The US and the UK Have Largely Ignored Antibiotic Resistance

Drug companies and health professionals are quickly losing the evolutionary arms race with bacteria, as more pathogens begin to show antibiotic resistance and more patients are suffering treatment failures. In fact, the rate at which microbes are evolving resistance is handily outpacing Centers for Disease Control estimates as doctors struggle to find new treatments for tuberculosis, gonorrhea, E. Coli, and other bacterial illnesses.

But funding to fight the problem has been highly insignificant levels.

In the US, politicians have weighed whether to incentivize drug companies for developing new antibiotics, which are notoriously expensive to develop and not very profitable once they're ready to go. In May, the Department of Health and Human Services decided to award GlaxoSmithKline $200 million over five years to develop new antibiotics in an attempt to stave off resistance. It's a good start, but a drop in the bucket considering that GlaxoSmithKline spent $6.1 billion of its own money on research and development in 2010 alone.

Across the Atlantic, the picture has been much the same. Public health officials realize antibiotic resistance is a serious and growing problem, but funding for new antibiotics has been slow to increase. According to a new study published in the Journal of Antimicrobial Chemotherapy, United Kingdom-based research institutions received £2.6 billion ($4.2 billion USD) for antimicrobial research between 1997 and 2010, just 4 percent of that (£102 million) was earmarked for research on antibiotic-resistant diseases. The study looked at public funding as well as funding from independent sources such as the Bill & Melinda Gates Foundation and the Wellcome Fund.

"There hasn't been very much funding for this particular area," Michael Head, the study's lead author, said. "Within that, there's been very little research in key areas such as tuberculosis, the more resistant forms of E. coli, and gonorrhea."

There are indications that in the UK, government is beginning to focus on the problem. Last month, Parliament requested a public inquiry on the topic, and Commons Science and Technology Chair Andrew Miller said "antimicrobial resistance is one of the most significant threats to public health today."

Motherboard spoke with Head about the role funding plays in fighting antibiotic-resistant diseases and about whether there's any hope that governments will begin taking this as a serious threat.

MOTHERBOARD: You look at funding for antibiotic-resistant disease research as a whole, but when you drill down you realize there's these shortages for TB and other specific diseases. Is this a problem that can be solved by saying "this money is for antibiotic-resistant disease" or do you have to target the funding more specifically than that?

You can sort of look at it as a whole. The CDC just launched a threat report looking at the problem as a whole, with key areas that require urgent attention, and the UK Department of Health just said we need to look at this on a global level too. There's been some high-profile focus on this area as a whole, but you have to at some point drill down to look at the urgent ones.

Gonorrhea and TB are the urgent ones—there's some bacterial and fungal pathogens that don't have a great deal of resistance yet, but what we need to do is invest now to prevent them from becoming a much larger problem in the future.

The idea of superbugs or antibiotic-resistant diseases like gonorrhea has been in the media much more over the past couple years. Has there been an increase in funding that goes along with that?

Our analysis covers 1997-2010, and within that there's a small increase in funding towards the end. If you saw from 2010-2013, I'd bet there'd be another increase. The funders are in discussion about prioritizing this topic.

When you think about antibiotic resistance, you hear a lot about the problem with TB in South Africa, gonorrhea in some places in Europe—are you seeing treatment failures in the UK yet? Or is this still a problem that's coming sometime in the future?

It is a huge problem globally, but in the UK it's not like it is in Russia or South Africa. Within the UK, the main areas of resistance are in hard to reach groups: Prisoners, drug users, those small pockets of people who are hard to reach. In a country like the UK or the US, we have several possible treatment options for most diseases and can delay onset of resistance by doing different combinations of antibiotics. In other countries they don't have that range of drugs available so they have to use what they have.

As one of the countries with a large drug industry, is there a sense of obligation that if you don't develop new antibiotics, nobody will?

There is a little bit of that. The US spends by far the most on infectious disease funding, but the UK is second. From that point of view, if we can lead on the issue then other countries may follow suit. It's one of these problems that will require multi-country coordination at a high level. Country leaders as well need to focus on this.

Well US politicians can't focus on much of anything right now. There are very few representatives who have focused on the problem of antibiotic-resistant disease. Is this a bigger issue in UK politics?

The problem is similar in the UK. The focus now is with the Department of Health Action Plan, and our government has an inquiry out on this very topic asking private industry and citizens to submit their thoughts. I think the focus is there and hopefully it will lead to some productive outputs in terms of managing the antibiotics we have and the development of new antibiotics.

So you're finally taking this seriously. While we're waiting for new antibiotics, what are we supposed to do?

From prior research we know the outputs of this are seen many years down the line. It's a long term process. Alongside the research, we need to introduce frontline policy on how we use the antibiotics we have and we need to make different treatment combos available while at the same time making sure we're developing new ones.

With antibiotic-resistant disease and treatment failures here, are we throwing money at this problem too late?

We're going to see more treatment failures. But is it too late? No. Would it have been better to address this 10-15 years ago? Yes.