A personal view from our Chief Executive on the current state of play and the role of the Third Sector
Antibiotic resistance is on the rise around the world. Bacteria are becoming resistant to antibiotics, resulting in infections that can no longer be treated with the drugs available. A recent paper in the Lancet (1) stated that in 2019 there were an estimated 4·95 million deaths associated with bacterial antimicrobial resistance (AMR), including 1·27 million deaths attributable to bacterial AMR. The authors state that the number of deaths from AMR is equal to deaths caused by HIV or malaria, if not even higher. You would think therefore that with this burden of disease there would be a large-scale global effort to tackle antibiotic resistance.
There have been numerous pronouncements about the AMR problem by world leaders (2), numerous white papers (3) published and numerous strategies outlined (4). The sad fact however is that none of this has led to a reinvigorated new antibiotic discovery pipeline.
The state of innovation
The US Biotechnology Innovation Organization (BIO) has just released a report on investigating ‘The state of innovation in antibacterial therapeutics’ which makes for depressing reading for anyone who is concerned about how we will treat antibiotic resistant infections in the future (5). The report pretty much mirrors the findings from the WHO’s global antibiotic pipeline survey (6) in that both conclude there are insufficient new antibiotics under development to tackle the rise in resistance, particularly in Gram-negative bacteria.
Cancer vs antibiotics
The BIO report makes some interesting comparisons between commercial funds invested in antibiotic drug development compared with those invested in cancer. The BIO report shows that 17 times more funds were invested in cancer than in antibacterials. This disproportionate investment in the two therapeutic areas is surprising since infection is the second most common cause of death in cancer patients (7).
Accessed 23 February 2022 at https://www.bio.org/sites/default/files/2022-02/The-State-of-Innovation-in-Antibacterial-Therapeutics.pdf
Providing the necessary ‘pull’ incentives
There is much discussion currently on how to address the antibiotic void through reimbursement / insurance schemes where antibiotics are valued not on the basis of volume sold but based on their value to healthcare systems and society in general. In a recent publication, Kevin Outterson, Director of CARB-X, proposes the necessary pull incentives governments might have to provide to get pharma companies to carry out antibiotic drug development – valuing them at around $2 billion ($2.2 – 4.8 billion for full delinkage)(8). This aligns with the sums the UK government are proposing for their pilot reimbursement scheme (the Netflix model) and the US’s PASTEUR Act when taking into account respective proportions of world GDP.
What about the Third Sector?
What appears to be missing from the current debate on antibiotic drug development is what role the Third Sector might play. In the UK, non-government funded medical research totalled some £1.9 billion in 2019. There is a presumption that any research findings arising from this support should be exploited by the commercial sector. But in the case of antibiotics, the commercial sector has withdrawn from this space, creating a gap in the market for academics to see their findings used for the public good.
I propose that the exploitation of a proportion of research findings might be carried out by the Third Sector. Models for this approach exist such as the TB Alliance (9) and the Medicines for Malaria Venture (10). A global non-profit organisation dedicated to the development of new antibiotics and alternative treatments could provide the pull that the market so desperately needs.
How can you help?
As a small charity, we are focused on highlighting the problem of drug-resistant infections supporting those affected. We cannot do any of this though without your support. Please get involved:
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Together, we can fight antibiotic resistance!
References
- Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Aguilar GR, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022.
- https://www.g7uk.org/wp-content/uploads/2021/12/AMR-G7-Finance-Ministers-statement-on-supporting-antibiotic-development-final-13-Dec-2021.pdf
- https://www.chathamhouse.org/2019/10/review-progress-antimicrobial-resistance-0/impact-amr-review
- https://www.who.int/publications/i/item/9789241509763
- https://www.bio.org/sites/default/files/2022-02/The-State-of-Innovation-in-Antibacterial-Therapeutics.pdf
- https://www.who.int/publications/i/item/9789240021303
- Nanayakkara AK, Boucher HW, Fowler Jr VG, Jezek A, Outterson K, Greenberg DE. Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward. CA: a cancer journal for clinicians. 2021 Nov;71(6):488-504.
- Outterson K (2021) Estimating The Appropriate Size Of Global Pull Incentives For Antibacterial Medicines. Heath Affairs Vol. 40, NO. 11 –
- https://www.tballiance.org/
- https://www.mmv.org/