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PHARMACEUTICALS AND GLOBAL HEALTH: INEQUALITIES AND INNOVATION IN THE 21 ST CENTURY ANTIMICROBIAL RESISTANCE AND GLOBAL HEALTH SECURITY UNIVERSITY OF SUSSEX.

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Presentation on theme: "PHARMACEUTICALS AND GLOBAL HEALTH: INEQUALITIES AND INNOVATION IN THE 21 ST CENTURY ANTIMICROBIAL RESISTANCE AND GLOBAL HEALTH SECURITY UNIVERSITY OF SUSSEX."— Presentation transcript:

1 PHARMACEUTICALS AND GLOBAL HEALTH: INEQUALITIES AND INNOVATION IN THE 21 ST CENTURY ANTIMICROBIAL RESISTANCE AND GLOBAL HEALTH SECURITY UNIVERSITY OF SUSSEX July 19 th 2013 Professor Anthony Kessel Director of Public Health Strategy, Director of Research and Development Public Health England Thanks: Jasper Littmann, Mark Wilcox

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3 Timeline I: Discovery of microbes and the first systematic infection control policies in hospitals 1847 1864 Florence Nightingale Louis Pasteur Ignaz Semmelweiss Joseph Lister Anton van Leeuwenhoek 1676 discovery of bacteria antiseptic hand wash 1870 1890 Robert Koch 1840s hygiene in field hospitals proposition of germ theory introduction of antiseptic surgery Theory of Miasma Germ Theory causal link between bacteria and disease

4 Timeline II: From germ theory to antimicrobial therapy 1928 1932 Johannes Mikulicz-Radecki Gerhard Domagk Selman Waksman William S. Halstead 1890 introduction of surgical gloves Introduction of surgical masks 1943 1967 Surgeon Gen. William Stewart 1897 discovery of penicillin discovery of sulfonamides Pre-antibiotic age Antibiotic age Streptomycin is discovered Alexander Fleming The time has come to close the book on infectious diseases

5 The War is Over! In 1967, the U.S. Surgeon General William Stewart stated: It is time to close the book on infectious diseases, and declare the war against pestilence won.

6 Timeline III: From antimicrobial therapy to antimicrobial resistance 1955 1961 Streptomycin first used in agriculture First case of MRSA TB & MDR-TB global health emergency 1948 Resistance observed in Staphylococci Treatment for plant diseases 1993 2011 Complete drug resistance 1952 S. Dysaentriae outbreak in Japan Methicillin resistance in S. aureus Pre-antibiotic age Post-antibiotic age? WHO declaration First MDR case First confirmed case of completely drug-resistant TB in Mumbai* Penicillin resistance *http://www.bbc.co.uk/news/health-16592199

7 Flu isolation wards 1918

8 Reserve Constable Albert Alexander John Radcliffe Hospital. Dec 1940. First recipient of IV penicillin for purulent staphylococcal infection of head and neck; one eye enucleated. Produced by Florey, Chain and Heatley in Oxford

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11 Antimicrobials by Indication No Quinolones, Rare Cephalosporin

12 42.0% 17.7% p<0.001 Critical illness Blood stream infection 61.9% 28.4% p<0.001 % of hospital mortality 60.8% 33.3% 0% 10% 20% 30% 40% 50% 60% 70% p<0.001 Pneumonia Consequences of inadequate initial antibiotic treatment 1. Kollef MH et al. Chest 1998; 113:412-420 2. Kollef MH et al. Chest 1999; 115:462-474 3. Ibrahim EH et al. Chest 2000; 118:146-55

13 Newly marketed antimicrobial agents in UK 3-year periods 1990–2010 Antibacterial agents Antiviral agents Antifungal agents Antiparasitic agents 1990-199210122 1993-19957411 1996-19983911 1999-20013801 2002-20043820 2005-20073710 2008-20101420 Antimicrobial Chemotherapy. Eds. Finch RG, Davey P, Wilcox MH, Irving W. OUP, 2012.

14 Would you develop a new antibiotic if... It took 10 years and cost several hundred million pounds? Chance of falling at the 1 st, middle or last hurdle? If get to market, put on the top shelf (out of reach of most)? If unlucky, arrived at wrong place wrong time? If manage to prescribe, use for 5 days only?

15 What do we need to do? New national strategy / WHO Optimising Prescribing Practice Improving Infection Prevention and Control Raising Awareness and Changing Behaviour Better research, better evidence Developing new drugs and treatments Improved surveillance Strengthen international collaboration

16 Super-wicked problems Time for finding a solution to a policy challenge is running out Those seeking to solve the problem are part of the cause Central authorities to address the problem are either weak or non-existent Policy responses discount the future irrationally

17 For discussion: Change from path dependency Rationing of antibiotic use Create new antibiotics but dont use them New ways to incentivise the drug industry


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