Because antibiotics are best used sparingly and actually cure people, drug companies lack a business case to find new ones.
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We’ve known about the impending antibiotic-resistant bacterial apocalypse for years now, but despite increasing rates of drug-resistant super-strains of bugs like TB, E.Coli, and MRSA, and even the spectre of untreatable gonorrhea, we haven’t done much about it.
There are ways to fight the crisis—primarily by developing new antibiotics and using the ones we have more sensibly—but a report out today by the UK’s Royal Pharmaceutical Society highlights one major barrier to the first of those: There’s not much incentive for drug companies to discover new antibiotics. Except for, you know, maybe saving lives. But the world we live in runs on costs and profits, and until antibiotics are worth cold, hard cash, Big Pharma’s interest will be limited.
The RPS report states that the last new class of antibiotics was developed in 1987, and that incentive is low due to poor returns on investment.
Chief scientist Jayne Lawrence, who led the report, told me that there’s several reasons why such a useful drug with a potentially wide market is actually not necessarily financially attractive. First up, they’re pretty hard to develop. “The easy-to-find antibiotics have been discovered, basically, so to get to discover new antibiotics is quite hard work,” she said.
With the low-hanging fruit already reaped, scientists are looking to find new drugs by researching naturally-occuring antibiotics found in nature and chemically altering them, or looking to bacteriophage—a virus that kills bacterial but not human cells—and immune-based therapies. But all that research takes a lot of time and money, with no promise of actually resulting in a profitable product. “If it were simple, I would be doing it and making a fortune.”
Then there’s the problem that in a lot of cases, antibiotics just work too well: They actually cure things. That means they’re only needed for a short time, so the amount sold is much lower than medicines taken to treat more chronic conditions. “The cost model is predicated on you selling a lot of your medicine to get paid for it,” said Lawrence. “And of course, if you treat your patients, it’s not the most financially viable drug to go for.”
In fact, the medical value of some antibiotics lies in not using them but keeping them in reserve so that when a bug is resistant to one type, we have others to fall back on. But that’s not an attractive prospect to drug companies relying on sales.
The RPS therefore proposes a shake-up in the current way medicines are funded, that helps reward companies in the development phase too so sales aren’t the be-all and end-all. They’re also encouraging people to work together so that profits, but also risks, are shared, and attempting to get universities involved in the research of new antibiotics.
There’s also a fundamental need to educate the public about the problem, especially when it comes to how we currently use antibiotics. Lawrence said many people still don’t finish a full course of antibiotics—which can make bacteria resistant to them.
And in case the exacerbating threat of antibiotic resistance isn’t enough to inspire widespread change, Lawrence warned that anti-virals and anti-fungals are also starting to become a problem.