“Silent pandemic” – why the antibiotic crisis is now spreading

It’s a race against time. Nearly 100 years after Briton Alexander Fleming unleashed a medical revolution with the discovery of penicillin, antibiotics threaten to become a blunt weapon against bacterial infections. Cases in which the active ingredients are no longer effective are increasing worldwide – including in Switzerland.

The consequences of such resistance are serious, because infections that were supposedly treatable can become life-threatening again. General practitioners prescribe antibiotics for pneumonia or blood poisoning. Every fourth hospital patient gets them, usually to prevent complications or to protect cancer patients from infections after chemotherapy.

This is getting more and more difficult. The Swiss Center for Antimicrobial Resistance estimates that about 300 people die each year from infections that could no longer contain antibiotics – in 2010 that was only half. Time is running out. Because there have been no new antibiotics on the market worldwide for about 20 years. And the doctors urgently need new material.

But the priorities are different at the moment. Doctors and hospitals here don’t even know how long there will be enough conventional antibiotics available to buy. The Federal Office for National Economic Supply (BWL) recently warned that there was a serious shortage of antibiotics in tablet form. That is why the mandatory stocks by 1 March should help. The group of active substances penicillins is particularly affected by the supply crisis.

“We are feeling the aftermath of the pandemic,” says Monika Schäublin, head of the Medicines Agency in the Business Administration, about “Switzerland at the weekend”. Due to the lockdowns, fewer people got sick and needed fewer antibiotics. Therefore, demand has declined. At the same time, suppliers have withdrawn from the less lucrative market. These consequences are becoming visible now, at the end of the pandemic. “Demand shot up again at the end of 2022 – and that in a market that was already at its limit before the pandemic,” says Schäublin. Depending on the active ingredient, up to 20 percent of the Swiss antibiotic requirement is currently missing.

In hospitals, antibiotic infusions have long been scarce. Now patients who receive a prescription for tablets or capsules are also feeling the effects of the antibiotic crisis.

The current bottlenecks and the development of resistance are closely linked: if hospitals and doctors can no longer obtain the right active substances, they have to resort to so-called broad-spectrum alternatives – which in turn promotes the development of multi-resistant germs.

Rudolf Blankart follows this development with care. The 42-year-old is not only a professor for regulatory issues at the University of Bern, he also works at the Swiss Institute for Translational Medicine and Entrepreneurship and chairs the so-called “Round Table on Antibiotics”. Over coffee, Blankart tells how six years ago he appealed to the Federal Council to draw attention to the urgency of a safe supply of effective antibiotics.

Finance Minister Ueli Maurer was the first to respond and invited for an hour-long talk. Blankart had to wait a whole year before he got an appointment with Health Minister Alain Berset. Finally, Blankart spoke with five federal councilors and all political parties. Although the Bundesrat subsequently invested money in various projects and launched a national action plan, no concrete measures have yet been taken to ensure that Switzerland can better guarantee the supply of old antibiotics and promote the development of new antibiotics. The Bundesrat intends to present an overview of the efforts to date this summer.

“We have to react quickly. The development and production of new antibiotics can take up to ten years,” says Blankart. Given the spreading resistance, one cannot wait any longer. The tone of the press releases he writes as chairman of the association “Round Table Antibiotics ” shows how seriously he takes the situation. There is talk of a “silent pandemic” and “a race against pathogenic bacteria that we are in danger of losing”.

Instead of simply raising the price of an antibiotic x-fold so that pharmaceutical companies invest more in new products, he argues for innovative financial incentives. For example, the state can pay a premium when a new antibiotic comes on the market or provide long-term subsidies to ensure that a product stays on the market. “Politicians here are obliged to find a solution,” says Blankart. Switzerland can play a pioneering role as a test market and a pharmaceutical location.

To improve the security of supply of antibiotics, Blankart proposes long-term contracts with the manufacturers. “The federal government or the cantons should enter into agreements with antibiotic manufacturers in which the companies commit to supply certain products.” If the companies do not deliver, sanctions will follow. In return, the state pays prices that allow manufacturers to invest in measures to secure their supply chains.

For years, the industry has criticized the consequences of the devastating global price competition. Novartis’ Austrian country manager explained that “a therapy unit of a potentially life-saving antibiotic costs as much as chewing gum”. The lower margin in the antibiotics business is one of the reasons why Novartis is splitting off its subsidiary Sandoz later this year.

Nevertheless, the Sandoz case shows that government interference can have an impact. Austria supports the Sandoz factory in Kundl, Austria, with 50 million euros. It is the only remaining manufacturing facility in Europe that still produces penicillin from the active ingredient to the tablet. In exchange for the government subsidies, the company will stay on the site for ten years and increase its investments itself.

Demands from SP exponents who want to nationalize Sandoz go one step further. In addition, ideas are circulating to bring production back to Europe. Blankart would like to approach this in a more differentiated way: he thinks that well-thought-out financial incentives are more efficient than bringing an entire industry back to Europe through regulation.

The state-led construction of production facilities and the recruitment of specialized personnel is not only very expensive, but also takes far too long. “It’s a utopia.” The production of antibiotics is too globalized. A large part of the chemical precursors today come from India and China.

The Federal Office of Public Health states that it supports various programs that promote research and development. Preliminary clarifications were also made on incentive systems.

“However, new antibiotics are being developed for the global market and this development is very expensive. As a small country, Switzerland can only make a small contribution with a national stimulus,” says spokeswoman Katrin Holenstein. Therefore, internationally coordinated approaches are needed for the development of new antibiotics, but also for new stimulation models. They are in contact with the “Round Table Antibiotics” and are open to appropriate advances.

It’s the business cycle of any crisis: once it becomes noticeable to ordinary people, as it is now, the pressure mounts. Chances are greater than ever that Rudolf Blankart will not have to wait another year for an appointment with the Minister of Health. (aargauerzeitung.ch)