Antibiotic Resistance | 14th CRO Assembly | 2018 1

Antibiotic Resistance: Potential Risks across Lines of Business14th CRO Assembly 2018Ramiro Dip, Senior Risk Engineer P&C Centre, Swiss ReUrs Widmer, Senior Medical Officer, Swiss Re

Antibiotic Resistance | 14th CRO Assembly | 2018

Antibiotics PipelineSoil People – The next generation: Revival with iChip

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Selman A. WaksmanAlexander FlemingKim Lewis s.epstein@northeastern.edu Slava Epstein created the iChip

High-tech platform for synthetic AB

failed

JAMA. 2016;316(11):1193-1204

Teixobactin

Antibiotic Resistance | 14th CRO Assembly | 2018 3

Reference: Goossens H. et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365: 579–87

Source: US Centers for Disease Control and Prevention

Antimicrobial resistance is by large man-made phenomenon

How antimicrobial resistance happens

More antibiotics used → more resistance

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Global antibiotic consumption 2000–2015 by country

Reference: Proc Natl Acad Sci U S A. 2018 Apr 10;115(15):E3463-E3470

By country income

Projected total global antibiotic consumption (billions of DDDs)

Antibiotic Resistance | 14th CRO Assembly | 2018

• Death toll

– yearly death toll: approx. 50’000 in USA and EU, and 700’000 world-wide

• Estimated additional medical costs and non-medical costs (e.g. loss of earnings, disability expenses)

– EU: EUR 1.5 bio extra healthcare costs and productivity loses (ECDC 2009)

– US (US CDC 2013):

– Medical costs: USD 20 bn

– Loss of earning and other societal costs: USD 35 bn

– China (2018 study on multiple drug resistant intra-abdominal infections only):

– ¥ 37 billion total medical costs (approx. USD 6 bio)

– ¥111 billion societal costs (approx. USD 18 bio)

Health and Economic burden

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Antibiotic Resistance | 14th CRO Assembly | 2018

AMR Risks across Lines of Business

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Swiss Re SONAR 2015

Antibiotic Resistance | 14th CRO Assembly | 2018

Casualty scenarios

7Source: US Centers for Disease Control and Prevention

• Medical Malpractice; nosocomial infections e.g. in intensive care units

• Defective products (medical devices) that allow for transmission of AMR bacteria through the product itself

• Food Industry: food contaminated with AMR bacteria, not properly processed prior to consumption

• Farm dwellers: AMR bacteria from livestock, directly or through the environment

Antibiotic Resistance | 14th CRO Assembly | 2018

• Ronald Reagan UCLA Medical Center reported that patients had fallen seriously ill and two had died from the improperly sterilized duodenoscopes used in an endoscopic procedure (ERCP) in 2015

• FDA released “Awareness Letter” regarding duodenoscopes used for ERCP, followed by a warning letter to Olympus later in 2015

• Multiple million awards have been granted; litigation still ongoing

• All three US ERCP device manufacturers under investigation: Olympus America Inc., Pentax, Fujifilm

Outbreaks at healthcare facilities: AMR contaminated duodenoscopes caused deadly infections

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Antibiotic Resistance | 14th CRO Assembly | 2018

• 634 cases-patients identified in a period of 14 months

• Of 69 clinical isolates, 2/3 were drug resistant, and 1/3 showed multiple resistance

• Source: single source of chicken to 3 California production establishments from which 6 of 7 outbreak strains were isolated

• The company recalled an undetermined amount of chicken

Outbreaks from contaminated food: US national outbreak of AMR Salmonella Heidelberg infections from poultry

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Antibiotic Resistance | 14th CRO Assembly | 2018

Expected burden of AMR on antibiotic prophylaxis and on expected longevity improvements

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Number of additional infections per year in the USA under four scenarios of decreased efficacy of antibiotic prophylaxis

Reference: Teillant et al. Lancet Infect Dis 2015; 15: 1429–37

Comparison of plausible mortality improvements vs. mortality deterioration from AMR

Source: Matthew Edwards, Senior Consultant, Willis Towers Watson

Antibiotic Resistance | 14th CRO Assembly | 2018

Antimicrobial Resistance: Tackling a crisis for the health and wealth of nationsChaired by Jim O’Neill, December 2014

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AMR’s impact on World GDPin trillions of USD

Deaths attributed to AMR every year compared to other major causes of death

$100.2 x 1012

Antibiotic Resistance | 14th CRO Assembly | 2018

AMR – the need for global solutions

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Rare in remote settings, resistance in the environment is likely anthropogenic

Lancet Infect Dis 2013

Waste-water treatment facilities can be hotspots for horizontal transfer of resistance

Culture-based methods remain the cornerstone of diagnosis and resistance testing

High standards of food processing can prevent contamination of food with bacteria

Dispensary staff are key in providing access to antibiotics, but also have a role in preventing excess – prudent antibiotic use

Governance (Swedish Minister of Health Goran Hagglund)

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Thank you

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Antibiotic Resistance | 14th CRO Assembly | 2018

Legal notice

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©2018 Swiss Re. All rights reserved. You are not permitted to create any modifications or derivative works of this presentation or to use it for commercial or other public purposes without the prior written permission of Swiss Re.

The information and opinions contained in the presentation are provided as at the date of the presentation and are subject to change without notice. Although the information used was taken from reliable sources, Swiss Re does not accept any responsibility for the accuracy or comprehensiveness of the details given. All liability for the accuracy and completeness thereof or for any damage or loss resulting from the use of the information contained in this presentation is expressly excluded. Under no circumstances shall Swiss Re or its Group companies be liable for any financial or consequential loss relating to this presentation.