NHS aims to expand UK subscription model for antibiotics across the country

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The National Health Service (NHS) plans to expand its subscription model for antibiotics to multiple pharmaceutical companies. The purpose is to incentivize the development of new treatments to combat drug-resistant “superbugs” and implement it nationwide in the UK.

Under the proposed model, drugmakers would receive up to £20mn annually for selling their innovative antibiotics in England, regardless of the number of prescriptions. This doubles the current amount paid by NHS England under the fixed-fee pilot program introduced last year.

The model will also be extended to Scotland, Wales, and Northern Ireland following the successful pilot program involving NHS England, Pfizer of the US, and Shionogi of Japan. The expansion across the UK is contingent on a 12-week public consultation.

NHS assistant director of medicines analysis, David Glover, emphasized the health service’s commitment to leading the global fight against the growing threat of antibiotic resistance, which undermines routine hospital care.

“In light of the lessons learned from the Covid-19 pandemic, the development of new antibiotics is absolutely crucial to enhance our ability to rapidly respond to new superbugs and save lives,” he stated.

The UK has pioneered this scheme as a strategy to address the escalating problem of antimicrobial resistance, where bacteria, viruses, or fungi develop the ability to resist drugs intended to eliminate them.

According to a study published in the medical journal The Lancet, antimicrobial resistant infections caused 1.27 million deaths globally in 2019, surpassing the combined deaths from HIV/AIDS and malaria that year. It is projected to cause 10 million deaths per year by 2050, raising concerns about a future pandemic triggered by a resistant superbug.

However, despite the pressing need for new drugs, numerous pharmaceutical companies have reduced their investments in antibiotics research. These companies argue that it is financially unviable to invest in risky drug development when they face competition from inexpensive generic antibiotics. Additionally, the traditional strategy of payment based on drug usage does not work as the new treatments should be used sparingly to prevent the development of resistance.

The subscription scheme aims to address this issue by providing a fixed fee to drugmakers for their treatments. This ensures they receive compensation even if the drugs are kept in reserve for special cases or emergencies.

In the pilot program, the fee was capped at £10mn annually, but pricing will now be tiered based on the effectiveness of the drugs and their ability to target the most problematic pathogens.

Nick Crabb, program director of scientific affairs at the National Institute for Health and Care Excellence, emphasized the critical role of a new panel in evaluating antimicrobial drugs. This panel will use a novel and pragmatic, clinically-led award criteria and scoring system.

Crabb also acknowledged that the UK cannot address this growing challenge alone and will continue to share its insights with international stakeholders, encouraging other countries to offer similar incentives.

The United States is exploring a similar model under the Pasteur Act, which was reintroduced into Congress last month. The European Union is considering an incentive that grants an additional year of exclusivity to drugmakers developing antibiotics before generics enter the market, which can be utilized for another drug of their choice.