Global Antibiotic Research and Development Partnership (GARDP):

Written Evidence on the Future of UK Aid

25 May 2021

INTRODUCTION

The Global Antibiotic Research and Development Partnership (GARDP) is pleased to provide the following written evidence for the UK Parliament’s International Development Committee inquiry on the Future of UK Aid.

GARDP is a not-for-profit organization developing new treatments for drug-resistant infections that pose the greatest threat to health. An independent foundation since January 2019, GARDP was created by the World Health Organization (WHO) and the Drugs for Neglected Diseases initiative (DNDi) in 2016 to ensure that everyone who needs antibiotics receives effective and affordable treatment, no matter where they live. We aim to develop five new treatments by 2025 to fight drug-resistant infections, focusing on sexually transmitted infections, sepsis in newborn babies and infections in hospitalized adults and children. GARDP is funded by the governments of the United Kingdom, Germany, Japan, Luxembourg, Monaco, Netherlands, South Africa, Switzerland, as well as Médecins Sans Frontières and private foundations. www.gardp.org

GARDP is proud to be a partner with the United Kingdom in the response to antimicrobial resistance (AMR) and have long appreciated the international leadership the UK has provided in this area. We maintain robust partnerships with institutions in the United Kingdom, including the British Society for Antimicrobial Chemotherapy, St. George’s hospital, London, Oxford University, and the Wellcome Trust.

We are submitting our evidence to continue to promote the role of the UK as a key international leader and as part of its wider ability to project the country’s values, scientific expertise, and vision.

DISCUSSION

Strategy

We recommend the UK should include antimicrobial resistance (AMR) as both a priority area for UK aid and a cross-cutting objective across its seven focus areas. This requires investments in surveillance, preparedness, and strengthened health systems, as well as new investments into research and development to address drug-resistant infections.

As noted by the Review on Antimicrobial Resistance, mandated by the UK government five years ago, the crisis of AMR presents serious challenges to the UK and the planet. The Review stated that, ‘by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug-resistant infections if we do not find proactive solutions now to slow down the rise of drug resistance.’  Besides the consequences to the global economy and in terms of lives lost, the Review noted that if antibiotics ‘lose their effectiveness, key medical procedures (gut surgery, caesarean sections, joint replacements, and treatments that depress the immune system, such as chemotherapy for cancer) could become too dangerous to perform.’

The importance of AMR was again emphasized in the UK Government Integrated Review of Security, Defence, Development and Foreign Policy, which was published in March 2021. The Review noted that AMR ‘remains a long-term challenge to human health’ and indicated that the UK ‘will also strengthen domestic and international efforts to combat the threat posed by increasing AMR.’ AMR also plays an important role in UK foreign policy and bilateral relations with key trading partners.  For example, the UK included AMR within its G7 Presidency and included collaboration on AMR in its newly announced 2030 Roadmap with the Government of India.  

We believe that AMR would benefit from its placement as a standalone priority area, especially as this can ensure a comprehensive, UK-led response to the challenges and reforms needed across human health, agriculture, and the environment. Overseas Development Assistance (ODA) is especially critical since AMR, like any infectious disease, is a common problem which must be tackled effectively by all countries. Considering the overlap between UK’s ODA priority countries and high burden AMR countries, UK’s ODA investments against AMR in these regions will not only protect vulnerable populations but also support UK’s development, security and economic interests. UK ODA’s investments in antimicrobial resistance would also strengthen the UK’s current political leadership, such as its membership to the Global Leaders Group on Antimicrobial Resistance.

One critical element in addressing AMR is the need to ensure access to and develop new antibiotics that target WHO-designated priority pathogens for which there are few or no antibiotics to treat drug-resistant infections. The latest review by WHO in 2021 noted that the 43 antibiotics currently in clinical development are vastly insufficient to address the problem of drug resistance.

Such investments are essential to both protect the health and well-being of people worldwide and in the UK. This is especially critical considering the COVID-19 pandemic, which has demonstrated the extent to which infectious diseases can be imported and transmitted. A lack of preparedness, including investments in research and development of new countermeasures, and stockpiling of existing countermeasures, left all countries unprepared to respond to the pandemic.

AMR is a silent pandemic of drug-resistant infections, which can spread rapidly through international travel, migration, and supply chains. Yet unlike COVID-19, where governments and scientists are still learning about the disease and adjusting the international response, with AMR there is the ability and knowledge to prepare now. The drug-resistant microbes are known, and the potential economic and health impacts of AMR over the next 30 years have been calculated.

GARDP also considers that AMR should be considered a cross-cutting investment across several of the other priority areas that the UK government has identified. 

For example:

• AMR is a critical element of any credible prioritisation of global health security. AMR has been included within the global health security agenda for the last two decades and has featured in G20 discussions since 2016. In 2019, WHO named AMR as one of the 10 most urgent global health threats.

• Addressing AMR is necessary for a comprehensive approach to humanitarian preparedness and response. Drug-resistant infections can be a critical challenge in humanitarian emergencies and in conflict-affected areas and settings.  War wounds are often infected by bacteria.  For example, one observational study conducted by Médecins Sans Frontières (MSF) found that 40 percent of patients admitted into an MSF post-operative care facility in East Mosul arrived with multi-drug resistant infections. Inappropriate use of antibiotics, as well as lack of access to appropriate antibiotics, are also heightened in humanitarian emergencies.

• Investments in AMR are also investments in science and technology. This includes investments in the development of new antibiotics and diagnostics and improved investments in surveillance (which can also strengthen surveillance of other pandemic risks).

• Investments in AMR are also critical to strengthen economic development and trade. Such investments can ensure all countries adopt appropriate standards for both manufacturing (of medicines or raw materials) as well as appropriate agricultural and livestock management practices. Such investments in AMR can also lead to increased bilateral and multilateral cooperation to improve the development and production of antimicrobials that threaten the economic prosperity of both the UK and its trading partners.

Administration

GARDP recommends ensuring that the Department of Health & Social Care and the Foreign, Commonwealth and Development Office's (FCDO) have a co-equal role in determining how to allocate and spend UK contributions to safeguarding human health and strengthening health systems. While GARDP recognizes the benefits of centralizing and harmonizing aid spending, we believe that there is considerable expertise and insight across both DOH and FCDO that should be relied upon to make investments in international health.

GARDP recommends that the UK government should continue to make substantial investments into multilateral challenges for ODA, including investments into product development partnerships and not-for-profit drug development PDPs and not-for-profits provide an important channel for multilateral contributions from several governments that seek to address the many unmet needs across the pharmaceutical system. GARDP hopes that the UK can continue to make such contributions to drug-development partnerships, which can also collaborate constructively with the private sector and governments to develop necessary medicines, diagnostics, and vaccines to strengthen health systems and many of the priority areas identified by UK Aid.

Process

GARDP does not have any feedback.

Impact of the changes

GARDP considers that AMR must continue to be a priority of the UK government because such drug-resistant infections, if they go unchecked, untreated, and undetected, will have significant repercussions on the well-being and economic prosperity of the UK. Furthermore, addressing the social, economic, and health burden of AMR in low- and middle-income countries will ultimately benefit the UK (and the global community) due to effectively treating drug-resistant infections. 

The World Bank, in its 2017 Report: ‘Drug-Resistant Infections: A threat to our economic future’, noted that AMR, if unchecked, is a crisis that will affect all countries, but would be a crisis for which low-income countries would experience larger drops in economic growth than wealthy countries, and that global poverty and economic inequality would increase. The World Bank projected that in a ‘high AMR-impact scenario’, ‘an additional 24 million people would be forced into extreme poverty by 2030’, with most of the increase occurring in lower-income countries. These consequences would significantly hinder the capacity of the international community to reach the Sustainable Development Goal of eliminating extreme poverty by 2030.

On the positive side, there are many investments that can not only forestall the worst consequences, but can also allow countries to prepare, and where resistance does emerge, to provide people with safe, affordable, and effective treatments, including treatments for neonates and children.

In fact, while the World Bank estimates that the cost of AMR containment in low-and middle-income countries is at US$ 9 billion annually through 2050, the annual rate of return could reach 88 percent per year, which, according to the Bank, ‘is an exceptional economic and health investment for countries.’

CONCLUSION

GARDP recognizes the many difficult choices and trade-offs that must be made by the UK government to spend its aid commitments effectively. Yet we also strongly consider that investments in addressing AMR are not just crucial to preserve the economic gains of the last decade, to protect human life, and to safeguard many common medical procedures, but also because the consequences of AMR are known, and can be avoided.

The COVID-19 pandemic has taught all countries that no one is safe until everyone is safe, and that pandemics, including AMR, a pandemic of drug-resistant infections, requires not just investments at home, but partnerships and investments around the world.