Effective antibiotics for the Swiss health care system: today and in the future

Polek, Barbara; Fürst, Walter; Bachmann, Valérie; Blankart, Carl Rudolf (2024). Effective antibiotics for the Swiss health care system: today and in the future. Bern, Switzerland: Swiss Round Table on Antibiotics

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Antibiotics have played an indispensable role in clinical medicine, public health, animal husbandry, and veterinary medicine since the early decades of the 20th century. Their remarkable effectiveness in treating bacterial infections and reducing the risks of surgery, chemotherapy, and other medical procedures has established them as the cornerstone of modern medicine. However, their widespread success and affordability have also led to their overuse, often exceeding clinical necessity. This has accelerated the natural development of what is known as «antibiotic resistance» in bacteria as they adapt to their environment.
As resistance continuously erodes the effectiveness of antibiotics, bacterial infections can become challenging or even impossible to treat, particularly when bacteria develop resistance to multiple antibiotics. The growing number of fatalities underscores the gravity of this trend.
Despite the pressing need for new antibiotics and for a dependable supply of existing ones, the stark reality both in Switzerland and globally is a troubling stagnation in the renewal of the antibiotic arsenal. This is a consequence of (i) low research and development (R&D) activity, (ii) manufacturers’ reluctance to launch antibiotics in more than just a few high-income countries, (iii) shortages due to neglected supply chains and, (iv) in Switzerland, the frequent withdrawal of antibiotics from its relatively small market.
To address these multiple challenges, the Swiss national action plan Strategy on Antibiotic Resistance Switzerland (StAR), has outlined initiatives across eight fields of action, including one that calls for government and stakeholders «to promote the availability of first-choice antibiotics and the development of new antibiotics» (Chapter 2).
In this white paper, the Swiss Round Table on Antibiotics presents a proposal for increasing the availability of new antibiotics in Switzerland, particularly those needed to treat multidrug-resistant infections. To achieve this goal, it is imperative that the remuneration of antibiotics in Switzerland represents a fair share of the income manufacturers need to generate globally to cover the costs of research, development, manufacturing, and market maintenance, while also allowing for a reasonable profit. This financial viability is essential for encouraging industry investment in antibiotics, a field that many larger companies have abandoned in recent decades due to the higher risk of financial losses.
To reinvigorate antibiotic innovation, it is essential to implement economic and regulatory incentives throughout the entire pharmaceutical lifecycle (Chapter 3). Our proposal focuses on so-called pull incentives, which take effect after a new antibiotic has been granted marketing authorisation. Chapter 4 outlines our approach to developing this proposal. Chapter 5 provides a detailed description of four pull-incentive models, followed by their evaluation in Chapter 6, which helped us identify the subscription model as the most suitable for implementation in Switzerland. Lastly, in Chapter 7, we propose a remedy for a key limitation of the transferable exclusivity extension voucher (TEEV) model and explore the prevalence model as a potential interim solution if the implementation of the subscription model takes longer than expected.
Throughout our efforts, we have consistently maintained our focus on the StAR mandate “to promote the availability of first-choice antibiotics”. The troubling rise in antibiotic shortages and market withdrawals has compelled us to evaluate the potential of pull-incentive models to mitigate these problems. While acknowledging that a range of measures will be necessary, our analysis indicates that the subscription model we propose can play a significant role in achieving this goal.

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