The World Health Organisation has highlighted antimicrobial resistance (AMR) as one of the leading global public health and development threats today. AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobial medicines (including antibiotics, antivirals, antifungals and antiparasitics). This makes infections harder to treat and increases the risk of disease spread, severe illness and death. Microorganisms that develop AMR are sometimes referred to as “superbugs” and were directly responsible for 1.27 million global deaths in 2019 while contributing to 4.95 million deaths.
Combating this looming threat requires significant cooperation between national and international institutions as well as antimicrobial drug developers. The world needs new antimicrobials (as well as avoiding overuse of existing ones) but companies working in this field face an extremely challenging commercial landscape. Without the implementation of creative procurement, pricing, and reimbursement mechanisms for antimicrobials, the rewards for innovation in this space are simply too low. This means that even more companies will likely pull out of an already sparsely populated field, thereby increasing the risk that AMR poses.
Switzerland & the Global Fight Against AMR
However, there are glimmers of hope in the fight against AMR, many of them coming from Switzerland. On the public sector side, Switzerland has long held a leadership role in this space, with four different departments within the country coming together to develop a ‘Strategy against Antimicrobial Resistance (StAR).’ “This strategy contributed to the relatively low levels of AMR in Switzerland compared to our neighbouring countries,” explains Daniel Roth, general manager of Menarini, which was the industry sponsor for the last three antibiotics launched in Switzerland. “In June 2024 the Federal Council approved the Once Health Action Plan 2024-2027 with six priority areas of action. In some of these, international collaborations around AMR are also defined.”
Roth feels that Switzerland has a key global role to play. “The aim is that Switzerland, being a wealthy and capable country, should not wait for others but take the lead in shaping policies and solutions,” he states. “By doing so, Switzerland can inspire other countries to join and contribute. It’s a cause we believe Switzerland is ideally suited to champion, especially in the antibiotic space, where swift and decisive action is needed.”
One example of how Switzerland is moving the dial on this issue is the Swiss Tropical and Public Health Institute (Swiss TPH)’s work on digitalisation initiatives in Africa. Swiss TPH has developed clinical decision support systems, transforming cumbersome paperwork into accessible digital tools. “Now, instead of relying on manual, time-consuming processes, healthcare providers can use algorithms on tablets to quickly assess symptoms, determine necessary tests and reduce unnecessary treatments,” explains the Institute’s director, Jürg Utzinger. “This has led to a reduction in antibiotic prescriptions by as much as 80 percent and is therefore a crucial weapon in the growing yet silent pandemic of AMR.”
A Challenging Commercial Landscape
However, challenges abound for companies working in this space. For innovators, the development of an antibiotic is a costly endeavour, requiring more than EUR one billion in investment. However, the revenues derived from these products are very low, since innovative reserve antibiotics are only used as the last option to minimize AMR. This makes it difficult for pharmaceutical companies to commit to antibiotic R&D.
The situation is similarly tough for generics players. Miro Venturi, executive chairman of Stragen – a Switzerland-based but Europe-focused generics player with a significant antibiotics portfolio – explains that “the challenge with antibiotics is twofold: the market is saturated with generic producers, but hospitals frequently face shortages of essential antibiotics, especially those needed to combat AMR. This shortage is a pressing issue in healthcare.”
Venturi continues, “Larger pharmaceutical companies have largely exited this market due to low margins and the complexities involved in production. However, the need for antibiotics is growing, particularly with the rise of AMR in hospitals.”
This situation is set to worsen in the coming years. “Currently, we still have many older antibiotics that work effectively in many patients,” begins David Veitch, CEO of Basilea, a Basel-based biotech that has been able to commercialise (and turn a profit) with its own antimicrobial medicines. “The issue is the remaining instances when these treatments fail, which is increasing as bacterial resistance increases. Bacteria adapt quickly, and if they become resistant to our existing treatments, we could face a similar situation to COVID.”
“Although there are a lot of discussions about AMR, there is still not enough concrete action,” states Veitch, who highlights demonstrating superiority over existing treatments as the key component to his company’s commercial success in the notoriously challenging antimicrobial space. He warns, “We need to focus on real steps and meaningful incentives to encourage more companies to invest in this area.”
New Commercial Models
Cognisant of the issues facing antimicrobial companies, the European Union has launched several R&D schemes to support the development of these drugs. Roth feels that these schemes are “well-intended but fall short of being truly attractive,” highlighting the high development costs and low commercial rewards currently on offer.
New models are being bounced around, sometimes taking influence from unusual sources. “A promising solution under discussion is the ‘subscription model,’ sometimes referred to as the ‘Netflix model,’”, says Roth. “Under this framework, pharmaceutical companies receive a fixed annual payment for a well-selected product, guaranteeing its availability on the market. The UK has applied this model so far to two drugs, from Pfizer and Shionogi, guaranteeing these companies around GBP 20 million annually, independent of the volume of product used. Once sales reach a certain threshold, the company doesn’t receive any more payments.”
Veitch, himself a Brit, is similarly enthused with the UK’s approach. “I believe that this is one of the best global examples of a so-called ‘pull’ incentive, that can help companies once they get the new drugs to market. This approach promotes good medical practice, by keeping the drugs usage for appropriate patients, but incentivizes companies to continue investing in antibiotic development, knowing that they will receive a predictable fair return on their efforts. This kind of innovative commercial model is essential to ensure that we have the treatments we need, without overusing them and driving resistance.”
Roth is keen for Switzerland to adopt a similarly innovative approach domestically, especially given the country’s leading position in the global battle against AMR. “In Switzerland, we are still defining the eligibility criteria for this model,” he says. “A dedicated team, including representatives from the Federal Office of Public Health and the Swiss Round Table on Antibiotics (a group of experienced specialists) will determine which antibiotics qualify and what the appropriate compensation levels are. This approach could offer much-needed financial stability for companies in the antibiotic space, but more than financial incentives are required.”
