Inside Germany's push for a global anti-microbial resistance hub

German Chancellor Angela Merkel at the G20 Summit in Hamburg, Germany. Photo by: Bundesregierung / Steins

BERLIN — Germany is positioning itself as a key player in antimicrobial resistance research with the expected launch of a Research and Development Collaboration Hub, likely to be housed in Berlin. G-20 leaders agreed to form the research hub at their July summit in Hamburg and an initial planning meeting will take place in Germany later this month.

AMR has shot to the top of the global health agenda in recent years, spurred by worries that microorganisms — bacteria, viruses, fungi and parasites — are developing a resistance to the drugs that exist to combat them. With few replacements in the R&D pipeline, people may increasingly become infected with diseases with no cure.

The development of drug resistance is a natural phenomenon, but it has been hastened by the misuse and overuse of antibiotics and other treatments — including attempts to prevent livestock from getting ill by regularly giving them drugs preemptively.

Global leaders are coalescing around a World Health Organization-led framework to address the challenge: better stewardship of antimicrobial medicines, both in their human and animal uses; improved access to the drugs, but also to the diagnostic tools that ensure they are used appropriately; and rapid advances in research and development into new antimicrobial medicines, diagnostic tools and vaccines.

Germany has positioned itself as a leader on the third front. Officials told Devex they envision the hub as being based around a secretariat that will collect and analyze research into all facets of AMR: its spread, drug development and investment opportunities. Experts there will then try to guide donor countries and other actors as they decide where they will put their money. The hub will also pull together researchers, policy experts and drug company representatives to attempt to strike novel partnerships and address R&D roadblocks.

"This is the first time ever that such a comprehensive approach has been pursued that brings governments and nongovernment donors together so that they can coordinate their funding decisions with regard to actual needs in the area of public health," Georg Schütte, the secretary of state for the Federal Ministry of Education and Research, told Devex.

The threat

The full scale of AMR has never been documented, but antibiotic resistance is widespread enough to be present in every country, according to the WHO. At least 25,000 annual deaths in Europe are attributed to drug-resistant bacteria. Similar surveillance has not been conducted in the developing world, where the numbers may be even higher.

There is enough alarm that the United Nations General Assembly convened a high-level meeting on AMR in 2016 which concluded that drug resistance, if left unchecked, could devastate the broader Agenda 2030.

In the midst of the ongoing conversation about AMR, Minister of Health Hermann Gröhe said at a recent Berlin press conference that the German government had decided to "stop talking and do something.” Even though AMR is not overwhelming the country, it may take a toll on the health system in the longer term. Germany, officials said, has the resources to lead that effort.

Germany has now used its presidency of two critical rich-country groupings — the G-7 in 2015 and the broader G-20 this year — to push for action on AMR. Chancellor Angela Merkel secured consensus at this year’s G-20 on improving public awareness of AMR and infection prevention and control, as well as the creation of the R&D Collaboration Hub "to maximize the impact of existing and new antimicrobial basic and clinical research initiatives as well as product development."

The hub

Despite growing evidence of AMR, the private sector largely hasn’t responded with new research. Every antibiotic that is currently available is derived from classes that were discovered in 1984 or earlier, according to research from the Pew Charitable Trust. Drug companies have not expected new treatments to be profitable, both because the patient base is still low and many would likely be deployed in low- and middle-income settings.

"The challenge is that there hasn't been a market incentive to work on drugs and vaccines, which is why we've ended up a little bit where we are,” said Jamie Bay Nishi, the director of the Global Health Technologies Coalition, which pushes for R&D on a range of essential health technologies. “Now it's tricky. We have to make up that time gap and develop products as quickly as possible."

The hub might look into innovative financing models, such as creating pull incentives for pharmaceutical companies to re-engage in the field.

Keeping R&D around AMR at the top of the scientific agenda will be another hub priority. Because it emerged from the G-20 Summit, officials said the hub might be able to continue to leverage the clout of that body to renew attention over time by feeding back into G-20 mechanisms, such as meetings of health ministers.

"I think it's really to support coherence in terms of approach, to identify areas where we need to put more financial support" said Dr. Manica Balasegaram, who heads the Global Antibiotic Research and Development Partnership, a joint effort of the WHO and the Drugs for Neglected Diseases Initiative to develop and deliver new treatments.

Initial details about the hub — including who will participate — should be set following a meeting in Berlin later this month. The German government has invited representatives from other G-20 governments, as well as the WHO and other nongovernment actors, to Berlin for an early consultation on how to structure the hub and secure commitments to participate. Officials said they expect to invite non-G-20 members to join the hub down the road, as well.

An additional initiative emerging out of the G-20 process should also contribute to global efforts to address AMR. The AMR Industry Alliance emerged out of a May meeting of global business leaders, known as the B-20, in Berlin. The participants pledged to track progress on global commitments that have been made on AMR, while also identifying gaps and setting future targets.

Through the Federal Ministry of Education and Research, the German government has already committed 500 million euros ($599 million) over 10 years to AMR, some of which will go toward running the secretariat. Officials said they are waiting for the conclusion of the September meeting to set an official price tag.

Dr. Peter Beyer, a senior advisor at the WHO, said it was important to underscore the significance of actually putting money behind AMR research. In addition to the hub, Germany recently secured 56.5 million euros ($67.7 million) in pledges toward GARDP's efforts to develop new treatments for bacterial infections.

"I work for the WHO and we have a lot of resolutions and then you don't get the money to implement the resolutions sometimes," Beyer said. "Putting it in a declaration is diplomacy. Putting up money is much more challenging."

Update, October 4, 2017: This article has been updated to include additional information on AMR Industry Alliance.

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    Andrew Green

    Andrew Green is a Devex Contributor based in Berlin. He writes regularly about global health and human rights issues. He has also worked as Voice of America’s South Sudan bureau chief and as the Center for Public Integrity’s web editor.