Pull Incentives for AMR: Where is Biden?

Will there be pull incentives to support the broken antibiotics market? Where is Biden?

We are about to dedicate an entire ASM/ESCMID session to planning for the implementation of forthcoming pull incentives.  We do this because we all agree that without significant pull incentives (1) to address the broken antibiotics market we will all pay a high price later. But where are these pull incentives and will they arrive in time?

We just celebrated (if you say that) Antibiotics Awareness Week around the world.  The White House in the US released a statement that said nothing about pull incentives at all. It referred to antimicrobial stewardship and to the National Action Plan to Combat Antibiotic Resistance (see the Pew summary noting its lack of provision for economic incentives). While I know that many working at top levels of the Department of Health and Human Services in the US support the idea of pull incentives, without the additional support of President Biden, I’m not sure whether we will see legislation like the Pasteur Act pass in the foreseeable future. 

After reading the White House release, I turned my attention once again to Europe. I have spoken to several contacts there who are convinced that Europe will devolve any expenditures for antibiotic subscription payments to the various national authorities of the European Union. This may contradict the impression that some (including me) have drawn from public statements coming out of Brussels.  And I was just getting ready to submit my comments for the European effort. That Europe will not take on incentives as Europe but rather through the various national authorities would be a wake-up call.  A subscription model that depends on 27 national authorities agreeing on criteria and eventual awards for products is doomed from the start. If Europe cannot act as Europe from Brussels, this shuttles the responsibility back to the US (in my view).  That means that the US must pass the Pasteur Act.  And that means that Biden must get off the sidelines and lead.

I understand that Covid with all its variants is taking center seat in the administration’s concerns right now – and that is as it should be. But ignoring the steadily building problem of antimicrobial resistance is just setting the table for another crisis that could be if not avoided then at least diminished in its scope and consequences. Clearly, the presidency of the US is a tough job and comes with many moving parts. That’s why we elect those we think are most competent to take on that job. Biden must step up to antimicrobial resistance. I’m afraid that without his direct support we are headed to disaster. 


(1) A pull incentive is one that works on the market side.  A push incentive provides support for research and development.  The Pasteur Act currently being reviewed in the US Congress provides for a subscription payment for a critical need antibiotic. This would be an advance payment assuring the sponsor or company of a market even if the drug is used infrequently. Such a payment provides a needed financial incentive to companies and investors to invest in antibiotic R&D.  The situation now is that many small companies marketing new antibiotics over the last decade have gone bankrupt after market approval. Pasteur fixes this problem for deserving products.