October 16, 2019

AMR Alliance Japan Urgent Forum Report

The Stable Supply of Antimicrobials andCrisis in the Antimicrobial Market
A Call for Action from the G20
The G20 Osaka Leaders’ Declaration released in June 2019 expressed a commitment to global
cooperation on antimicrobial resistance (AMR). To support discussion on this topic at the October
2019 G20 Health Ministers’ Meeting, AMR Alliance Japan held an urgent forum on two causes ofantimicrobial access problems – the global antimicrobial supply chain, and the structure of the global
antimicrobials market. AMR Alliance Japan submits the following summary of the discussion at thaturgent forum for consideration by the governments of the G20.

Problems Ensuring the Stable Supply of Antimicrobials Encourage the Spread ofAMR and Pose a Serious Health Security Threat
Antimicrobial supply problems have been emerging recently across the world. These problems hinder
the effective treatment of infectious diseases and prevent proper antimicrobial stewardship, thereby
encouraging the spread of AMR. This poses a great risk to the health security of all countries bythreatening to create a situation in the future in which infectious diseases are increasingly difficult, if
not impossible, to cure. The G20 must recognize the threat of AMR and undertake the following
measures to ensure the stable supply of antimicrobials.

Global Cooperation is Needed to Strengthen Antimicrobial Supply Chains
Antimicrobial supply chains as a whole are extremely fragile – economic issues in the antimicrobial
market mean that production often relies on just one region. G20 leaders must come together toprotect their people against antimicrobial supply risks. Extensive global cooperation is needed on thisissue. The G20 should consider the construction of a public-private partnership (PPP) or similar
framework that can ensure the stable supply of antimicrobials on a global scale. This framework must
include mechanisms for real-time information sharing on the production, demand, and supply ofantimicrobials, the appropriate stockpiling of antimicrobials, and measures for multilateral support
when supply problems do occur. The framework must also include financial measures to support
antimicrobial production.

Action is Needed to Address Global Antimicrobial Market Issues
Recent antimicrobial supply problems are a result of structural issues in the antimicrobials market,
including falling price and reimbursement rates, which are increasingly forcing pharmaceuticalcompanies to produce antimicrobials at a loss. This situation makes it extremely difficult forcompanies to enter or stay in the market. Such difficulties also discourage innovation and efforts tofoster the antimicrobials researchers of the next generation. Recognizing that a stable antimicrobial
market is indispensable to the public health of all countries, the G20 must advance discussion on how
to solve antimicrobial market issues, including through pricing and reimbursement rate reforms,
antimicrobial regulation harmonization, the construction of new incentive models, and the creationof risk-sharing frameworks.
This report was compiled by the AMR Alliance Japan Secretariat (Health and Global Policy Institute), and should not be construed to represent theopinion of any singular forum speaker.
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