Drugmakers are being urged to make more antibiotics and antifungal drugs available to low- and middle-income countries as drug resistance rises faster than expected globally.
Infections that are resistant to drugs can spread rapidly without people’s access to essential antibiotics and antifungals that treat serious systemic infections such as cryptococcal meningitis, a type of meningitis caused by a fungus.
Much of the attention so far has been on developing new antibiotics and other drugs to tackle “superbugs”, but there has not been enough focus on making older medicines available in low- and middle-income countries, according to a report from the Access to Medicine Foundation, a non-profit group based in Amsterdam. It is sending the study to the group of G20 nations in the hope of having the issues included for discussion at their next summit in Bali in November.
Worldwide, more than 1 million people die of antimicrobial resistance each year, more than the 700,000 estimated in 2014, according to a report by the Gram (Global Research on AntiMicrobial resistance) project published in the Lancet this year. Drug resistance is worst in sub-Saharan Africa.
When doctors cannot get hold of the drugs they need, they are forced to prescribe less effective alternatives, which creates opportunities for viruses and bacteria to develop resistance and become “superbugs”.
“The people who face the highest risk of infection and the highest rates of drug resistance have the hardest time getting the antibiotics they need to survive severe bacterial and fungal infections,” the foundation’s report said. Only 54 of 166 medicines and vaccines for infectious diseases assessed by last year’s study were covered by an access strategy to make them available to low- and middle-income countries.
The coronavirus pandemic has made things worse. Antibiotic supply chains tend to be international and complex, with many players, and were disrupted by the closure of borders and lockdowns. While lockdowns and increased hand-washing helped reduce other infections, “Covid definitely threw a big curveball into the supply chain”, said Jayasree Iyer, the foundation’s chief executive.
She added that there was little incentive for drugmakers to sell their antibiotics and antifungals in poorer countries, where they face thin profit margins and fragile supply chains.
However, the report concluded that better insight into local demand, diversifying supply chains and long-term procurement strategies via tenders (to secure a volume of medicines or vaccines at a specific price) should help drugmakers sell older medicines in those countries.
The study highlighted several positive examples. Since 2008, France’s Sanofi has allowed local firms in Nigeria to make an off-patent antibiotic called metronidazole (Flagyl), which treats gastrointestinal infections and other conditions. In 2015 Sanofi partnered up with May & Baker, once the subsidiary of a British chemical company, which now produces 500,000 boxes of the antibiotic every year for the Nigerian market.
