The World Economic Forum is an independent international organization committed to improving the state of the world by engaging business, political, academic and other leaders of society to shape global, regional and industry agendas. Incorporated as a not-for-profit foundation in 1971, and headquartered in Geneva, Switzerland, the Forum is tied to no political, partisan or national interests.
At Davos’ Open Forum on “The Fragile Future of Antibiotics,” leaders from public health, economics, diagnostics, medtech and healthcare distribution warned that antimicrobial resistance (AMR) is shifting from a technical concern to a systemic risk. Rachel Glennerster defined AMR simply: infections where “the antibiotics don’t work,” already driving an estimated $66B in annual inpatient costs and rising. Panelists stressed that the stakes extend beyond hospitals: without effective antibiotics, bacterial pandemics become more likely, and “it’s not just a fragile future, it’s about a fragile present.”
The core failure is misaligned incentives. As Glennerster noted, society wants companies to develop new antibiotics “that we then don’t want to use very much,” undermining the traditional volume-based business model. Proposed fixes included subscription-style payments for new antibiotics and direct innovation rewards (e.g., a $60M prize for low-cost neonatal sepsis diagnostics).
Operationally, the group emphasized prevention, rapid diagnosis and stewardship. Deepak Nath argued clinicians must deliver “the right antibiotic at the right time,” while Vanina Laurent-Ledru said diagnostics are “the brakes on antimicrobial resistance” because without them “we are simply flying blind.” A patient with a chronic superbug reminded the room stewardship must also protect access for those who truly need high-dose treatment.
Good evening everyone. My name is Moussa Moshabela. I am the vice chancellor and president of the University of Cape Town in South Africa. It's a pleasure and honor for me to be moderating this amazing panel of experts, where we will be talking about antibiotics, and infections. So let me take this opportunity to thank you for showing interest in this panel, for being here. And I'd like to welcome all of you. And, just to let you know that, at some point during the session, we will have an opportunity for you to engage with the panel as well. And I hope that, in the meantime, you will be able to listen and prepare your thoughts, organize your thoughts and your questions for for the panel. Let me also just say that, if you are going to be, having an opportunity to share about the session on social media, please include hashtag Waff 26 and hashtag Openforum 26. It will be appreciated. So thank you very much. I want to welcome all our panelists that are here, and introduce you to them. And, let's start with, Vanina, who is the chief public health and government, affairs officer. She's from France for institute. Let's welcome her with a warm round of applause. She'll tell us more about exactly what she does. And, as she shares her experience and her thoughts. Let me also welcome Deepak, who is the CEO of Smith and Nephew, based in London in the UK. And, he's he's a meta company and also he will be sharing with us his experience. Let's welcome him with a round of applause. Next. Let's welcome Rachel, who is the president of the center for development based in DC. And she'll also be sharing with us her experience. Let's welcome her with.
A round of applause.
And, last but not least, let's welcome Stanley Berkman, who is the chairman and CEO of Henry Schein. It's a healthcare company. Thank you.
Very much.
So all of our panelists, as you'll see, they come from diverse backgrounds. And you'll see some of them come from finance, accounting. Some of them come from medtech, some of them come from public health, come from their economists. And we're trying to bring the diversity of all these sectors across science, policy, implementation, practice to try and inform this conversation. And, I'm hoping that, by the end of the conversation, we would be able to address some of the things that we are hoping to address in framing the problem and also thinking about how we're going to, to move forward. I am a medical doctor and have a background in public health and have engaged in infectious diseases quite a bit. And, I'm very acutely aware of, the seriousness of the topic of antimicrobial resistance that we are discussing this evening. And also acutely aware of how it affects all of us. At some point we all are exposed to infections. At some point we use antibiotics. Sometimes we demand antibiotics, don't we? But all of these things can come with risks because they can contribute to the development of this superbugs that we now have to deal with. And the risks that the panel will be, will be sharing. So I'm going to just ask the panelists to give their opening remarks. And in doing so, I would like to invite you also to share a little bit about your background and how you are on the panel and also share a little bit frame the problem for us from your perspective in terms of what is antimicrobial resistance and how you would like to inform the audience about it, we can start with you, Stanley.
Thank you professor. So my company, Henry Schein, is the largest provider of dental products in the world, as well as products to office based healthcare practitioners. That's outside the care center. So I was at a panel, similar panel in 2012, in Davos. Same topic in that year we were talking about Amr related deaths at a couple of hundred thousand is now estimated. I'm not a public health person, but do some research at somewhere around a million people are expected to die through Amr this year. Maybe another 5 million people indirectly. And it's now estimated that 2050, it could be in the range of 8 to 10 million people. That was a panel I was on in 12, 2012 and 2014. I was on a panel related to pandemic supply and pandemic preparedness. And on that panel, I'm not a public health person. I'm not a physician. I'm not clinical. I don't even understand how Amr works. I cautioned that the supply chain for PPE and basically for masks would not work if there were an epidemic, forget a pandemic. So I'm sure other panelists will address Amr. Why there is no medical solution yet. I don't want to cause panic, but I have been advocating personally for decades that we need to ensure that the supply chain works for an emergency response, where we have an infectious disease type issue that is spreading. Because what happens if you're not prepared is the health care system break down, as we saw with Covid, but in particularly in the developing world where they don't have access to supplies of masks and gloves. The mask business is a relatively small industry in the world, but it's critical. And so. Professor, I don't want to be an alarmist, but I would like public health people, governments, to be focused on this. I think governments learnt a lot, and maybe now it's a little bit in, people thinking about it, but it's not in the DNA of governments. They're not worried about what's going to happen next should there be an epidemic, let alone a pandemic.
Yeah. I think you're starting to address this point about how the future is fragile, and we need to be talking about that. Thank you very much, Rachel Anthony.
So for those of you who are new to this subject, antimicrobial resistance means that you have a bacterial infection, but the antibiotics don't work, right. So we all use antibiotics. We rely on them enormously. But the the bacteria becomes resistant to the antibiotics that we use, and therefore you don't get. Well now, as you've heard, increasingly people are dying because antibiotics don't work. Or they're staying in hospital longer. And that is already costing. I'm an economist. So I think about, you know, the economic costs, not just the lives, but also the cost of the healthcare system, of the fact that our antibiotics don't work as well, or we have to get use more and more expensive antibiotics. And, and our estimates at the center for Global Development are that, currently we're spending $66 billion just in the hospital costs, the inpatient costs globally for treating people because they're, they have a bacterial infection that is resistant to the first line, antibiotics. By 2050, that's expected to go up to $160 billion. And that as if we think about the lost days of work and all the other economic impacts, that's much higher. And on pandemics, the Black Death, the plague, these were all pandemics based on bacteria infections. And if you go back and look at how frequent pandemics were, that frequency halved when we got antibiotics. So if we run out of antibiotics, you know, Covid is twice as likely to, to come back. You know, a Covid like pandemic is quite just as likely. And even without a pandemic, just this ongoing increase, is going to be there. And there's a lot of challenges. There's a lot of, you know, that's a lot of economic costs, but there's also a lot of academic of economic challenges to addressing the problem, because normally you incentivize people to produce something new, like an antibiotic, a new innovation, by selling a lot of it. Right. But if we produce a new antibiotic that's that can cope with those really extreme, you know, cases of, of resistance, we don't want to use it except in the really extreme cases. So we we want to encourage people to produce something that we then don't want to use very much, which causes, a lot of, challenges in the economic side. So I can come back to some of the solutions that economists and others and public health and public sector has come up with to try and solve that problem. But, you see, it's a big problem and it's difficult to solve.
That's concerning. And I do think that if we if we think that the problem of superbugs has the potential to grow into an epidemic or even a pandemic or a large scale infection, infectious disease burden, and yet there is no incentive for developing the new technologies that are needed to be prepared for that. That's going to be quite a challenge, but I think maybe we can come back to that and think about how we could organize ourselves to deal with that as we're thinking about way forward.
Yeah, that's what I work on.
Yeah.
Thank you. Deepak.
Yeah. Just to pick up the thread a little bit and to bring this issue to life and to make this a bit more relatable. How does this come about? Right. Just to build on Rachel's comments, resistance develops when people are, treated with antibiotics unnecessarily. This could be that people get prescribed antibiotic when they in fact have a viral infection. So what that ends up doing is killing all the bacteria. That's not so dangerous. That allows other potentially more dangerous bacteria to, to take root and to and to cause infection, or that a patient has a relatively benign type of bacterial infection and they get treated with a really broad spectrum or a really powerful antibiotic. In other words, going after the proverbial ant with a sledgehammer. And what that does is basically you're throwing your kitchen sink at a problem. And the bugs that remain, in effect, have an environment in which to, to grow and ultimately, exact their toll on a patient. Right. And so the issues are complicated. The issues have both to do with making sure people get the right treatment, the right antibiotic at the right time, but also not to get overtreated when they don't in fact need it or in fact have an infection that's not bacterial at all in nature. So that's what makes this problem a little bit tricky, because there's both an overuse and an underuse that creates the issue. To compound matters is to build on Rachel's comments is one of the treatments is antibiotics. And the current pharmaceutical industry, you know, works of course has a certain business model. And in that business model, there's a high level of investment required to develop and develop the evidence that the treatment and antibiotic is safe and efficacious. There's a high cost associated with them, and pharma companies expect to recoup, the returns, returns on that investment. And in something like antibiotics you use this right antibiotic, right treatment. Basically the patient gets well. Right. And in order to make that economics work, you either have to charge a really high amount for the effective treatment or encourage overuse, which is not what you want to do. Right. So that requires some level of partnership, typically public private that makes this complicated. So the issues then coming to how do we tackle this is first is prevention. Right. The second is diagnosis rapid diagnosis that allows clinicians to first figure out what pathogen is is infecting or infecting pathogen and then to treat it with the right kind of treatment, whether it's a topical thing or a systemic thing. So I now lead Smith and Nephew. It's 170 year old healthcare company met Portfolio MedTech company. It's the second oldest healthcare company in the world, and where we come in is primarily on the prevention side, particularly on management of wounds where a lot of infections occur or where infections start, and progressive systemic infections, and to some extent on selective treatment. That's where we come in. Going back a couple lifetimes ago, corporate lifetimes ago, I was involved in diagnostics, where we were involved in potentially rapid diagnosis for identifying pathogens. Your company, is now involved in that. The company I was with was trying to come up with something that you guys ultimately did. So I've had experience now in multiple facets, so hopefully that helps frame the issue.
So I like your framework of prevention, diagnosis and treatment, but you're also raising other challenges whereby when you're talking about overuse and this overtreatment idea, then that speaks to the behavior of, my fellow medical doctors and practitioners. I hope we have some doctors in the room. But you're also mentioning the the behavior of, an incentives for pharmaceutical industry in terms of meeting this sort of economic, issue that Rachel was also beginning to frame as well, to say, what is the incentive for producing this kind of drugs, that or new technologies that are needed when you're looking at at the pricing pricing as well? So, so I think we're going to have to think about how in a multi-sectoral fashion, we can begin to deal with those tensions that exist. But let's give vanilla a chance to also introduce and, tell us about your company, your background, and also your thoughts on Amr.
Thank you very much. And it's an honor to be here. Thank you for showing up. So I will elaborate on Deepak's point and the other panelists point and maybe share with you a little anecdote. Not too long ago, I was in Senegal and I met with a clinician at a hospital, and she introduced me to this patient. This patient had a very high fever, and the patient was battling a severe infection. So we discussed and she said, well, I don't have diagnostics at hand, so I'm forced to use antibiotics. She gave a broad spectrum antibiotic. What that did is that of course, it is creating the resistance that we have been speaking about. But I would also like to emphasize that these antibiotics, they then flow back to wastewater systems, they flow into farms, they flow into soils. And that is something very important that we are forgetting. So meanwhile, upstream livestock that were just grazing grass near the hospital, they were treated preventatively because of the tools that we have to detect early diseases in animals. But what you see is downstream, the ecosystems are absorbing more and more residues that in the end, erode the effectiveness of the very antibiotics that the pharmaceutical industry is trying to develop. So none of this is necessarily dramatic. None of this is making the headlines, but it is quietly eroding the foundations of public health, because at the end of the day, it's exactly what Rachel and the other panelists have emphasized. Without antibiotics, we will see that antimicrobial resistance will kill more than cancer by 2050, we are expected to see more deaths from those drug acquired infections than cancer. It is very important that we understand that antimicrobial resistance. It is not a slow burn. Scientific issues for the techies among us. It is a very real and now problem. So in the end, it's very important as well to think about what we can do before a prescription. And that brings me to why I'm here. I represent Biomérieux Biomérieux is a diagnostics company. And what we have seen is that rapid diagnostics that tell us if there is an infection, what it is, what antibiotic will work and what won't. And it's almost as important to to know now what will not work. So if you think about, Amr, well, we need to have brakes on this unfolding crisis and think of diagnostics as really the brakes on antimicrobial resistance, because without diagnostics, we are simply flying blind. And that is why it's so important to equip clinicians and to equip, everyone who is treating patients with this. But coming back to my Senegal story, I also want to point out to the importance of working with a one health approach. Ultimately, it's not just a human health concept. It is critical to understand how connected human, animal and environmental health are connected together. And at the end of the day, it's it doesn't start and stay in the hospital. It is really affecting all ecosystems. So that's why I'm so pleased that there is wide representation of sectors in this panel. It will take collective action. It has started and you will hear maybe more from the World Economic Forum about antimicrobial Resistance Global Compact that is being issued today. But really, it is important that Henry comes back next year. Sorry. Henry. Stanley. Exactly. Stanley comes back next year with more outcomes. And we really want to work at this together.
The outcomes will come from you.
We are there for that.
The other manufacturers.
I have a question for you. And I think Stanley started framing this earlier to say that even as back as 2012, this conversation was already taking place and they were trying to raise the priority, the importance, the urgency. But this is not happening. Rachel alluded to the same. Why is it that this problem is not making headlines? Why is that so?
I, I see two answers to that. The first one, storytelling is not great because it's, I think you use the word complicated twice, Deepak. It is complicated, but at the end of the day, it's very simple. If it's going to kill more than cancer, it is a pandemic in the making, and we have a responsibility to ensure that everybody knows that there are solutions, that they are, again, prevention that can be used. And again, invest perhaps a little bit more in diagnostics, which gives you the, first line of defense against this pandemic. So that's one part of the answer. The second I said storytelling because it is I don't know about you. You tell us in the audience, but Antimicrobial resistance is a mouthful. Yeah. It is difficult for the lay public to grasp how really they should relate to this and how their parent who is having a knee surgery, their kids who is hospitalized for a mild infection, might actually need antibiotics and therefore be exposed to resistance. So making it more relatable. And that includes probably changing the language that we use around the crisis. That includes increasing the trust in science, because ultimately it's also about trusting the system. When you want an antibiotic and the doctor is telling you you don't need an antibiotic, respect that decision. Make sure that you are also using them responsibly.
Wow. Okay. You're layering it and you've already layered this environmental aspect. Which makes me think of the fact that when you're thinking of infections, you actually have to think broad, you know, some of the things that predispose us to infections and how we respond to infections include access to clean water, those kind of basic foundations of public health are things that we can so easily overlook. And, they are not, evenly distributed across the globe. And that introduces an inequality and social inequalities that then predispose people to, to, to, to infections. But then you've also added the animal health aspect to it. So you're layering it in a way that I think perhaps you your argument for a one health approach might be important here. There's a thing that you pointed out and I want to ask Deepak about that. You've also pointed out the process of arriving at the the diagnosis of of this superbug. And, Deepak, if you can just outline, outline that for us and then highlight what it is that we should be caring about given in terms of that process.
Yeah. I mean, you highlighted a couple sources of infection, right? So people get infected in all sorts of ways. You talk about, you know, sanitation, you talk about community acquired infections. And those certainly can, involve drug resistant, in this case, bacteria. But an important source actually is in a hospital or a care setting. And in fact, it's that is a actually a very significant source of, of superbugs. To put it simply, I mean, hospitals where all the sick people are. Right. So it's where germs tend to collect and particularly ones that become, become resistant. And so the process, particularly for the hospital acquired ones and to some extent, community starts by a patient presents, let's say, a fever, a fever of unknown origin. So a clinician and before they ever get to a clinic, a patient is confronted with, well, is this a cold? Is this a viral thing? Most people don't even think about that. They know there's a fever. And diagnosing that, can be complicated, right? So you don't know when to administer a test versus waiting to see what happens. Right? On the one end of the spectrum, there's costs associated with waiting, for example, sepsis, bloodstream infections. There's a lot of awareness around that, right? Where every hour leads to something like 18% increase in mortality if there's a bloodstream infection. And unless you catch that, early prognosis is not very good at all. So all of us have greater awareness around that right before we ever get to that point. There's a whole, you know, vast majority of infections that don't have that kind of a implication. Right? So the role of diagnostics here is, first, whether it's, a blood test or some other biological sample, sputum, for example, or a site of an infection, collect the sample and you send send it off to a lab to analyze whether it's blood or other things for bacterial infections, the way you identify this is typically you have to culture this bacterium, right. You have to take and let let the thing grow. And depending on the type of bacteria you're talking about, that can take anywhere from 18 to 24 hours. If it's a case of a fungal infection, it could take up to 3 or 4 days, right? But let's just focus on bacterial infections for now. So what happens in those 24 hours 18 to 24 hours is important, right? So if there's reasons to suspect a severe infection, a clinician like if you're a patient come in, maybe you see an open festering wound, whatever your inclination is to say, I'm going to treat it with the broadest spectrum antibiotic just to make sure that this is in a bloodstream bloodborne infection.
So that covers most bugs.
That covers most bugs. And and you'd be very responsible in treating it this way. Right. On the other end, you could be in a particular clinical setting where, you know, there's certain strains of bacteria that typically are manifest for one reason or another. And your inclination may be, I'm going to hit it first with a, I don't know, Z pack or Cipro or something like this, right? Where in fact, the the bacterium that you've got is something altogether different, right? Both are different manifestations of the same underlying issue, which is you're having to wait 18, 24 hours before you actually know what strain this is. And this is where the role of the diagnostic comes in. Right. And there are tech technologies that are available. Products are available. Your company happens to make one of them where you can get a result in four six hours, something like this. Right. And that's very critical because that's the time window when you can actually guide the therapy properly first determine whether it's bacterial infection or not. And secondly, once you determine it what strain it is, then you can figure out whether it's a simple z-pack, whether it's, vancomycin or carbapenem, whatever. The different types of antibiotics that may be needed are. So that flow of getting information about what the infection is as quickly as possible helps determine the right therapy, which means you're hitting the the bacteria with the right kind of treatment. And what that does is minimizes the risk that these drug resistant strains in a patient that's already immunocompromised. Right. So this is another important part of this. When a patient isn't able to fight off this infection for whatever reason, then that's the conditions under which bacteria grow, right? And when all the relatively benign or relatively less harmful bacteria have been killed off, that's when, you know, these these more virulent strains grow.
And identifying what organism you're dealing with doesn't necessarily mean you know which drugs it's going to respond to. You can know which one it will typically respond to, but if it's resistant, then you still have to do further tests to identify.
Then you're in containment and you're in mitigation strategies. Right. And that's where, for example, if the source of the infection is a wound, perhaps a bedsore. So one of the big sources of infection, is, you know, bedridden patients that end up getting, pressure related injuries, or sores. And that could be an avenue where bacteria enter into the body, whether into a bloodstream or other things. So whether it's a drug resistant bacteria or other things, one of the first things you do is try and mitigate, right? Try to localize, try to contain the infection. And that's where the a lot of products, a lot of technologies that are available in the market, some of them are ones that we as Smith and Nephew manufacture, but it's not related to any one company. There's a whole suite of solutions out there that are dressings with antimicrobial treatments. They're dressings that have other coatings that inhibit, pathogens from from growing. Or there are other things that you can apply before anything happens. So for example, surgical site complications. Right. You mentioned, you know, knee surgeries. So there are antibiotics or other things that are given prophylactically. But there are other solutions out there that are not, drug related. There are other things like negative pressure wound therapy. So in certain patients or certain settings where there are high levels of pathogens, you can apply more than a standard gauze or a standard surgical, dressing that prevents or inhibits infections from forming in the first place. So these are some strategies that can be used in a clinical setting, integrated into workflows that can minimize the chances of drug resistant bacteria from, from growing or becoming a bigger issue.
Well, we're going to have to ask Bernina to simplify that language. You're the one who who said that we need to make this language accessible. But Rachel Deepak mentions an important point about if you do, if you don't intervene properly, you end up with sepsis. And the sepsis can affect different populations. And it just means that it's a more complicated problem that arose out of something that we've failed to deal with along the value chain. Can you can you talk a little bit about that and why it's important to make sure that we deal with sepsis.
Yeah. So I've been doing a lot of work on neonatal sepsis, which is this bacteria in the blood. That's what sepsis is. And, also so it's with very new born babies who are obviously weak and fragile and, and find it hard to fight off infection. So this, you know, this problem of the diagnostics can take too long is really, even more important for young babies, you know, the first couple of days of life because sepsis, you know, the diagnostic that is used in, in most of the world, culturing, will take several days, as you've heard, a couple of days. But the baby will die in, in a day if they're not treated. So the and and I mainly work in low and middle income country settings. So we this is a huge problem in India where we've been studying it. And a quarter of all the deaths of young babies in India come from this sepsis in, in these young babies. So and yet there's also huge Amr so huge resistance in the hospitals. So we've got this problem of a lot of children who have sepsis not being treated with antibiotics, and a lot of children who are, not who don't need antibiotics. Getting antibiotics and the antibiotics they might get is then a blood, you know, is is intravenous broad spectrum. It kills all the bacteria in their gut. So then they can't, just food. So it's hugely damaging for the baby to get the, these very strong antibiotics, if they don't need them. So doctors are in this terrible dilemma. And what we need is a diagnostic, but we need a diagnostic that you can use in rural clinics in India and is cheap. Right. So we're making some progress on some other forms of diagnostic, although we've got a lot further to go. But we also need these diagnostics, for these other environments. And why does India, in much of the much of the world outside the rich world, get so much neonatal sepsis? It's because kids are born in less sterile environments, so they're much more likely to get these bacterial infections. So, you know, I talked about the economic incentives to do this. If you if you're designing a diagnostic that's useful only in low and middle income countries, you're not going to make a lot of money out of it. And, you know, it's only going to be taken up if it's really cheap. And a lot of these countries, when I talk to Indian policymakers, they're very proud of the fact that they manage to drive the price down very low, which is great for getting access, but it isn't great for incentivizing companies to work at the problem. So there's actually a way to solve this, right? We normally worry about patterns that provide incentives but reduce access. Well, economists have come up with a way to solve this problem, which is you pay the innovator money directly for the innovation in return for them charging kind of marginal cost for the, you know, for the actual diagnostics. So you say, you know, we will buy a large quantity of neonatal sepsis diagnostic if you produce something that can be, you know, tell whether it's viral or bacterial, can be used in a clinic is less than $3 a shot. You know, you put these and then we will give you a bunch of money. So this is one of the solutions that we've been working with, working on. And we've recently done the estimates of how much we think you should reward innovate the successful innovator. So you only pay if they come up with a product that produces these things $60 million. Now that's a lot of money, but it's nothing compared to the costs that we've been talking about. Right. This could significantly reduce Amr. It could save millions of lives. And it's and we could get a solution for $60 million.
Okay. So we know that the problem is big and actually it should be a crisis or treat it as a crisis, but it's not. We know that, it's complicated to diagnose. The language is complicated to communicate. And it's broad. It affects environment, animals and all sorts of things. We know that it can create serious complications for patients and contribute to death. And as you said, it can eventually overtake cancer if we are if we live the trajectory as it is. So that trajectory needs to change. And we are now saying that there are things that can be done. Stanley already. The. Rachel is beginning to frame what could be a model that could be used to incentivize innovation, to help us change the trajectory of of Amr going forward. You've been running business for a long time. Healthcare products distribution. Can you reflect on on this, on as to whether you think there is a business model that we could work with that could help us to change the trajectory of this problem?
I think Rachel was moving towards that, but I want to make the problem a little worse for a moment before I give you the answer.
It can't get any worse.
So what happened to me in the summer of 2015? I was in Colorado. I was about to go and address our national sales meeting, and I was walking towards the stage and I couldn't breathe. So I called my wife and I said, should I get a doctor? I said, a pulmonologist. And she said, no, no, go to the hospital. So I go to the hospital. And it happened to be in Aurora in Colorado, and it used to be a pulmonary hospital. So the people in intensive care, a lot of them were pulmonologist types, but they were doing, you know, in the emergency room, not intensive in the emergency room. So they take me into a room and they do all sorts of stuff with me, and they take a panel. They come back an hour from two hours later and they say you have a form of pneumonia that is just going to go away. You're just going to keep you here. Let it keep me there for a day. They did some stuff and whatever. And then they told me this particular pneumonia was spreading around the US. But general practitioners didn't have access to this particular panel. And so what the solution would have been prescribe an antibiotic. And this particular problem I had would not have been solved by an antibiotic at all. It just was going to go away. So I think we have an issue here with how do we firstly make sure we get the right diagnosis diagnostics. And I think you said 60 million, which is nothing in billions of dollars spent in healthcare. But there's also a bit of an education issue. I'm going to say something which is probably not that popular with our customers, the dentists, but the dentists, I think in the United States prescribe about 10% of the antibiotics. And, it's not that they're trained to do that. It's just that's what's done. And so I have two questions here. And one is how do we get the right equipment to do the diagnostics. And that's a bit of an investment. And how do we do the right education. And professor, to me the only answer to that is public private partnerships. We have to bring people together. And you bring the diagnostic people, the manufacturers, the public health people, the economists, people like ourselves that distribute these products. And, I think the various trade associations that we belong with have and even the forum need to be encouraged to put together a public private partnership, just like they did with the bringing of vaccines to market. And I think panels, discussions like this make people aware, and that's the only way to get there, is to bring the parties together and to advocate for this, because this is not going away. As we mentioned early on, the statistics are going to get worse and worse, and by 2050, we're going to have a mess on our hands. So how do we get this thing on the public agenda in all different countries and put the public private partnerships together?
Anyone wants to respond to that on the panel? I'm going to in a minute, I'm going to open the floor to the audience to help us answer your question. I guess the audience will also be assisting us in thinking about how we move forward, but we would very much encourage questions as well for the panel. Anyone wants to respond to that.
Maybe I'll make a couple of additional points to the to the challenge. The first one, as you have rightly pointed out, Stanley and everyone truly, it's not just a story of developing new antibiotics. It is truly a story of protecting those antibiotics that we have because they are fragile themselves already. So it's not just about a fragile future, it's about a fragile present, if I may say. And one thing that we know is that you can diminish antibiotic consumption by 50% by using diagnostics. So it is truly important to make sure that when we are working in public private partnership mode, we invest in surveillance. We we make sure that we, know what we are fighting against. So my company bio, Mario, has been investing very much in public private partnerships, and we've worked with public health agencies to develop rapid testing in many healthcare settings. But one thing that was mentioned as well is what is called stewardship in policy language. And that means educating clinicians to use less antibiotics or to use them responsibly. We have a foundation as well called the Mario Foundation. And to your challenge, Rachel, it is critical to make sure that we start in the, in the South, by working with those healthcare professionals that are our frontline, army and that are the ones most exposed to antimicrobial resistance. The foundation has invested in 17 laboratories in low income countries and slowly, not only by training, but by developing more and more testing capacity in those countries. We are handing those laboratories over to the countries themselves. But you need to make sure that at the end of the day, there is also investment in ensuring that this laboratory capacity can continue and that it's not just a one off. So all in all, it's a story of responsible investment. And it goes both ways. It cannot just come from the private sector.
Rachel.
Yeah, let me talk about a couple of examples that have been successful because we're getting a bit down here. Yeah, but I want to show that there are ways.
You can blame Sandy for that. Keeps wanting to make it worse every time.
So, I talked about this challenge of how do you incentivize people to produce something that then you don't want to use, right. So, so one one thing that people have done is that governments have done is provide do what's called a subscription model. So, so basically governments have said we will reward you for for innovating and coming up with a new, antibiotic that can, you know, address these resistant strains, but we will pay you not based on how much it's used, but just to have it in our back pocket for when other things fail. And so the UK, you know, has promised 6 million to 24 million a year for people, you know, selling them an antibiotic that's new and can address these superbugs, but you get paid whether it's used or not, so that then they try and keep it, you know, under a national health system where it's a bit easier to control this. And, the EU has some similar approaches. Unfortunately, the US had a really nice act, the Pasteur Act, to do a similar thing, and it hasn't passed yet. So we need to push that, to be passed. So these are some of the things that have worked, you know, these are some examples. The other example is that actually if you if you get more people vaccinated against, for example, pneumococcal. So this happened in South Africa. Then they use less antibiotics because, you know, the kids been vaccinated and therefore they don't go to the doctor with an unknown fever and then it's not prescribed. So you actually got a reduction in the use of antibiotics by inventing a new vaccine. And that new vaccine, the pneumococcal vaccine came from exactly the kind of thing I was suggesting for the diagnostics. It was a group of countries came together and said, we will pay you, to invent, a pneumococcal vaccine that addresses the needs of low and middle income countries because there was a vaccine that was very close to finishing, that was, you know, designed for the US market, basically the US and European market, but it didn't cover the strains in the rest of the world. So $1.2 billion commitment to reward someone for not only coming up with that vaccine, but getting it out to a lot of people, because for vaccines, you need it to get to lots of people. For antibiotics, you need to reward people for not getting it to lots of people. But that vaccine rollout in South Africa, as they say, substantially reduced. So I think there are a lot of different ways that we can attack the problem.
To reduce the need for.
To reduce the need for antibiotics.
Deepak, do you want to comment on that? Because you also, your work is very much about reducing the need for antibiotics as well.
Yeah. So I think, my fellow panelists have covered the a lot, of, lot of important points about what we do about this. Right? So it's not all gloom and doom. There's things that have been done, things that we can do yet around it, but around speaking to prevention and mitigation strategies, that's about integration into current workflows. Right. So this is about what do you do with, you know, patients who have gotten, surgeries, depending on the kind of settings in which they've gotten, and what they get discharged with. Right. So what's the standard of care? So that's something that can be done today, right? By embracing solutions that are already on the market. So that's a little bit about awareness. Back to your point of awareness, not about general public awareness but more about clinician awareness. Maybe call it marketing or clinical education or medical education type things. Right. So so that's something that can be done today. And there's efforts like by companies like ours and others who are active in this field. That could add to some of the, some of the efforts that are underway.
Excellent. So let me invite our audience, to please indicate if you've got questions. There's one, two, three, four, five, six, seven hands. So let's take the three hands in that row, and then we'll come to the front and then go to the back. The gentleman next to you start with him. Yeah.
Thank you I'm Christian Richard, a citizen of Davos. Thank you for organizing this. Phages are probably the most abundant organisms in the world. They eat bacteria naturally. They're cheap. Soviet, brilliant. Soviet, scientists and doctors have used them to heal people with infections. Why are you not. Why are we not, doing that?
Good question. We'll keep that question. We'll respond to it. Let's take the gentleman, I think, in the yellow shirt.
Thank you for the opportunity. My name is Gavin Mulumba. I'm a trainee at the DHL currently. And my question is, how do you intend to tackle the loopholes within animal nutrition and veterinary medicine? Because this is also an opportunity to get infected with, a CM.
Good point. Vanilla that's coming to you. Then there's a lady over here.
Good evening. My name is Huang. I'm a student and hopefully future pharmaceutical scientist. And my question is, we know now that climate change will in the future bring on more unknown diseases or, bring forward diseases we've had before. So what role do you think antibiotics will play in the future with these, increases in diseases? Thank you.
Okay. Phages. Deepak.
Yeah. So I think, look, I mean, it's I'm not necessarily qualified to to answer as I'm not I don't need a pharmaceutical company today.
But you run a med tech company.
True. So I guess that makes me an expert in this particular context. So. But I happen to know something about, the topic. So what I'll tell you is this, there's a variety of kind of treatment approaches, that are being tried. So for example, pharmaceutical approaches for drug resistant, so MRSA. Right. So the way you tackle that, you know, maybe phages are part of the solution. There are other approaches that you could try. So there's I don't think there's a particular, kind of inhibition to, to trying different things. But at the end of the day, in the current context, you've got to demonstrate that something works to a standard, safe and efficacious and well-established pathways for that, right as to what the underlying biochemical basis for why something works, you know, that can whether it's phages or, something else. You know, I think, approaches could, could, could vary. But at the end of the day, all of these things need to go through a standard that's well established. The phase one, phase two, phase three trials. And there's a process for, for doing that. So back to providing incentives for encouraging companies to do this. These things are expensive, right. In order to in order to demonstrate that something works. This is typically through randomized control trials, which requires the enrollment of patients, requires that you demonstrate in each stage that something is safe to a statistical statistical standard. Right. And it's in that where partnerships can help. Right. Because absent these incentives, you know, whether it's supply guarantees from governments or NGOs, most pharma companies or manufacturers have other places where they would prioritize. These are higher return, kind of areas. So this is where incentives to look for the types of therapies, whether it's phages or something else, can help. And there's models that, Rachel, you've kind of identified for what happens at the other end once you've gone.
Are you are you aware of any startups perhaps, or biotech startups that are working on phages currently?
Personally, no, not I am.
So maybe that's an opportunity to to think about, again.
The climate change thing.
Yeah. No. Let's go to Animal Health and then I'll come to you on climate change.
Rachel, I'll bundle the two questions because I think they're actually closely related. And I will, count on your help to support the arguments. So you're absolutely right. Climate change is very much part of the story because it's changing diseases patterns. We are seeing dengue in Europe now. We are seeing that heat waves, floods, water stress, they're all impacting the way diseases behave. And in turn that, increases antibiotic consumption at the end of the day. So it's very much the same story. Basically, antimicrobial resistance and climate change are not parallel trends. They are closely connected. And that brings me to animal health, of course. We are seeing that there are diseases that are transmitted from animal animals to humans. But there I think we have a lot to learn from the veterinarians. And I'm sorry, I'm not pronouncing that correctly.
But you're fine. You're fine.
Animal health, experts, they are, much better at driving responsible use of antibiotics. And I think there are a lot of lessons learned there for us in human health. So I think that's where we should turn our attention to and get to learn more from them. But, Rachel.
I may add one quick thing. Rachel, just just your comments triggered a thought just in response to the answer to to the student that asked, part of development of therapies, you know, pharmacological therapies has to take into account that the pathogens mutate, right? Evolve, whether it's response to climate change or other factors, it doesn't really matter all that much. Right? But the key here is pathogens evolve. And we've kind of learned that in somewhat real time. And we all experience Covid together. We were talking about all the different, you know, waves, the delta wave, the Omicron and all these different things. So we learned we got a lesson in biology or molecular biology and kind of real time. Right. But in the context that we're talking about, it's important to have a program. So it's not developing the next big, you know, Vanc or Penem or equivalent. Right? You've got to have an impetus and an incentive to make sure they're active programs that surveil pathogens. Right? A systemic, program for surveilling and then translating that into into therapeutics that are that evolves. It's kind of a little bit like back to your vaccine example, Rachel. Right. Every year, you know, we get or encouraged to get flu shots, right? And every year the shots are different. Right. And and again, most of these are zoonotic in origin right. They start in a chicken farm somewhere or poultry farm somewhere and then migrate over to humans. A particular strain in a year, you know, varies from year to year, can actually vary within a season as well. Right. So that's an example we're all kind of aware of in the popular, kind of consciousness. But that applies on the drug side as well. So I just wanted to add that point.
So surveillance of the pathogens linked to the innovation in terms of the products as well. Rachel.
Yeah. So another reason why climate change is causing more, causing more diseases and really increasing the risk of pandemics is that as animals move because of the climate changes, they're then interacting with animals they've never interacted with before. So, you know, then things are passed. You've got a different host, that might be closer to human. And so it makes it easier for these or might interact more with humans. And so it makes it easier for these animal diseases to be passed on to humans. And that's very like we're already seeing that it's very clear in the science that that this is increasing. Now what do we do about and what do we do about it? We could have a whole nother panel on that. But, I mean, just to say our work on pandemics suggests that, we are losing every year, $2.7 trillion to pandemics. What do I mean? Like, we're not losing it this year because we're not in a pandemic. But if I add up all the costs over the next, you know, 5000 years and divide it by 100, then I get 2.7 trillion. So every on average, every year we are losing 2.7 trillion to pandemics. So some of them could come from, you know, bacteria and these superbugs, and climate change, is, is increasing that over time.
So it comes back to this thing of preparedness that we've been talking about. Let me take another round of questions.
Quickly on the animal health.
Yeah. Please.
So very quickly, there's bad news and good news. The bad news is on the diagnostic side, the animal health diagnostic companies have sort of spun out of the human, the human diagnostic companies. I don't know about you guys, but I'm not really doing the animal health. There are specialty animal health, so they're not getting as much funding. And on the pharma side, the same thing has happened. But there are a few pharma companies that have kept their animal health business and are doing mutual work. But the exciting part, the good news is that AI, they are not distinguishing between human and animal health. The software can be used both ways. Yeah.
So that that can give us some leverage. Let's take there were two hands, the gentleman here and the lady over here. And then there was one hand at the back.
So my name is Warren. I'm director of R&D at Softserve. So we had the privilege of working with you and Henry Schein on technology, and I know that it can bring positive impact. My question is, what is the biggest gap or an opportunity that can be addressed with the technology and you think may have a biggest impact on curing infections in the next five years?
We'll come back to that. Just hold it. Let's take the lady over here.
Hi. So my name is Nicole and I'm actually here as a patient. So I am one of these people who has a superbug. And it's also a chronic infection. So carb vancomycin all these things, they don't really work for me and for a lot of people like me. So you guys are here talking today about telling doctors to prescribe less and less antibiotics, which in principle is a good thing. But for people like me who are already kind of down the line, there are only really two solutions. One of them, like he said, it's phage therapy. The other one is high dose, long term antibiotics. Now, if you want to access these antibiotics, doctors really don't want to prescribe it because the push is to not prescribe. I mean, in my case, I only find one doctor in the entirety of Western Europe that wants to prescribe, if they don't, I die. So I was just wondering if when you talk about, compacts against Amr, if you're even considering people like me who actually need high doses of antibiotics to survive, not just diminishing, but some people need to be educated to actually prescribe more rather than less.
I feel like you should have been here with us as well. Yeah. Let's take those two questions quickly. You can start and then.
I'll give you a quick answer. One of our businesses is the largest provider of dental software, and I believe there is an opportunity if we can put the right public private partnership together to do a lot of surveillance work in America. Unfortunately, only half the population goes to a dentist. But in that half of the population that does go, many of those don't even go to a doctor's office. So it is possible to put some software, a feature into software to track particular public health issues and collaborate with a CDC. If there is one to deal with this issue and you can do through surveillance.
Just just to build. To answer your question, I think there's two things that I see. One is systemic and the other is a particular thing around, okay, there are drug resistant pathogens today, bacteria that clearly need a solution, an antibiotic that will work against, let's call it MRSA. Right. So that's a gap I think it's a soluble gap. And you've heard certain approaches that can make that, you know, a way that companies can go after the systemic ones, almost by definition, are really hard to sell because no one person's problem. Right. And the solutions are very different. What works in a low resource setting, where the issues are very different from a high resource setting, the problem is the same. The patient impact is the same, but the issues are multifactorial. Right. And so there back to your communication point, Vanina. It's important to tailor not only the messages, but also education programs for those different kind of settings. It's soluble, but you've got to recognize what you're dealing with. Right. So that's my kind of answer to the to separate things back to your question about, you know, again, to you as a patient, first of all, you know, my, my empathy towards you for, for, for, for dealing with what you are, I can relate not maybe other personal experience, but those around me with, you know, diseases that are not so easy to diagnose, where the solutions are not so straightforward and you kind of fall through the cracks where you're not in one particular specialty that treats you. Right. So it's in a sense, so, so, so first off, look, I'm not a doctor. There is a doctor on the panel who can better guide what may be appropriate. Right. But what I will tell you is there is a role for patient advocates. And I don't think most of us was was kidding when we said, you know, you belong on this panel, together with perhaps a pharmaceutical company representative, because part of the awareness starts with people like you talking about your experiences. Right? Because it's very easy for patients like you to get dismissed. Right? It's very easy for people to not be aware. So things like Lyme disease, right, for example, it manifests in very different ways. And once you've kind of passed the window where you could intervene with a relatively straightforward antibiotic and we've missed that window, then you're in a very different place in terms of dealing with the chronic condition. And that's beyond the reach of antibiotics. People may think that antibiotics can but but but it's not because you've there's been a systemic response for which there's not an easy solution. Right. So for that, patients like you need to, need to present in forms like these and others so that the right experts can come in and say, I don't know what the right answer is. Maybe it's phage therapy, maybe it's, other things, but it all starts with awareness. It all starts with multiple disciplines tackling it, whether it's diagnostic companies, or pharmaceutical distribution companies. And you've lumped. Yes, medical device companies that want to also become pharma companies like ours. So there's different approaches to bringing to bear. But just wanted to highlight, that there is a role for, for patients who are suffering quietly suffering.
Absolutely.
Thank you for that, Rachel. You know comment.
Can I just say I think this is a dual problem, right? When we talk about antimicrobial resistance, and when we talk about antibiotics, we've got two problems. We've got overuse in some places and underuse in other places. Right. So your one case of, you know, you need treatment, but there also a lot of people around the world who could be cured, a lot of babies who are dying for lack of simple antibiotics. So we need to look at both of those problems together. I think we've got to look at, at, you know, cutting back where we don't need them, but but so that we can prescribe them in other cases. And there are a lot of people who are suffering from not getting antibiotics to.
Vanina, does the compact address people like, Nicole?
Well, first of all, your story is so critical to listen to. Countries are devising national action plan on antimicrobial resistance, and your voice is badly needed as those countries are devising their national action plans. So that's I'm echoing what Deepak was saying. It is, for sure that we need new antibiotics. It is for sure that the solutions that you are expecting is probably coming too slowly. But that's why, there are, calls to action, like the Global Compact to raise more attention than the issue. It is multifactorial, and we cannot single out one type of needs. If you don't mind me saying, it is also critical that we think of the babies in India and in other places of the world. So making sure that we balance needs, that's what policymakers do on a daily basis, and making sure that they, have all the stories coming at them is a great way of doing this.
Thank you. So for those who had questions, I'm going to invite you to engage with the panel that we did not get to. But let me take this opportunity to thank you, all of you, for being here. This has been amazing. A round of applause for everyone. So if you had any questions and you want to engage the panel, please come forward. Thank you.