Talent loss a major threat to addressing global AMR crisis
Antimicrobial resistance (AMR) is turning out to be one of the major health calamities, with two million deaths projected to occur in India alone by 2025 and 10 million globally. While the discovery of penicillin in 1928, revolutionised the field of medicine and saved millions of lives, the industry has witnessed a constant decline in the development of new antibiotics ever since then. The lack of resources and high investments are the widely considered reasons for this gap, but one key aspect that remains largely overlooked is the loss of potent scientific and research talent for more than two decades.
In an in-depth research report, Leaving the Lab, AMR Industry Alliance highlights alarming data on this brain drain phenomenon. According to the study, research and development (R&D) workforce is limited with approximately 3,000 AMR researchers currently active in the world, compared to around 46,000 for cancer and 5,000 for HIV/AIDS. Meanwhile, the total number of authors on all AMR publications declined from a high of 3,599 in 1995 to just 1,827 in 2020. Investigators with a focused research interest in AMR too have further declined since the mid-1990s, falling from a peak of 1,300 to less than 700 by 2020.
The situation is even more worrisome in the context of India. According to the World Health Organization (WHO), India contributes only 1% to the global antibacterial R&D pipeline, whereas 84% of this research is concentrated in high-income countries, with another 12% in upper-middle-income economies. For a country like India which not only carries one of the world's highest burdens of AMR but also contributes meaningfully to AMR resistance on the global level, the lack of focus on research and innovation severely undermines the efforts to combat this threat.
The 2016 UNGA High-Level Meeting on AMR discussed a number of actions, including talent loss to address these challenges globally. However, the industry is still witnessing slow progress on work to contain AMR. This brain drain could further exacerbate the situation if necessary steps aren't taken to tackle the crisis at hand.
This current trajectory of AMR research is deeply troubling and stems from a fundamental market failure. Currently most of the private investors and governments prefer directing fund to research in other disease areas, creating a vacuum for companies and SMEs who actively want to amplify work in the field of AMR.
And even if some of the biggest players in the market invest in creating new antibiotics, they often don't attract investment. In recent years, AstraZeneca, Novartis, and Johnson & Johnson have all exited or cut back their work on AMR, including closing R&D facilities, selling antimicrobial portfolios, ending AMR development, and letting go of research teams.
While SMEs are more agile and innovative in early-stage research and development of antibiotics in comparison to the bigger players, their situation too is marred by lack of funding globally. According to a report by the BEAM Alliance, 54% of the SME members struggle with enough funds to cover even a year's worth of operations and fear bankruptcy. Biopharmaceutical company, Achaogen is a prime example. Even after securing US FDA approval for plazomicin, the company was still forced to declare bankruptcy in April 2019 – after spending nearly a billion dollars and over a decade developing the antibiotic.
This phenomenon further exacerbates the broken market for antimicrobials where major pharmaceutical companies are unable to offer long-term careers as they either fear bankruptcy or lack of investments and funding to continue research.
On the incentives front, clinicians in antimicrobial and antifungal R&D teams face significant pay gaps when compared to fellowships across all other specialties. In 2022, 44% of infectious disease fellowships went unfilled in the US – more than double the proportion of unfilled fellowships across all specialties. A 2022 Medscape report showed a pay gap of $4,000 between infectious disease doctors and internal medicine doctors across the US, despite the additional years of training and debt required.
While India has made commendable strides in public health in the recent years, AMR continues to represent an unprecedented challenge--it can't be resolved by treatment alone. As the most populated country across the globe, India needs to have a strong, sustained investment in scientific human capital to challenge the future risks related to AMR.
The government has initiated varied efforts in identifying and filling gaps in knowledge on the development of new antibiotics and alternatives to existing one to combat AMR. For instance, department of biotechnology (DBT) and Biotechnology Industry Research Assistance Council (BIRAC's) mission to amplify research in the identification of new bacterial targets; call for proposals under the AMR Interdisciplinary Research (AMRIT) Team Grants, to foster collaborative research in AMR and collaboration with UK-based innovation charity organisation, Nesta, to create a pipeline of innovators who can develop a point–of–care diagnostic test to conserve antibiotics for future generations, are some of the progressive steps in fight against AMR.
Additionally, ICMR's flagship initiative Antimicrobial Resistance Surveillance & Research Network (AMRSN) to generate high-quality data on AMR trends across India through 30 tertiary care hospitals and research institutions; funding R&D in areas such as rapid diagnostics, novel antimicrobials with international bodies like WHO, CDC (USA), and the Fleming Fund are other examples of India's efforts.
Despite these efforts, challenges do persist in providing the much-needed boost in generating a talented workforce of scientists, researchers and innovators to fight against AMR.
One of the major systemic challenges facing loss of scientific talent is due to academia–industry leakages. Despite producing highly skilled microbiologists, pharmacologists, and biotechnologists, LMICs like India struggle to retain researchers in the AMR domain due to inadequate funding, limited career pathways and lack of translational research ecosystems. Additionally, limited interest from the industry to invest in providing hands-on training to the emerging talent further amplifies the challenges.
To mitigate these challenges, India Pharma Inc. needs to support adequate funding and pull incentives to support the talent eager to work in the field of AMR. The industry and the government must come together to support antimicrobial stewardship programs while ensuring adequate resources, and robust research infrastructure to retain and nurture talent in the larger ecosystem. Government bodies like BIRAC should further intensify their schemes like Biotechnology Ignition Grant (BIG) or Small Business Innovation Research Initiative (SBIRI) to seed innovation and support long-term product development, and market access in AMR. Given the alacrity of challenge at hand, India must focus towards creating a robust pipeline or sustained funding ecosystem for retaining talent instrumental in pushing new breakthrough in antibiotic discovery. Ensuring that we have a workforce of trained research personnel will be crucial for research funding to go as far as possible and yield the most successful results to tackle AMR.
This article is authored by Saransh Chaudhary, president, Global Critical Care, Venus Remedies Ltd and CEO, Venus Medicine Research Centre.
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