The short answer is I doubt it. The problem of bacterial antibiotic resistance is not new but successive governments around the world have failed to implement real change or put significant financial incentives in place. Numerous reports, meetings and government statements about the problem have failed to reverse the trend of major pharma withdrawing from developing new antibiotics against bacterial resistance especially in Gram-negative bacteria.
There are several reasons why pharma is not investing;
- Pricing for new antibiotics compared to say cancer drugs is low
- Generic antibiotic prescribing is high
- If a new antibiotic was developed against a multiply resistant Gram-negative infection the numbers of patients treated would be relatively small (at least in the developed world)
- Pharma’s pricing model is usually based on volume sales and chronic diseases – a new antibiotic against a multi-drug resistant infection should only be used to treat this infection ie it should sit on the shelf most of the time
Many reimbursement models have been suggested as a way of persuading pharma back into the AMR treatment space. The problem of course is that every country’s drug bill is paid for by different entities. In the UK the Department of Health pays for prescriptions, in the USA its insurance companies. It is difficult therefore to see how a one size fits all fits the reimbursement model bill.
On the other hand regulations were introduced across the globe to persuade pharma to develop paediatric drugs by offering financial incentives and indeed introducing legislation requiring pharma not to exclude children in their drug development programme. If we can come up with a model to encourage paediatric drug development, I am at a loss why we can’t come up with a model to reimburse new antibiotics.
And its not just me saying things are moving to slowly. Lord Jim O’Neill was recently quoted (https://www.telegraph.co.uk/news/2018/04/26/lots-talk-little-action-means-risk-losing-arms-race-against/) that there has been a lot of talk but little action by big pharma since the AMR Review’s Final Report in 2016.
I talked to one pharma industry executive recently who told me that he didn’t think big pharma would get back into the AMR space anytime soon. The reason he advanced was given the ROI for an anti-cancer drug or a drug to treat Alzheimer’s, pharma would just not commit resource to antibiotic drug development. This executive also said even if $1billion was put on the table for each new antibiotic developed, this would still not match the returns of an anti-cancer drug. He emphasized this point most clearly by saying that a small cancer biotech with a molecule in Phase 1 trials was likely to be valued over $1billion whereas a biotech with a new antibiotic in Phase 1 trials was likely to valued at $250million. Investors know where they will make the greater returns and they put their money where their mouth is. Until investors and pharma can see howto make a reasonable return this impasse is likely to continue. Of course there could come a time when the cancer drug discovery / development market becomes saturated and too many drugs are chasing too few patients. When this happens then pharma might re-examine if antibiotic drug discovery and development is something they want to get into.
This of course is an opportunity for the Third Sector to step in and fill the drug discovery void. But the Third Sector needs funds also whether these be from the public, Trusts and Foundations, government, major donors etc. That is why have called for the creation of a £100million UK Antibiotic Discovery Fund to fund pre-competitive research. Without the fundamental knowledge of how bacteria become resistant and how this can be overcome it will be that much harder to find new ways to tackle this problem. If there was a pandemic of an antibiotic resistant infection how prepared are we to deal with this? Only by funding charity’s such as ours can we hope to impact this problem.