← The CGD Podcast
The CGD Podcast
“Google For Doctors”: How the G20 and World Bank Can Help Tackle Antibiotic Resistance – Lord Jim O’Neill
00:20:52
The UK government-sponsored AMR Review, led by Lord Jim O’Neill, describes a burgeoning human tragedy wrought by growing antimicrobial resistance which, if unchecked, could see one person die every three seconds by 2050. O'Neill joins the CGD...
Loading summary
Transcript49 lines
- [00:05]
A
Hello, I'm Rajesh Merchandani. Thanks for joining me for this edition of the CGD podcast. Now, 10 million deaths a year by 2050 at a cost to the global economy of $100 trillion. Those are the scary projections if the world does nothing to tackle the advancing threat of antimicrobial resistance, that is the fact that diseases that used to be easily treatable with antibiotics are becoming resistant to those drugs. In this edition of the podcast, we're going to hear about what the world should be doing from the man who just authored a major UK government review, Lord Jim o', Neill, the minister in the UK treasury and a leading economist. He was the man who coined the term the BRICS countries. Lord o', Neill, welcome to the podcast.
- [00:49]
B
Nice to be here. Thank you for having me.
- [00:50]
A
Before we get into the recommendations of your report, I want to get your reaction to a couple of comments. These were from a recent high profile event that CGD hosted on this issue. Let's first hear from Margaret Chan, the head of the World Health Organization, about how serious the issue of antimicrobial resistance, or amr, actually is.
- [01:09]
C
If we do not address this problem, we will see more deaths in 2030, more deaths from AMR than cancer. Surgeons will refuse to operate on anybody coming from a car crash. Surgeons would refuse to do any transplant. I'm 68. I may need a hip replacement. Surgeon will say to me, sorry, Dr. Chen, I'm not going to operate on you because after all these important procedures, you need to cover the patient with antibiotics and the pipeline is empty.
- [01:48]
A
That was Dr. Margaret Chan from the WHO. Lord O', Neill, to what extent is she scaremongering or exaggerating or understating?
- [01:56]
B
Well, I trust the scientific facts, what the scientists say. And Margaret's up there, so I don't think she's exaggerating what she's giving a flavor there is consistent with the sort of numbers that we came up with on that part of our work in the 21 months that our review existed. Million people died. Million people. Way more than the number of people that have died from the worrying pandemic threats that have taken so much attention around the world the past two years. The second thing is, as we also put in, by 2050, the 10 million deaths a year that we suggest could happen, that would translate into somebody dying every three seconds. Pretty scary.
- [02:46]
A
So in the gap that we just left between you and me speaking, someone will have died.
- [02:51]
B
Yeah.
- [02:52]
A
Wow. What do those figures make you think?
- [02:55]
B
We better do something about it. And as I've said in a couple of interviews with people, given my background, those number of deaths and the economic cost of not doing something actually make the financial crisis that we've gone through now, eight years ago, seem like small potatoes compared to this potential risk. So people worry about things in the world. This is up there as something that we need to stop any chance of this happening.
- [03:25]
A
And actually, that brings me on to the next clip that I want you to react to. This is actually your boss, UK Finance Minister George Osborne. He also spoke at that recent CGD event.
- [03:35]
B
I can't argue with him, can I?
- [03:37]
A
Not if you want to keep your. But he was talking about why this is something that finance ministries should be tackling. Let's take a listen to that.
- [03:45]
D
Now, what we're really seeking to address is not just a medical development. We're seeking to address a market failure. It does not pay pharmaceutical companies to develop new antibiotics because at the moment you can use the existing antibiotics. And no single company, and no individual, and no single country pays a price for the resistance that develops as a result of that. Indeed, all the market incentives on pharmaceutical companies, like any company, are to produce something and sell a lot of it.
- [04:23]
A
So, Lord o', Neill, explain to me, then again, why you see this as an economics issue and why this is an issue that rich countries like the UK and the US should be worried about, because the majority of those deaths to are going. Going to happen in developing countries.
- [04:36]
B
So I think George summarizes this aspect of it very crisply and neatly. It's a classic market failure, as economists call it. Those that are so closely associated with the production and selling and commercialization of these issues aren't incentivized to worry about these negative externalities. And it's a huge problem, and we have to sort of, economists would call it, to internalize it, as well as explore ways of coming up of a system to compensate for market failure. And I think within the very complex things that we have to think about, it's quite important that the pharmaceutical world itself perhaps thinks a little bit more broadly about this issue than they may have done so so far. But it's tough, it's complex.
- [05:32]
A
So let's move on to the recommendations of your report because they do touch on the role of pharmaceutical companies as well. There are 10 recommendations, broadly grouped into three sections, which is reducing demand for antibiotics, increasing the supply of new drugs, and also improving global cooperation. So let's start with demand. How do you reduce demand?
- [05:54]
B
So of the 10 things you say, I would say about five and a half of them, the half being vaccines, a half in the demand reduction and half in the supply increase. But a lot of the recommendations relate to the demand side. Interestingly, when I first took this assignment, much of the advice I got from the small group who were behind it was that your big task is to get new drugs. And I realized pretty early on that as big as that task was, that's just a tiny part of it. And even if we got all the right new drugs, that would solve the problem for a generation. But of course, because of the nature of what antibiotics are, we all develop resistance to whatever comes next. And then you got the same problem again. So the demand side should be primarily seen foremost as a way of permanently reducing the dependency on them. And if I put them all together, all five and a half of the demand side issues we looked at at the core of it, I'd say the following simple statement is we need to stop treating these things like candy, or as we'd say in the UK, like sweets throughout our generation. All 7 billion of us around the world these days, we sort of generally think that these things are a miracle cure for anything. And not very few of us realize that if we take one and we shouldn't have one, that's going to cause a lot of damage. And so we've got to stop all of that. And so it ranges from one of our big recommendations. It sounds a little bit simple and it's not a new thing, but there probably needs to be a major, major global awareness campaign. Amongst many things that have been so intriguing as I've gone through this journey. Right at the start, I didn't know when I was asked to do this what AMR was. That's not much more than two years ago, four weeks before you and I are chatting, I spoke at a 500 strong, something called Wired Health UK. 500 of the most technologically informed people in the world about health. Show of hands, how many of you know about what AMR is? 1/3 didn't have a clue. Imagine if you're in a, in a slum in Mumbai or in some favela in Brazil, or people haven't got a clue. So some major awareness thing about what antibiotics actually are and why we need to be more sensible with them is the minimum.
- [08:32]
A
But how is it actually going to manifest itself in what exactly can the global awareness campaign achieve? Do they actually change behavior at that level?
- [08:41]
B
So we, and we discussed this in the paper. We looked at parallel or tangential dilemmas and challenges in the Past and tobacco is one that one can think of in this regard, where it seems there is some evidence that awareness campaigns in some parts of the world are perhaps.
- [09:01]
A
A big role in rich countries, in rich countries, uses on the rise in developing countries.
- [09:06]
B
It's true. So in this case it's undoubtedly a bigger challenge in developing countries than in so called developed countries. But such a campaign would need to be nuanced for that. So especially as how you introduced me, you know, I have Mr. Bricks on my forehead, so I think about these things a lot. So I could envisage a wee chance campaign which is the Chinese version of WhatsApp or Facebook, where particularly amongst the young aspirational Chinese, these guys live on this stuff. So something tailor made there in India, maybe some kind of Bollywood type thing the masses of Indian culture buy into because these are really powerful forms of credible information. But I think it's doable. But it's just policymakers have got to kind of grasp that this is the sort of thing we need to do if we want to stop this risk.
- [10:02]
A
And as you've just outlined, health systems and cultures in different countries are different. So you've got to tailor each of these awareness programs, campaigns to the specific conditions and environment in the country that it's in. That's even harder.
- [10:15]
B
It is very hard. So as it relates to the third area that you said, maybe we'll come back to this again, but one of the things that we're pushing that should be part of some kind of UN agreement is ownership of a global awareness campaign at the UN level. Because unless that's where it comes from, where is the collective global buy in to undertake such a thing. And of course through the UN there has been a number of important things done, whether it be for European young kids and infectious diseases for young children all over the world, to many other things too, involving the role of sport. I think about, you know, going from where I'm from and one of my own pet obsessions, British football, British Premier League these days, all over the world you have all sorts of people and you know, I want to have a conversation with people from that world as to whether I can get them engaged as to play some role in sort of communicating this around the world to people.
- [11:17]
A
So it sort of puts it on a par with, you know, other mass campaigns that sort of taken root in popular culture or taken a footing in popular culture, you know, say against sexism, against hiv.
- [11:29]
B
I mean breast cancer, HIV is a particularly good example where you look at the success of those kind of campaigns and I think so. That's exactly right. Yeah.
- [11:37]
A
Let's carry on talking about the international corporation, because you just mentioned the un. What do you want to see governments do? And intergovernmental organizations, either the UN or maybe the multilateral development banks as well. I mean they have a large role to play in development.
- [11:52]
B
Yeah, yeah, yeah. So the big two, I would say that we've spent a lot of time on. It's very much in my mind and a great reason why we're here in the US this week is in September this year, as you do every year, you've got the annual G20 meetings. Again, something that's been in my mind for so long as Mr. Brics, because this is an entity that's brought about bringing China and the like to the core of global governance. And this year historic moment is actually being chaired by China. So we believe issues to do with financing new drugs and to some extent also for diagnostics, that's something G20 leaders, because that's where the money really matters.
- [12:43]
A
But what do you want them to actually do?
- [12:45]
B
We want them to embrace the right mechanism, hopefully including something close to our recommended mechanism, which we call market entry rewards for coming up with the money to entice pharmaceutical companies to get beyond this market failure problem by rewarding them for coming up with the right desired drug to get to people in both the rich and the not so rich world.
- [13:17]
A
So this is the idea of a prize almost, isn't it?
- [13:20]
B
Yeah, we call it a market entry reward, but it's a very large prize.
- [13:24]
A
And then that's where you bring in the pay to play mechanism which effectively taxes or charges drugs companies to get involved in this prize. And that's how you make up the prize.
- [13:34]
B
So let me be careful and clear about how the money, where the money comes from, not surprisingly, given the controversy about that, that's got a lot of media attention. But I'm always eager to say that's just one of the ways that we've suggested the money could be raised. But I think it is important one and one that I think intrigues policymakers. Pharmaceutical companies in some ways can be seen as really sophisticated financial managers of risk that happen to have another really good expertise, which is the technical ability to manufacture a lot of pills within the kind of pills they know how to do that with is antibiotics. And importantly, pharmaceutical companies need these antibiotics themselves for a lot of other forms of their own business. So I don't think it. So, for example, the thing of our era which is currently so successful and so popular. And a wonderful thing, by the way, which is cancer treatments where you have this remarkable ongoing period where there's all sorts of wonderful things going on in cancer discovery and cancer treatments. We don't have any antibiotics. People are not going to be able to undertake cancer therapies because of the.
- [14:58]
A
Risk of infection, as Margaret Chan was saying.
- [15:00]
B
As Margaret was saying in that clip. So pharmaceutical companies are not exactly being fully enlightened in the way they think about this because they often say we're doing this at great expense and it's for the benefit of mankind. Actually, it's pretty important for all these other things you do where you earn enormous amounts of money. So I think they need to think about it a little bit differently, which is why I can see from a policy making perspective for those pharma companies that aren't prepared to try, it's like, okay, guys, is a bit of an incentive because if you don't, you're going to have to give up some of your revenue in order for us to get the money to help pay for it. There's plenty of other possible options as well, but that's one that I'm pretty sure policymakers are going to give some time to thinking about.
- [15:47]
A
So the supply side is something that the report goes into a lot of detail about. It's been quite, it's one of the elements I think has been talked about a lot, the idea of this inverted commas, prize, etc. And paying to play. But let's go back to. You mentioned diagnostics. One of the things that you recommend to reduce demand is better diagnostic tests.
- [16:07]
B
I don't like to say one particular intervention we're recommending is more important than the others, but this is right up there. I like to call it Google for doctors. We live in a world where our mobile phones dominate everything we do. And yet here, our doctors, our clinicians, they make a really educated guess whether we need an antibiotic or not. And a lot of the case we put them under this staggering pressure as humans because we want our sweet. So why don't we do something about it? And one way of doing it, and a particularly aggressive recommendation we're suggesting is to make it mandatory in the developed world as soon as 2020. No diagnostic, no antibiotic. And everybody's like, well, whoa, whoa, how can we do that? We don't have the technology, it's not cheap enough. And of course that's the case. But if you want to really stimulate the market and get venture capital wanting to take this seriously, and there's plenty of people in the technology space that are intrigued by it. If they see evidence that policymakers are adopting that kind of approach. The VC world solves that problem for you. We are also suggesting that for the right diagnostics in the emerging world, they should be a beneficiary of our market entry reward or some other close version of it, perhaps even a cousin of the advanced market commitment.
- [17:40]
A
So prize to develop not just the actual drugs, but I think it's just diagnostic.
- [17:44]
B
Just as important for the emerging world where there are such enormous challenges. Take the whole TB issue. Of our 10 million deaths, nearly one third of them are going to be because of tb. Within the infectious disease world, the rapid scary growth of drug resistant TB is horrific. So having state of the art diagnostics to deal with that hugely important thing. So why should they not be a beneficiary of some kind of market entry reward type mechanism too?
- [18:19]
A
And then who pays for the production and rollout of these diagnostic tools, machines or whatever they are, software in large enough numbers for the developing world? Is that something you want the G20 to underwrite?
- [18:33]
B
This is something that I think the G20 have to make some decision on and I think they have to make a significant commitment. But linked to something you touched on earlier, I think multinational financial institutions could play a role here. One thinks of the World bank and others. And indeed, if you think about it in the Sustainable Development Goals and its broadest sense, you bring in now clean water and sanitation. Many aspects of the antimicrobial resistance challenge for the emerging world should be seen in that context. So some kind of financial support, some kind of grants, some kind of incentives, some kind of prizes. Why would you not consider that as a very sensible investment?
- [19:28]
A
So a fund, say the World bank or another multilateral development bank.
- [19:32]
B
Yeah, why not?
- [19:32]
A
That would underwrite or pay for diagnostic tools? Probably not the development of new drugs?
- [19:38]
B
No, not that, no, I think that's differently. But yeah, why not? Again, in its broadest sense, going back to the fact that I am an economist looking at all of these things, if you take all of our interventions together, we kind of guess and It's a guess. $40 billion over 10 years. If that's going to. If that happened. And indeed we were right that all those interventions stop the loss of $100 trillion worth of global GDP. That's something like a two and a half thousand percent return in my opinion, to stop 10 million people in the world dying and to stop the loss of $100 trillion worth of GDP potential that seems to me like pretty good investment logim.
- [20:27]
A
O', Neill, great to talk to you. Thanks very much for joining us on the CGD podcast.
- [20:31]
B
Thanks for having me on.
- [20:32]
A
You can find out much more about our work on our website, cgdev.org don't forget I'm Rajesh Merchandani. Please do join me for the next podcast from the center for Global Development.