Antimicrobial subscription and pooled procurement
Authors: Manica Balasegaram
Journal: The Lancet Global Health (2022)

In their Viewpoint (February, 2022),1Berman D Chandy SJ Cansdell O Moodley K Veeraraghavan B Essack SY Global access to existing and future antimicrobials and diagnostics: antimicrobial subscription and pooled procurement.Lancet Glob Health. 2022; 10: e293-e297Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar Daniel Berman and colleagues describe how antimicrobial subscription and pooled procurement could leverage combined purchasing power in low-income and middle-income countries to ensure access to a portfolio of newer antimicrobials and diagnostic products. We want to emphasise that this purchasing mechanism, although important, must be combined with other key interventions to be successful, as defined in the SECURE initiative.2WHOSECURE: expanding sustainable access to antibiotics. World Health Organization, Geneva2022Google Scholar SECURE aims to provide countries with access to and support appropriate use of a portfolio of essential new and existing antibiotics, strengthen sustainable global supply chains, and create viable markets for these antibiotics through interventions, including pooled procurement and subscription mechanisms. SECURE is developed by the Global Antibiotic Research and Development Partnership and WHO, with support from UNICEF and the Clinton Health Access Initiative, and is endorsed by the G7. Although it is recognised that registration of newer antibiotics is delayed or non-existent outside the major G7 markets, it is equally important to address shortages of older agents and resulting overuse of agents typically reserved for infections caused by highly resistant pathogens.3Barber KE Bell AM King ST Parham JJ Stover KR Impact of piperacillin-tazobactam shortage on meropenem use: implications for antimicrobial stewardship programs.Braz J Infect Dis. 2016; 20: 631-634Crossref PubMed Scopus (9) Google Scholar, 4ReAct GroupShortages and AMR—why should we care? 4 consequences of antibiotic shortages.https://www.reactgroup.org/news-and-views/news-and-opinions/year-2020/shortages-and-amr-why-should-we-care-4-consequences-of-antibiotic-shortages/Date: Dec 3, 2020Date accessed: March 21, 2022Google Scholar Although we agree that both pooled procurement and a multi-year subscription plan are powerful tools to improve the antibiotic market, it is important to design a model to be flexible, nationally or regionally owned, and sustainable. SECURE (or any model that includes the concepts described in the antimicrobial subscription and pooled procurement Viewpoint1Berman D Chandy SJ Cansdell O Moodley K Veeraraghavan B Essack SY Global access to existing and future antimicrobials and diagnostics: antimicrobial subscription and pooled procurement.Lancet Glob Health. 2022; 10: e293-e297Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar) should: leverage regional pooled procurement mechanisms, while also supporting a centralised option for smaller states or regions with lower demand that do not yet have pooled procurement initiatives; include older products that suffer from shortages or price distortions due to fragmented or unpredictable markets; generate the right evidence to ensure introduction and conservation of new antibiotic treatments, and create the appropriate pathway to extend registration; be flexible and based on regularly updated surveillance that can help ensure products included in the model meet regional and changing public health needs and predict coming needs based on evolution of resistance and use of currently available antibiotics; recognise and leverage current diagnostic networks and work with partners to meet diagnostic needs, or even include partner diagnostics in the antimicrobial subscription and pooled procurement scheme; work with national ministries of health to find potential to harmonise guidance, ensure appropriate use, and consolidate the market, as far as regional epidemiology will allow; and include access provisions, including for pricing transparency, quality standards, and additional provisions tied to delivery of financial market incentives. We declare no competing interests. Global access to existing and future antimicrobials and diagnostics: antimicrobial subscription and pooled procurementThe COVID-19 pandemic has underlined the importance of an efficient and equitable supply of and access to essential health products. These factors are equally pertinent to the antimicrobial resistance pandemic, in which access to a portfolio of existing and pipeline antimicrobials plus complementary diagnostics is crucial. This Viewpoint focuses on market shaping in low-income and middle-income countries (LMICs), where the need for effective antimicrobials and complementary diagnostics is most acute. Full-Text PDF Open AccessAntimicrobial subscription and pooled procurementWith the growing burden of antimicrobial resistance, Daniel Berman and colleagues1 focus on global access to antimicrobials and pooled procurement for market shaping in low-income and middle-income countries (LMICs), where the need for effective antimicrobials is most acute. The pooled procurement option looks to be achievable and necessary, but there are many concerns. Full-Text PDF Open Access