Experts tout alternative payment model to boost antibiotic access in Canada

News brief

A new report from the Council of Canadian Academies (CCA) says a subscription pull incentive (SPI) is needed to provide the country with a more stable supply of novel antibiotics.

The report by an expert panel concludes that, of the pull incentives that have been proposed to boost antibiotic research and development (R&D), which is hampered by low sales and poor return on investment, an SPI holds the greatest promise for revitalizing Canada's antibiotic market. The report notes that Canada lags behind peer countries in access to novel antibiotics; of the 18 antibiotics that have been approved since 2010, only 3 are commercially available.

An SPI could boost access to antimicrobials that already exist but are not currently approved or available in Canada.

If Canada were to work with other countries and contribute to a global SPI mechanism, the experts estimate that fair contribution from the Canadian government would be in the range of $14.5 to $18 million (Canadian) per drug per year over 10 years, with payment levels varying based on drug value.

"An SPI could boost access to antimicrobials that already exist but are not currently approved or available in Canada," the panel wrote. "It could also motivate research, development, and commercialization of new drugs."

Incentivizing antibiotic R&D

The subscription model is similar to one in the United Kingdom, where the National Health Service is paying yearly subscription contracts for guaranteed access to two critically needed antibiotics, and to legislation (the PASTEUR Act) under consideration by US lawmakers. The idea behind subscription pull incentives is that paying for new, innovative antibiotics based on their public health value rather than sales volume will provide a stable return on investment for drugmakers and incentivize antibiotic R&D.

"The development of antimicrobials changed the face of medicine, but the numerous benefits they provide to individuals, healthcare systems, and society are increasingly under threat," CCA President and CEO Eric M. Meslin, PhD, said in a news release. "This report details an approach that would maintain these myriad benefits by finding new mechanisms to motivate the development and commercialization of novel antimicrobials."

Jynneos vaccine protects against mpox hospitalization, study finds

News brief

Stephanie Soucheray, MA

man getting shot it arm — AaronAmat / iStock

Today in Morbidity and Mortality Weekly Report, researchers from the California Department of Public Health show that one or two doses of the Jynneos mpox vaccine effectively prevented hospitalization among those who contracted mpox, people with HIV.

The study was based on 5,765 mpox patients in California who contracted the virus from May 2022 to May 2023. Among those patients, 4,353 (94.4%) were male, 2,083 (45.2%) were Hispanic or Latino, and 3,188 (69.1%) identified as gay, lesbian, or same-gender-loving.

Of infected Californians, 250 (4.3%) reported mpox-associated hospitalizations, of which 233 were unvaccinated, 4 had received one Jynneos dose, 1 received two doses, and 12 received Jynneos as post-exposure prophylaxis (prevention).

Most hospitalized mpox patients had HIV

People with both mpox and HIV accounted for 40.7% of all mpox cases in California during the study period and 56% of mpox-associated hospitalizations (140).

Compared with unvaccinated mpox patients, the odds of hospitalization with one dose of Jynneos was 0.27 (95% confidence interval [CI], 0.08 to 0.65) and for two doses it was 0.20 (95% CI, 0.01 to 0.90), for a vaccine effectiveness (VE) of 73% and 80%, respectively. For people with both mpox and HIV, the odds of hospitalization among those who had received one Jynneos vaccine dose was 0.28 (95% CI, 0.05 to 0.91) times that of those who were unvaccinated, for a 72% VE. (No mpox hospitalizations were reported in HIV-positive people who had received two doses.)

Since May 2022, an estimated 64% of California's at-risk population havereceived one dose and 40% received two doses of Jynneos, the authors said.

"Messaging to persons at higher risk for Monkeypox virus infection and persons with HIV infection should encourage completion of the 2-dose Jynneos vaccination series to limit virus transmission and mitigate disease severity," they concluded.

Higher rate of depression found in older cancer patients amid COVID-19

News brief

Mary Van Beusekom, MS

Man standing at end of dock — SanderStock / iStock

One in eight older cancer patients with no history of depression in a Canadian cohort developed new-onset depression—and just under half of those with cancer and a history of depression experienced a return of their depression—during the COVID-19 pandemic, according to a study published yesterday in Cancer Management and Research.

A University of Toronto–led research team parsed data on 2,486 cancer patients aged 50 and older from four waves of the Canadian Longitudinal Study on Aging Comprehensive Cohort and depression screening results in fall 2020.

Women at 50% higher risk of new depression

Among 1,765 cancer patients with no history of depression, one in eight (11.8%) were diagnosed as having new-onset depression, and 45.8% of the 721 patients with a history of depression had a recurrence of depression. The risk of both new-onset and recurrent depression was greater in those who reported loneliness, had functional limitations, or experienced escalated family conflict amid the pandemic.

While strict adherence to lockdowns was an important step for many cancer patients to minimize their risk of COVID-19 infection, for many individuals this also meant forgoing social support, which is an important source of strength during cancer treatment and recovery.

Andie MacNeil, MSW

The risk of both new-onset and recurrent depression was higher among women and those not active in church or religious activities, who lost income during the pandemic, or who became ill or had a loved one become ill or die during the pandemic. Patients who reported feeling isolated and those without enough income to meet their basic needs were at elevated risk of recurrent depression.

Women were 50% more likely than men to experience new-onset depression. "Women are more likely to take on time-consuming caretaking roles and household labor," coauthor Margaret de Groh, PhD, of the Public Health Agency of Canada, said in a University of Toronto press release.

Older cancer patients have the added stress of being particularly vulnerable to severe COVID-19, coauthor Andie MacNeil, MSW, of the University of Toronto, said in the release. "While strict adherence to lockdowns was an important step for many cancer patients to minimize their risk of COVID-19 infection, for many individuals this also meant forgoing social support, which is an important source of strength during cancer treatment and recovery," she said.