Presentation on theme: "Professor Anthony Kessel Thanks: Jasper Littmann, Mark Wilcox"— Presentation transcript:
1 Professor Anthony Kessel Thanks: Jasper Littmann, Mark Wilcox PHARMACEUTICALS AND GLOBAL HEALTH: INEQUALITIES AND INNOVATION IN THE 21ST CENTURY ANTIMICROBIAL RESISTANCE AND GLOBAL HEALTH SECURITYUNIVERSITY OF SUSSEXJuly 19th 2013Professor Anthony KesselDirector of Public Health Strategy, Director of Research and DevelopmentPublic Health EnglandThanks: Jasper Littmann, Mark Wilcox
3 Timeline I: Discovery of microbes and the first systematic infection control policies in hospitals Anton van LeeuwenhoekFlorence NightingaleJoseph Lister167618471870antiseptic hand washproposition of germ theorycausal link between bacteria and diseasediscovery of bacteriahygiene in field hospitalsintroduction of antiseptic surgery1840s18641890Ignaz SemmelweissLouis PasteurRobert KochTheory of MiasmaGerm Theory33
4 Timeline II: From germ theory to antimicrobial therapy William S. HalsteadAlexander FlemingSelman Waksman1890Introduction ofsurgical masks1928discovery ofsulfonamides“The time has come to close thebook on infectious diseases”1943introduction of surgical glovesdiscovery ofpenicillin18971932Streptomycinis discovered1967Johannes Mikulicz-RadeckiGerhard DomagkSurgeon Gen. William StewartPre-antibiotic ageAntibiotic age44
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 Penicillin resistanceFirst MDR caseTB & MDR-TB ‘global health emergency’1948Treatment for plantdiseasesMethicillin resistancein S. aureus19551993First confirmed case of completelydrug-resistant TB in Mumbai*Resistance observedin StaphylococciS. Dysaentriaeoutbreak in Japan19521961WHO declaration2011Streptomycin first used in agricultureFirst case of MRSAComplete drug resistancePre-antibiotic agePost-antibiotic age?*http://www.bbc.co.uk/news/health66
8 Reserve Constable Albert Alexander John Radcliffe Hospital. Dec 1940. First penicillin treatment for staph infectionReserve Constable Albert AlexanderJohn 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 Oxford8
11 Antimicrobials by Indication No Quinolones, Rare Cephalosporin
12 Consequences of inadequate initial antibiotic treatment 42.0%17.7%p<0.001Critical illnessBlood stream infection61.9%28.4%p<0.001% of hospital mortality60.8%33.3%0%10%20%30%40%50%60%70%p<0.001Pneumonia1. Kollef MH et al. Chest 1998; 113: Kollef MH et al. Chest 1999; 115: Ibrahim EH et al. Chest 2000; 118:146-55
13 Newly marketed antimicrobial agents in UK 3-year periods 1990–2010 Antibacterial agentsAntiviral agentsAntifungal agentsAntiparasitic agents101274398Antimicrobial 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 1st, 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 PracticeImproving Infection Prevention and ControlRaising Awareness and Changing BehaviourBetter research, better evidenceDeveloping new drugs and treatmentsImproved surveillanceStrengthen international collaboration
16 “Super-wicked problems” Time for finding a solution to a policy challenge is running outThose seeking to solve the problem are part of the causeCentral authorities to address the problem are either weak or non-existentPolicy responses discount the future irrationally
17 For discussion: Change from ‘path dependency’ Rationing of antibiotic useCreate new antibiotics but don’t use themNew ways to incentivise the drug industry