Lack of financial incentive for antibiotics has led large pharmaceutical companies to have abandoned antibiotics. We summarize a recent article in Nature that discussed why big pharma has abandoned antibiotics and what this means for emerging antibiotic resistance.
The threat to healthcare caused by the misuse of antimicrobial drugs has been known for a while. Even in 1945, bacteriologist Alexander Fleming noted that the overuse of penicillin might lead to forms of bacteria that were resistant to its effects. In fact, drug-resistant diseases kill around 700,000 people each year. Despite widespread acknowledgement that something must be done to address crisis, society has struggled to respond.
Unfortunately, no new classes of antibiotics have been discovered since the 1980s. Discovering and developing new antibiotics is challenging. It can take 10-15 years and cost over $1 billion to develop a new antibiotic, often with high failure rates. Additionally, the average revenue generated from antibiotic’s sale is roughly $46 million per year, which is nowhere near the amount needed to justify investment. To put it plainly: antibiotics are not an attractive investment. As a result, many pharma companies have dropped out of the market in pursuit of more profitable lines of drug development, such as cancer therapeutics.
Costly developments
One approach could be to reduce the cost of antibiotic development. As microbes have evolved more mechanisms to evade the antibiotic arsenal, the challenge of devising new drugs has increased — and with it, the cost. “We’ve lost the low-hanging fruit now,” says Jeremy Knox, who leads Welcome’s policy and advocacy program on drug-resistant infections.
The preclinical stages of antibiotic research and development (R&D) are the most risky and create the biggest financial burden. They account for close to 45% of the total costs, not least because many promising avenues of investigation don’t pan out, leaving manufacturers with a large bill for very little gain. Conventionally, antibiotic development starts by searching for antibacterial compounds in nature — often those synthesized by other microorganisms. These chemicals are then put through a series of experiments to see whether they can be scaled up, whether they’re safe for humans, and what the ideal concentrations would be.
Going forward
There are only four major pharmaceutical companies still with active antibiotic research programs. However, some smaller companies and charities have anticipated the public health problems that are likely to arise from a lack of investment in antibiotics. Fortunately, in July this year, the International Federation of Pharmaceutical Manufacturers and Associations announced the AMR Action Fund. This initiative involves 24 companies that aim to bring between two and four new antibiotics to market by 2030. It has so far committed nearly $1 billion to support the research needed to achieve this goal.
Elsewhere, some healthcare providers and drug firms are switching to a model whereby antibiotics are paid for through a subscription. Buyers would pay a pre-agreed amount to use as much or as little of the drug as they need – the so-called ‘Netflix’ model. UK Health Secretary Matt Hancock said that the UK government will pay pharmaceutical companies for access to new antibiotics, rather than on a per-pill basis. The companies will receive their first instalments during the expensive early stages of R&D.
