FAQ

• Never dispose of unused drugs in the toilet or sink.
• Be informed on the safe, recommended methods for disposing or returning unused antimicrobial drugs.
• For more information on safely disposing drugs and the risk associated with the presence of antimicrobials in the environment, check the Safer Pharma Campaign
• If you live in Europe, you can find out more on the national collection schemes for drugs on medsdisposal.eu.
• If you live in the US you can find information on safely disposing medication with the EPA.

Unless drastic measures are taken to contain the proliferation of drug-resistant microbes, resistant infections could kill 10 million people annually by 2050 and lead to an economic slowdown comparable to the global financial crisis of 2008.

Any of us could be the next victim of AMR. According to United Nations experts, in the next 30 years 2.4 million people in Europe, North America, and Australia could die from drug-resistant infections. As life-saving antibiotics stop being effective, AMR could end our capacity to combat infections and halt all surgical procedures. (AMR Review 2016, WHO 2019).

Drug-resistant infections are foreseen to cost the world more than the current global economy – the predicted amount is as high as $100 trillion (EUR 88 trillion) in lost output between now and 2050 (World Bank Group, 2016).

• Rational use of antibiotics: often, patients will not be prescribed or take the adequate antimicrobials (e.g. because of misdiagnosis, no diagnosis done, using previously bought antibiotics etc.), which is a significant contributor to AMR. There is a need for public and professional education on the adequate and rational use of antimicrobials.
• Over-the-counter antibiotics: buying antibiotics over-the-counter, without medical advice, is an ideal breeding ground for AMR. Their use has been reported to vary from 3% in Northern Europe studies to 100% in African studies (Morgan et al., 2011). There needs to be an urgent development of further regulatory control over these over-the-counter antibiotics.
• Guidelines for the use of antibiotics at local levels: when planning a treatment strategy that involves antimicrobials it is important to understand which pathogens are most common in your community and whether they have exhibited any signs of resistance in the past.
• Standards of hygiene: when dealing with infections, whether as a professional, patient or household member, hygiene standards need to be stressed to prevent the spread of microbes (e.g. alcohol-based hand rubs).

Taxing has been used previously to raise revenues or alter the behaviour of the public (e.g. tobacco) and it could be a solution to reducing the overall use of antibiotics. Taxes may also have the added benefit of providing a revenue stream to fund future research in antimicrobial development. However, O’Neill, in his extensive AMR Review for the UK government, warns that the impact of an antibiotic tax will greatly vary depending on its context. It is therefore wiser to implement it at the national level rather than globally (AMR Review 2016).

In the case of antibiotics, it might be more interesting to impose a tax on antibiotics only for animal-use. This would discourage their use in husbandry but would not directly increase the healthcare costs of citizens. Furthermore, it is unlikely that raising the costs of antibiotics for medicine would lead to behaviour changes from patients (AMR Review 2016).

Two examples of countries that have successfully applied such a tax are Belgium and Denmark.

Belgium introduced the tax in 2014 and it was increased by 75% in 2018: this tax only targets veterinary antibiotics and is based on the quantity of active substance used. The price is multiplied by 1.5 in the case of critical antibiotics (e.g. quinolones, cephalosporines and macrolides) (AFMPS, 2018).

Denmark is one of the earliest countries to establish a plan to deal with AMR. After establishing the Danish Veterinary Medicines Statistic Program, VetStat, they observed that antimicrobial usage increased from 2003 to 2009 in pigs in particular. In response, the Danish Veterinary and Food Administration (DVFA) developed the “Yellow Card” initiative, where a pig farmer that exceeded the national threshold limits for use of antimicrobials in weaners, grower pigs and mature pigs would receive an injunction to lower their use. A decline in antimicrobial use was observed after 2010 and can be attributed to this initiative (DANMAP, 2017). To further tackle AMR, two new interventions were used: a “differentiated tax on the active antimicrobial compound, thus favouring narrow-spectrum antimicrobials and vaccines compared with broad-spectrum compounds” and “a requirement of laboratory verification of the diagnosis on an annual basis for issuing prescriptions for group treatments of intestinal and respiratory infections” (NAM, 1, 2, 3) As a result of these various strategies, Denmark is currently showing lower levels of AMR than most EU countries (EFSA, 2017).

Discovering new antimicrobials and using them inherently poses the risk that those new drugs may develop resistance over time. Ideally, the newly discovered antimicrobials should be restricted for last resort use only, which makes the market unattractive for the private sector in terms of sales volumes.

Developing a new antibiotic can take over a decade and cost over €850 million (Drive-AB, 2018). It can generally be divided into two main phases: initial R&D development, which is done by SMEs and public institutions mostly, followed by drug development and testing, which is done by larger pharmaceutical companies. The AMR Industry Alliance reports investment of around 2 billion into AMR research across 22 companies in 2018 (AMR Industry Alliance, 2018). While a number of companies are producing antibiotics (IFPMA, 2015) (Access to Medicine Foundation, 2018), many of them are variations on existing antibiotics. While these are a safer bet for companies to invest in as less research is needed and approvals are faster due to similarities to existing approved drugs, these slightly modified antibiotics only overcome resistance for a short period of time. Research into novel antibiotic classes is very low.

As our last-resort antibiotics, such as colistin and carbapenem, lose their efficacy (CIDRAP, 2017) (Meletis, 2016) it is imperative that antibiotic R&D is prioritised so that we may have new and effective antimicrobials in time.

Yes, as evidenced by the extensive AMR review commissioned by the UK Government, “the cost in terms of lost global production between now and 2050 would be an enormous 100 trillion USD if we do not take action.” (AMR Review 2016)