Antibiotic and antimicrobial resistance is a major threat to public health – described by the World Health Organisation as threatening the “core of modern medicine”.
It is driven by the slow pipeline of new medicines development by the pharmaceutical industry and the overuse of antibiotics by humans and in farm animals, particularly pigs and poultry.
Countering this is widely seen to require both tougher regulation and the enforcement of existing rules, where these even exist. In particular regulation is needed for the promotion of antibiotics by the pharmaceutical industry and tighter rules on their usage in animal agriculture.
International cooperation is vital in the race to develop and distribute a safe, effective, affordable, and globally available Covid-19 vaccine.
Despite calls from low-income countries for greater levels of coordination, most rich countries are choosing to largely go it alone in the pursuit of Covid-19 vaccines that will serve their own populations first.
Governments are being urged to increase existing commitments to multilateral funding for international vaccine development, to prioritise cooperation through bodies such as the World Health Organisation, and to prioritise investing in global manufacturing capacity to ensure vaccines get to those that need them the most.
The business model of the major pharmaceutical companies incentivises them to pursue the development of drugs that are potentially the most lucrative. This could mean focussing on treating chronic conditions experienced by elderly people in wealthy countries rather than researching diseases widely experienced in low-income countries.
Drug prices can be very high and companies hold effective monopolies for treatments – problems of particular importance during any pandemic.
It has been proposed that private industry should be better incentivised to develop the medicines society needs most. Others argue that the profit-led pharma business model is in need of more fundamental reform. with a more direct hand for governments in the medicines innovation process itself.
Some go even further, advocating new models of public ownership of key parts of the development and production process, and the government taking a greater equity stake in the medicines that it supports.