In the wake of recent reports showing that antibiotic-resistant superbugs are on the rise, some scientists in the UK are pushing for a fix that might seem radical. They argue that the research and development of new antibiotics should be taken out of the pharmaceutical industry’s hands and publicly funded on a global scale.
The premise of their argument, which is described in an op-ed published Tuesday in Lancet Infectious Diseases, is easy enough to follow. The pipeline of new antibiotics that can treat resistant bacterial infections—once richly flowing as recently as the 1980s—has slowed to a drip, as pharmaceutical companies have abandoned the field of antibiotic research en masse. And it’s not clear that our attempts to convince Big Pharma to buy back in will succeed in time, so something more drastic is needed.
There are a few reasons why the pipeline has gone dry. One is simply that it’s become harder and more expensive to develop these drugs over time. Scientists need to look deeper in nature and in the lab to find molecules that attack bacteria in a different way than before, because bacteria have evolved defenses against the weapons already used on them. And many of these attempts will inevitably end in failure, representing a sunk cost.
Even if you do bring a new antibiotic to market, it isn’t a cash-making machine compared to the latest heart disease medication. The more we use a particular antibiotic to stop a particular bacteria, the greater the odds it will eventually be resisted as well. So its use needs to be carefully managed like the last drops of fresh water on a desert island—hardly the recipe for a big profit.
Regardless of the why, the problem remains the same. Since 2000, there have only been a handful of truly distinct antibiotics developed, but these are still related or work similarly to existing drugs. As of June 2019, 42 antibiotic candidates are in development, and it’s expected that only one in five of these will eventually make it to the public. Meanwhile, some 700,000 people die annually from resistant infections worldwide, a number only likely to get larger in the years to come.
Faced with this, governments and some organizations have tried to incentivize companies to pursue antibiotic research again, with some limited success. Some incentives have included paying an upfront sum to companies to compensate them for their risky investment at the start of development. More recently, the UK government announced it would test out a “subscription model” for new antibiotics, where it pays a company the same annual money for a drug no matter how much of it is actually used.
According to the new paper’s authors, these public-private partnerships should be maintained and funded for the immediate future. But over the medium to long term, they argue, it’s unlikely these incentives will do enough to keep us protected from antibiotic resistance.
“The problem is that you need a steady supply of new antibiotics coming to market all the time, because bacteria will eventually become resistant to them. That’s what they do. They are experts in adaptation. So you need this pipeline continually producing new products that we can use,” author Claas Kirchhelle, a researcher from the Oxford Martin Program on Collective Responsibility for Infectious Disease at the University of Oxford, told Gizmodo by phone. “That all requires a longevity of funding, which doesn’t necessarily exist at the moment.”
Instead, Claas and his co-authors say the only real way to ensure we’ll have these life-saving antibiotics in the years to come is to gradually disconnect their development away from the pharmaceutical industry altogether. In other words, they want nations across the world to come together, buy out antibiotic research from Big Pharma, and “internationalize” it.
From then on, antibiotic research and development would largely be run as a public service, the pipeline funded in perpetuity through an annual investment by member nations and managed by a large, transparent institute staffed with full-time scientists and others who would take the place of industry in shepherding promising candidates through the development process.
It would take around $5 billion annually to effectively jumpstart the pipeline and take over for the industry in as little as two years time, they estimate—roughly the amount of money spent every year by the UN’s Global fund to prevent and treat HIV, tuberculosis, and malaria. But it’s an investment that would more than pay off in terms of the lives these new drugs would save down the road, they say.
“We’ve been thinking about private solutions to this public problem for a long time. And we’ve been discounting the fact that a large part of other very effective medicines and interventions were the result of successful public development,” co-author Adam Roberts, a molecular microbiologist at the Liverpool School of Tropical Medicine, told Gizmodo, referencing the discovery and development of penicillin as well as many early vaccines.
Bold and steeped in history as the idea is, it’s unlikely to win whole-hearted support any time soon from many corners from the antibiotic research and development world.
“It’s not clear to me that it needs to be an either/or proposition,” Allan Coukell, senior director of health programs at Pew Charitable Trusts, told Gizmodo. “The skills required to develop a drug and bring it to market are something that generally exist in the private sector, the pharmaceutical companies, and they don’t generally exist elsewhere. So if you can make the market work, I think that’s the path that most immediately rejuvenates antibiotic discovery.”
Other scientists, Coukell also noted, have floated the idea of dedicated non-profit projects that would work on a smaller scale alongside the industry to find and test out new antibiotics. That’s an approach that already has many fans, including Coukell.
But Roberts and his co-authors say they want to push the conversation further, to start convincing their fellow scientists and others that the status quo is no longer worth maintaining.
“We hope this article can galvanize action—either around our specific model or other forms of public development,” Roberts said. “The diagnosis we make in the article is that we are at the point of crisis already.”
It’s a realization that everyone, including the average person, is likely to have sooner rather than later.
“One of the things we can all do is stop thinking about the post antibiotic apocalypse as if it’s in the future. Because actually, we’re living in that now—we already have bacteria which are just resistant to everything we throw out at it,” Roberts added.