This week’s warning from the National Risk Register of Civil Emergencies that “[u]ntreatable superbugs that have evolved to be resistant to drugs could kill up to 80,000 people in a single outbreak…”1 highlights a message that the pharmaceutical industry has been making for years now – antimicrobial resistance is a critical and emerging public health threat and we urgently need new medicines and approaches to address this.
There are some treatments in the pipeline, but certainly not as many as we may need. This is partly due to the fact that science progresses at its own pace; if pouring money into research was all that was needed, our collective scientific horizon would look very different today. Research in antimicrobial agents is being cast ever wider, to look for new targets and to look at old treatments using new techniques. This would include taking into account the research conducted by the University of Nottingham on the ninth century Saxon treatment for eye infections which seems effective against MRSA.2
However, the challenge should not be underestimated. When Dr Jim O’Neill forecasts that “…about $25 billion (£17 billion) would be enough to develop ten “powerful” antibiotics,”3 it is important to ask by when, by which targets and development approaches, and what happens if fewer succeed?
And what happens if they do succeed? As the ABPI has argued consistently, the real challenge is how to achieve a sustainable solution for the future. Even if an arsenal of new antibiotics is created in the short term, evolving resistance remains a constant and new approaches will be needed, whatever form they take. For this challenge, we need to address the “sick market” and the misalignment between the clinical need for new antibiotics and the incentives for their development. Recent research considers this problem and draws comparisons from other sectors (“Business Model Options for Antibiotics: Learning from Other Industries”). At the core of the authors' advice is the suggestion to “delink” volume from reimbursement, establishing a long-term contract to provide antibiotics when needed with an annual “service-availability” payment that rewards innovation but avoids many risks for companies and healthcare authorities alike. The ABPI welcomes this research and other related research undertaken by Dr O’Neill’s commission as it is imperative that we get to a sustainable business model. This isn’t being “narrow-minded” but being focused on the long term.
Nor is this only an issue for governments, companies and esteemed academics. Again, for long term sustainability, stewardship of antibiotics remains top priority for all of society. Through appropriate use, we can all collectively work to battle the threat of the superbugs.
Dr Virginia Acha
Executive Director – Research, Medical & Innovation