NHS plans wider rollout of UK subscription model for antibiotics

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The NHS is planning to expand its subscription model for antibiotics to more pharmaceutical companies to encourage them to create new treatments to tackle infections caused by drug-resistant “superbugs” and roll it out across the UK. 

Under the new proposal, drugmakers would receive up to £20mn a year for selling their novel antibiotics in England no matter how many were prescribed, double the existing amount NHS England pays under the fixed-fee pilot scheme introduced last year.

The model would also be expanded to Scotland, Wales and Northern Ireland, after the success of the pilot between NHS England and two drugmakers — Pfizer of the US and Japan’s Shionogi. The UK-wide expansion is subject to a 12-week public consultation. 

David Glover, NHS assistant director of medicines analysis, said the health services wanted to lead the response to the global battle against the growing threat of antibiotic resistance, which can undermine the ability to offer routine hospital care. 

“As we continue to take lessons from the Covid-19 pandemic, the development of new antibiotics is absolutely essential to help build resilience to respond rapidly to new superbugs and save lives,” he said. 

The UK has pioneered the scheme as a way to tackle the growing problem of antimicrobial resistance, when bacteria, viruses or fungi develop the ability to defend themselves against drugs designed to kill them. 

Antimicrobial resistant infections caused 1.27mn deaths worldwide in 2019, according to a paper published in the medical journal The Lancet, more than the number of people who died from HIV/Aids and malaria that year combined. It is forecast to cause the deaths of 10mn people a year by 2050, and scientists worry that a future pandemic could be caused by a resistant superbug. 

But despite the huge need for new drugs, many pharmaceutical companies have cut investment in antibiotics research. Drugmakers say it does not make financial sense to invest in risky drug development when they have to compete with cheap generic antibiotics, and that the normal strategy of paying for drugs used does not work, because the new treatments should be used sparingly to prevent resistance developing. 

Instead, the subscription scheme aims to pay drugmakers for the treatments with a fixed fee, so they receive money even if the drugs are just kept in reserve for special cases or an emergency. 

In the pilot scheme, the fee was capped at £10mn a year, but pricing will now be tiered depending on how effective the drugs are and whether they target the most problematic pathogens.

Nick Crabb, programme director, scientific affairs, at the National Institute for Health and Care Excellence, which assesses value for money, said a new panel would play a “critical role” evaluating the antimicrobial drugs using a “novel and pragmatic, clinically led award criteria and scoring system”. 

But he added that the UK “could not face this growing challenge on its own, so we will continue to share our learning with international stakeholders and encouraging other countries to offer similar incentives.”

The US is exploring a similar model under the Pasteur Act, reintroduced into Congress last month. The EU is considering an incentive that gives drugmakers that develop an antibiotic an extra year of exclusivity before generics come on to the market, which they can use for another drug of their choice.