The Access to Medicine Foundation has released a new White Paper calling for solutions to a failing antibiotic market.

In the work, entitled “Shortages, stockouts and scarcity: the issues facing the security of antibiotic supply and the role for pharmaceutical companies”, they argue that antibiotic supply chains are “on the brink of collapse”, and detail how pharmaceutical companies are responding.

It is welcome that this complex issue is being given due prominence. While new antibiotics alone will not solve AMR, they can certainly buy time to implement interdisciplinary solutions. The lack of economic incentives for ‘big pharma’ to fund development of new antibiotics has been spoken of in AMR circles for some time; however, there is now acute pressure even maintaining the supply of existing antibiotic production.

Furthermore, the effects are starting to bite. To highlight one example, there is an ongoing penicillin shortage in 39 countries, including Brazil, the US, Germany and India; and in Brazil, this shortage has coincided with an increase in cases of syphilis that should be treatable with penicillin, in turn increasing the number of babies born with congenital syphilis.

The authors discuss some the underlying causes: the vulnerability of relying on a disproportionately small number of factories to produce the majority of the world’s antibiotics; a lack of oversight in the supply chain, leading to failure to match supply with demand as well potential for corrupt practices to proceed unchecked.

They call for a unified approach to dialogue between governments, regulators and industry. High on the agenda, they recommend increased competition at key stages of the supply chain; incentives for companies to enter and stay in the market; the creation of reserve stocks to manage fluctuations in demand; and prioritising delivery to populations most in need.

Some steps are already being taken in these areas, but there are two questions that are integral to this discussion and, in my view, to its success – the first is ethical, the second is practical. First, with regards to responsible stewardship, how do we choose where to draw the line between access and restriction of antibiotics? Second, at what point does education need to meet the limits of regulation? Many countries already have regulations to control use of AMR that are neither effective nor enforceable.

If we can ‘incentivise’ this area by educating informal suppliers and practitioners what constitutes responsible use of antibiotics and that this is in their material interests, then we might see real change