Medicines in Health Systems: Advancing Access, Affordability and Appropriate Use. Chapter 4 – Annex 1: Innovation Tackling Antibiotic Resistance. Open Source Drug Discovery Initiative in India
(2014; 6 pages)


The challenge of growing antibiotic resistance has placed the effectiveness of antibiotics in treating infections in jeopardy. In so doing, the benefits of modern day medicine, from surgical prophylaxis to chemotherapy, have been compromised. There exists, however, a paradox between patients receiving unnecessary antibiotic treatment and those who go without such access. Across the pharmaceutical value chain, the challenge of ensuring access to needed antibiotics might be characterized by therapeutic, financial and structural barriers. Overcoming each of these barriers, this paper describes innovative approaches to tackling antibiotic resistance.

Therapeutic access most directly relates to the R&D of new antibiotics. The dearth of novel antibiotics over the past few decades is symptomatic of a stalled pharmaceutical pipeline, which could be improved by the sharing of resources, risks, and rewards. India’s Open Source Drug Discovery Initiative (OSDD) is one example of these three “Rs” in action, and this initiative has built a network of online and wet-lab collaborators to innovate treatment by crowdsourcing contributions that advance pre-clinical research, publicly funding clinical trials for diseases such as tuberculosis and malaria, and eventually licensing scale-up at close-to-marginal cost pricing. Financial access requires not only ensuring the affordability of needed antibiotics, but also a price point that enables the sustainability of that treatment’s supply. A solution that delinks the return on investment from volume-based sales is crucial to addressing both the supply- and demand-side barriers to financial access. Finally, structural access is linked to the delivery system of antibiotics and involves the relationships among prescriber, dispenser and consumer. Innovations seeking to improve structural access can improve the rational use of antibiotics by targeting the consumer, but must not neglect the need to examine the patterns, incentives, and guidelines that influence the behavior of health providers. The Antibiotic Smart Use (ASU) Project in Thailand is an example of such a multi-pronged approach. Working through a staged implementation process, ASU has seen impressive declines in inappropriate antibiotics use by substituting culturally appropriate herbal remedies for viral or self-limited infections when antibiotic use is unnecessary, improving diagnostic capabilities by providing illuminators, and introducing a more robust discussion of the rational use of medications among local health providers. The case studies throughout this paper examine the issues of therapeutic, financial, and structural access along the pharmaceutical value chain and illustrate innovative approaches that work towards tackling antibiotic resistance.

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