Antimicrobial subscription and pooled procurement
Authors: Prasanta Raghab Mohapatra
Journal: The Lancet Global Health (2022)

With the growing burden of antimicrobial resistance, Daniel Berman and colleagues1Berman 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 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. Pooled procurement needs continuous monitoring of its efficiency, and pricing competition among antibiotic suppliers is essential. In many countries, the cost of antibiotics is borne by the out-of-pocket expenditure of individuals, which largely depends on affordability. For example, many patients cannot afford costly antibiotics in India. Again, with an everchanging resistance pattern and without a centralised record of drug consumption, there is inaccurate data on antibiotic consumption in LMICs. The real need is enormous, but the types and quantities of the particular antibiotics needed remain unclear.2Fitchett JR Antibiotics, copayments, and antimicrobial resistance: investment matters.Lancet Infect Dis. 2015; 15: 1125-1127Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar There are reports of inappropriate and empirical prescriptions of macrolides, fluoroquinolones, and carbapenems, ultimately wasting valuable global resources.3Laxminarayan R Duse A Wattal C et al.Antibiotic resistance—the need for global solutions.Lancet Infect Dis. 2013; 13: 1057-1098Summary Full Text Full Text PDF PubMed Scopus (2375) Google Scholar Low-cost Asian drug producers, such as those in India and China, have substantially lowered the price of antibiotics compared with the rest of the world. Pooled procurement could struggle to get competitive prices for medicines because of higher transportation costs, which could be avoided by local procurement and decentralisation. The first choice of purchase should be from local manufacturers. The purchase of imported products should be considered only if locally manufactured products are unavailable. International global health coordination can ensure accessibility and improve the transparency of markets for medicines. The proposed Trade-Related Aspects of Intellectual Property Rights waiver proposal will be a crucial initiative for removing intellectual property barriers to access generic and biosimilar medicines based on the cost of manufacturing.4World Trade OrganizationCouncil for Trade-Related Aspects of Intellectual Property Rights. Waiver from certain provisions of the TRIPS agreement for the prevention, containment and treatment of COVID-19—communication from India and South Africa.https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/IP/C/W669.pdf&Open=TrueDate accessed: April 10, 2021Google ScholarOut-of-pocket health expenditure has shown a significant association with antimicrobial resistance, but the reasons underlying this finding remain unclear.2Fitchett JR Antibiotics, copayments, and antimicrobial resistance: investment matters.Lancet Infect Dis. 2015; 15: 1125-1127Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar The linking of nationwide antimicrobial resistance data from the private and public sector is important before pooled procurement mechanisms are planned in participating countries. I 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 procurementIn their Viewpoint (February, 2022),1 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. Full-Text PDF Open Access