these plans encourage multisectoral collaboration, including (but not limited to) governments, agriculture, healthcare providers, and pharmaceutical industry. The pharmaceutical sector’s role in developing new antimicrobials is well recognized, but industry also helps to address AMR by supporting AMS.
Does the pharmaceutical industry’s business model preclude its support of AMS?
Some would say “yes”—but I argue “no”.
The traditional commercial model relies on maximizing profits through sales volume. Although product promotion is a minor driver of actual antibiotic use,4 we know that antimicrobial use is a key driver of AMR. Some companies are experimenting with how to best alter their business model to decouple volume from sales incentives, and some countries5 are implementing ways6 to support such de-linkage.7
For such approaches to be successful, action from pharmaceutical companies and from legislative/regulatory bodies needs to happen in concert—it’s somewhat of a chicken-and-egg debate.
However, even with the current business model, companies that market antimicrobial agents have a social responsibility to support responsible use of these drugs, and investment in AMS also benefits commercial viability. There are four important reasons for this.
First, the responsible use of antimicrobials leads to better patient outcomes, which in turn promotes advocacy for the given product(s).
Second, slowing the development of AMR prolongs the commercial lifespan of a company’s marketed antimicrobial agents.
Third, AMR surveillance can lead to increased awareness of the need for certain antimicrobials based on the observed resistance patterns. This, in turn, can facilitate access to a company’s products where needed most.
And fourth, if patients are succumbing to AMR, they don’t have the opportunity to benefit from medications in other therapeutic areas (eg, oncology, diabetes, etc.) that may also be part of a company’s overall portfolio.
Although not necessarily reflected directly in a company’s bottom line, these benefits are no less important and have the added value of advancing a significant public health priority.
Is the pharmaceutical industry a good AMS partner?
Some would say “no”—but I argue “yes”.
Pharmaceutical companies certainly are not directly responsible for the successful implementation of institution-based AMS programs. However, the expertise and capabilities found within pharmaceutical companies can complement those of other stakeholders when collaborating on multi-sector AMS initiatives.
For example, pharmaceutical companies have employees with a broad range of experience, including but not limited to clinical practice, pharmacoeconomics, epidemiology, health literacy, communications, consumer behavior, market research and analytics, and marketing, along with a large customer network to facilitate best practice sharing.
Global pharmaceutical companies also offer an understanding of both the global and local perspectives and have a worldwide network of institutions with demonstrated ability to conduct clinical studies and surveillance.
The pharmaceutical industry is indeed a good AMS partner.
A recent article8 that I co-authored provided multiple examples of AMS activities that pharma companies can support. As a case study, we used our employer, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (known as MSD outside the USA and Canada), since ours is a globally-operating company marketing antimicrobials and vaccines for humans and animals. A few examples are provided below, grouped into 4 categories:
The pharmaceutical industry can and should take diverse, impactful actions to support AMS, free from commercial influence. We have the capabilities, capacity, and expertise to be a credible partner. Will you save us a seat at the table?
Figure 1. The One Health partnership to improve human, animal, and environmental health.
Source: CDC. Use of this figure, which is freely available at https://www.cdc.gov/ncezid/pdf/ncezid-2018-accomplishments-H.pdf, does not constitute endorsement or recommendation by the US Government, Department of Health and Human Services, or Centers for Disease Control and Prevention
Figure 2. The “Star of stewardship” principles used at Merck & Co., Inc. (Kenilworth, NJ, USA) to ensure that the company’s antibiotic and antifungal promotional material is supportive of AMS.
Hermsen is an infectious diseases—trained pharmacist who created, implemented, and co-directed a hospital antimicrobial stewardship program for several years before moving to the pharmaceutical industry, where she is now responsible for developing and executing a strategy to advance antimicrobial stewardship globally through education, implementation, research, and advocacy, with a One Health perspective.
The views expressed are those of the author and do not necessarily reflect the position or policy of Merck & Co., Inc., Kenilworth, NJ, USA.
Medical writing assistance was provided by Dominik Wolf, MS, and editorial assistance was provided by Michele McColgan, BA, both of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.
Potential conflicts of interests
Elizabeth D. Hermsen is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and owns stock or stock options in the Merck & Co., Inc., Kenilworth, NJ, USA.
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