Sandoz Anti-Infectives head Ian Ball addresses key healthcare policy meeting in Tokyo

Ian Ball, global head of Sandoz Anti-Infectives, was in Tokyo this week for a high-level meeting jointly organized by the Japanese Foreign Ministry ahead of this year’s G7 summit in Tokyo.

The Japanese government, which is hosting the G7 summit, has identified the interface between future pandemics and the global spread of antimicrobial resistance (AMR) as a key challenge to be addressed by the global community. Ian was invited to join and share his views as the only participant from the generics industry.

Here’s his summary in five questions of what the meeting, on February 21-22, was all about and why it matters.

1. What was this meeting and why were you invited?

The meeting was organized by the Japanese Foreign Ministry (MoFA), the Asia-Europe Foundation Public Health Network (ASEF PHN) and the Japanese AMR Clinical Reference Center (AMRCRC). The subject was “Universal Health Coverage (UHC) in an era of AMR and pandemics”. 

The goal is to advance a much-needed dialogue between governments and others ahead of the G7 summit about how to integrate strategies to combat AMR into overall plans to achieve UHC. The discussion panel focused on the topic of “Effective antibiotics to support UHC”. 

UHC is fundamentally about ensuring people and communities worldwide have access to health services they need, of sufficient quality to be effective, without enduring financial hardship.

Sustainably functioning antibiotics represent the backbone of modern medicine, saving and protecting millions of lives both by treating infectious diseases and in preventive settings including surgery. 

I was invited to speak on behalf of Sandoz, which is the largest global supplier of generic antibiotics, with a strong internal program focused on combatting the growing threat of AMR.

2. Remind me what AMR is and why it matters? What is the connection to Covid and pandemics?

AMR represents a growing threat to the sustainable use of antibiotics. It occurs when bacteria evolve to resist antibacterial medicines: a natural phenomenon that has been progressively accelerated by antibiotic (mis)use over the decades.

Per a comprehensive analysis in The Lancet last year based on data collected in 2019, an estimated 1.3 million people die annually as a direct result of AMR – as many as HIV and malaria combined. In total, nearly 5 million annual deaths can be associated with AMR. 

Studies also show that annual global GDP could decrease by approximately 1% by 2050 due to the impact of AMR, with a 5-7% loss in developing countries: translating into a global loss of USD 100 to 210 trillion.
Children, the elderly, women, and the poorest of the poor bear the brunt. Up to 40% of common infectious diseases in children are now resistant to standard treatments.

A global pandemic threatens to accelerate the problem. Secondary bacterial infections increase pandemic-related mortality rates and the inappropriate use of antibiotics in this setting accelerates the spread of AMR.

3. What were your key messages to the meeting?

The main point I made is very simple: “what we have is what we’ve got!” 

Much of the current debate around AMR focuses on innovation, i.e. the search for new antibiotics. I’m the first to acknowledge the need for new drugs, but we need to realize that they will not be some kind of “silver bullet”. Any new antibiotic will also be subject to resistance once it enters clinical use, and the majority of antibiotics used in our healthcare system today are off-patent.

So, to truly beat AMR into a corner, we will need to combine forces across sectors and realize a balanced global approach based on all four pillars of the global AMR response strategy: Responsible Manufacturing, Responsible Access, Responsible Use and Innovation. 

I would particularly stress the importance of Responsible Access: getting the right drug to the right patient at the right time, to prevent millions of avoidable deaths, while preventing the spread of AMR due to lack of appropriate treatments. To achieve this, we need a much greater policy focus on the very real challenges to sustainable supply of existing off-patent antibiotics. 

Industry obviously has a key role to play in ensuring sustainable supply of these critical medicines, but we cannot do it alone. Current market frameworks effectively treat antibiotics like commodities – but without the ability to pull the price lever when external costs shoot up. This is simply not sustainable in the long run and that fact needs to be recognized by all concerned.

4. What happens next?

That’s the million-dollar question. AMR is sometimes described as the “climate change of healthcare” – not enough has happened yet and there’s still a real risk that we fall into the same trap of collective inaction in the face of what the scientists call a complex adaptive challenge to our existence. 

But I’m an optimist and the good news is that we do still have time to act to mitigate the impact of AMR, if the right people apply their minds to the problem in a concerted and collaborative way. 

That’s why I am so pleased and excited that the Japanese government has identified AMR as a key topic for the G7 summit and is focusing its considerable resources on the issue. The global initiative to develop a Covid-19 vaccine in record time shows how success in this field might look.

I like the comment from novelist Margaret Mitchell, who said: “ Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

5. How does the Sandoz AMR Program fit into the overall Sandoz strategy?

It’s really very simple. Antibiotics are one of our two core global businesses, together with biopharmaceuticals. That’s no coincidence: our leading biosimilar business evolved out of the same fermentation technology that was harnessed by our predecessor company nearly 80 years ago to convert a former brewery in the Austrian Tyrol into Europe’s first major penicillin factory.

As the leading global producer of generic antibiotics, Sandoz is committed to playing its part in the global battle against AMR, which is why we have a dedicated internal AMR program led by my colleague Boumediene Soufi (Bo). Bo is also a board member of the AMR Industry Alliance (AMRIA).

What’s more, I believe that an active AMR “mindset” across the business can help to differentiate us in the market by ensuring that we are flexible enough to adapt quickly to changing market needs and national resistance profiles. 

We’ve all seen how the rapid succession of Covid-induced supply and demand swings and the Ukraine war / energy crisis combined to upend traditional corporate forecasting techniques. AMR is one more factor that could make the future look very different and our strategy needs to recognize that, not ignore it. To quote a song from my childhood: “Won’t get fooled again”…