BERLIN — Conceived during Germany's 2017 Group of 20 presidency, a new hub for efforts to combat antimicrobial resistance is now taking shape in the country's capital, Berlin.
Germany used its leadership of the rich-country grouping to spotlight growing global concerns about AMR, or drug-resistant bacteria and viruses. The World Health Organization has stressed that the problem is fueled by the misuse and overuse of antibiotics — not just in humans, but also in animals and farming — and that no new significant class of antibiotics has been developed since 1987.
An annual report on the use of antimicrobial agents in animals aims to respond to the deaths of 700,000 people each year that are attributed to drug resistance.
But global health experts have also emphasized how little is known about AMR, with no comprehensive overview of what research is being done to understand, mitigate or combat it. In creating the Global AMR Research and Development Hub, Germany has sought to fill that gap.
The hub was launched at last year's World Health Assembly, although activities only really got underway toward the end of 2018. The secretariat is focusing first on creating a dashboard to document research and development efforts already underway, while it works to set future priorities.
Development actors are pushing to ensure those reflect the particular needs of low- and middle-income countries, concerned that those nations tend not to guide the global AMR agenda given their lack of funding for research.
The hub “will be an important tool for making prioritizations,” said Andreas Sandgren, policy advisor at ReAct, a network that has long been pushing for global engagement on AMR. “We need to ensure that we are not too one-sided on the area of research that it covers and that it's not too narrow a scope of geographic distribution — that it covers the needs that are taking place around the globe.”
A looming crisis
AMR has risen quickly on the global health agenda, spurred by the looming crisis of “a post-antibiotic era in which common infections could once again kill,” as the WHO’s 2015 “Global Action Plan” warned. The hub joins a range of new efforts to prevent this from happening, including a center for international research on antibiotic resistance in Denmark, and an ad hoc U.N. interagency coordinating group that just released draft recommendations charting a global response to AMR.
The hub was conceived as a fulcrum for these efforts — helping align national and international initiatives and using data to bolster the research agenda. It is fully financed by the German government, part of a €500 million ($556 million) pledge over 10 years to address AMR, though the hub's funding is only initially guaranteed for three years. That puts some pressure on the small secretariat to move quickly on delivering useful products, Dr. Elmar Nimmesgern, who leads the hub’s five-person team, told Devex.
The dashboard emerged as a clear early priority, he said. "There are plenty of things going on, but there's really no place where you can assess ‘is this really the right thing that we should be doing? Are we perhaps overemphasizing certain areas of research and not doing enough in other areas?’"
The team is drawing from established databases, including those compiled by the U.S. National Institutes of Health and the Sweden-based JPIAMR, which draws funding from the European Commission and Wellcome Trust among others, to map activities across many of its 27, mostly European, member countries. But the hub is also reaching beyond to capture efforts that are less well documented, including research into animal and environmental health.
“I hope it will become a virtuous feedback loop,” Nimmesgern said, “where when we have data and can present it, it can help us identify additional sources and information.”
A truly global response
Given the influence the hub's mapping could have on AMR R&D, outside observers said that inclusiveness will be critical — particularly in ensuring that the opportunities and needs presented by lower-income countries are not overlooked.
“What's currently missing is what's going on at the country level of the G-20 countries, but also outside the G-20 countries,” said Richard Gordon, executive director of the grants, innovation, and product development unit at the South African Medical Research Council. “What research institutes are there and what infrastructure is already there? That needs to be a really key role that [the hub] can help coordinate.” A comprehensive census will highlight what is still being overlooked, and raise questions as to why, analysts said.
In welcoming the hub's creation last year, Médecins Sans Frontières called for a focus, “on new health tools that are affordable, accessible and adapted for use in even poorly-resourced settings.” Nimmesgern said the goal is for the dashboard to be as comprehensive as possible, though he cautioned the research would take time, before leveraging the findings to spur conversations about financing and incentives. “These are really discussions that the community needs to have, but we can instigate it,” he said.
Germany is positioning itself as a leader on R&D of new treatments for diseases facing antimicrobial resistance.
The hub is also taking steps to create opportunities for representatives from lower-income countries to regularly give feedback, both on the dashboard, but also its general direction. The secretariat is currently finalizing a stakeholder group that will include academics and civil society organizations, alongside industry representatives, who can provide direct feedback to the hub's board, which draws its 15 current representatives mainly from the governments of higher-income countries.
While the hub is not a funding instrument, the idea is that the information it gathers will help guide policymakers as they decide what investments to make, and also point to under-resourced areas — particularly into potential drugs that do not traditionally draw attention because their research costs are seen as too high and their market too limited. The U.N. coordinating group’s recommendations underscored that encouraging research into new antimicrobials and effective alternatives is critical to any global AMR response.
At the same time, the hub’s initiatives “must span a large area of research and development and innovation," Sandgren advised. “Not only focusing on initiatives and research that are within the area of drugs, vaccines, and diagnostics, but also the whole panel of research questions that might also cover operational research and behavioral research and other areas that do need innovation and investments.”
Given the limited global resources dedicated to AMR, ReAct cautioned that a disproportionate focus on antibiotics might pull funders’ attention away from health system innovations, for instance, that might prove more useful in slowing resistance.
Although the hub’s early efforts are likely to focus on mapping new antibiotics, Nimmesgern said that would be “just the starting point,” with an aim to expand to other interventions that have an R&D component. For now, the team is focused on delivering an initial version of the dashboard, with the aim of having a technical plan in place and publishing the first round of analysis by June.