Resources for health

Today's Financial Times has a feature on antimicrobial resistance, pointing out that resistant pathogens are thought to have killed 1.26 million people in 2019, and that the problem is getting worse. 

Few venture capitalists or large drugmakers want to fund the costly clinical trials required by regulators.... As with climate change and future pandemics, no one is taking enough responsibility for the ever-present global threat of antimicrobial resistance.... Why it's so hard to stop the 'silent pandemic', Hannah Kuchler, 'Financial Times', 29 August

The article does talk about philanthropic investment aimed at launching two to four new antimicrobials in the next decade, but this is thought to be insufficient, and:

attention is turning to changing how health systems buy antibiotics. This year, the UK has proposed expanding its novel subscription model, so drugmakers would receive up to £20 million a year for selling innovative antibiotics, no matter how many - or how few - are prescribed.

...nor indeed how effective or ineffective they are - which is the problem: we shouldn't be targeting how many new antibiotics are marketed; that's, at best, a surrogate endpoint. It's not a meaningful outcome to people who want to optimise their health nor, therefore, for policymakers who represent those people. What we need to be doing is targeting broad, meaningful indicators of national health and reward improvements in these indicators however they are achieved. Funding should be dictated by its expected benefits to people, rather than to drugmakers; and it should be directed to where it will achieve the maximum improvement in health per pound spent. Such improvement could be measured using such indicators as Quality Adjusted Life Years, longevity and an array of other measures. It may be that these investments in producing new antimicrobials are appropriate on that basis  - or there may be other priorities that would generate a higher return. My concern is that there is little to suggest an analysis of expected benefits per pound spent has been carried out.

My suggestion, therefore, is that national governments issue Tradeable Health Outcome Bonds, which would provide incentives to research, develop and refine all approaches to improving our health, including measures that are currently thought to be beyond the remit of health authorities, but that could have large positive health improvements. Such measure could include providing better public transport for low-income households, or subsidised apprenticeships. There are many other possibilities, but there are few incentives to consider their health impacts. The linked essay is long, at 9500 words. A shorter version is here.