[Recommendations] Creating Pull Incentives for Antimicrobials (March 24, 2021)

Since 2016, Health and Global Policy Institute has been working on the important issue of antimicrobial resistance through its work as secretariat of AMR Alliance Japan. Related to that work, today, the Nikkei FT Communicable Diseases Conference Asia Africa Medical Innovation Consortium (AMIC) AMR Consortium (Secretariat: AMR Alliance Japan) has announced new recommendation on the creation of a pull incentive for antimicrobials in Japan.

As we use antimicrobials more and more, the microorganisms that cause infectious diseases adapt, and grow resistant to treatment. This naturally occurring process is called “antimicrobial resistance” (AMR). The threat of AMR as a ‘silent pandemic’ is growing. In 2019, it was estimated that already approximately 8,000 deaths are occurring annually in Japan due to blood-stream infections attributable to two antimicrobial-resistant organisms, methicillin-resistant Staphylococcus aureus (MRSA) and fluoroquinolone-resistant Escherichia coli (E. coli). Antimicrobial Resistance (AMR) is already a health crisis. New antimicrobials are urgently needed to protect the public from this problem.

However, the number of new antimicrobials in development has been declining worldwide since the 1980s. This problem has arisen from a market failure. It can take 10-15 years and over US$1 billion to develop an antimicrobial. New antimicrobials are needed as insurance against the spread of AMR. For that reason, once an antimicrobial is approved for use, it is important to take care not to overuse it. As a result, new antimicrobials typically see low usage, and hence low sales, and companies face problems in covering post-approval costs. This issue has led to the collapse of five companies that developed antimicrobials in recent years.

The sustainable development of new antimicrobials will be impossible unless new policies are implemented to help address the problems in the antimicrobials market. Specifically, the world needs policies that can delink reimbursements for antimicrobials from their sales volume. Such measures are called “pull incentives.” Many countries are currently considering the implementation of these kinds of incentives. The United Kingdom has already begun a pull incentives pilot, and the United States is considering the Pasteur Act, which would create a pull incentive there as well.

AMR Alliance Japan (Secretariat: Health and Global Policy Institute) has been serving as secretariat for the Nikkei FT Communicable Diseases Conference Asia Africa Asia Medical Innovation Consortium (AMIC) AMR Consortium. Over the course of FY2020, the AMR Consortium has developed recommendations on measures to solve the above issues and organize discussion toward the development of recommendations on the introduction of a pull incentive in Japan. The full recommendations are available in Japanese. An executive summary from the recommendations is available below.


Recommendations on Pull Incentives for AMR in Japan Executive Summary
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