Antimicrobial resistance poses one of the biggest threats to public health faced in modern times. If left unchecked, it’s thought by 2050 the global number of deaths from
antimicrobial resistance may be as high as 10 million per year—
costing $100 trillion dollars annually just to manage the effects.
Antibiotic resistance is natural selection in action. It arises
when infection-causing bacteria survive exposure to a treatment
that would normally kill them, allowing drug-resistant strains to
spread due to a lack of competition from other bacteria.
The overuse—and misuse—of antibiotics to treat non-bacterial
infections, their increased use in agriculture and poor patient adherence to treatment regimens have created the perfect environment for this resistance to emerge.
In fact, the U.S. Centers for Disease Control and Prevention estimates that 70 percent of bacterial infections are already caused
by bacterial pathogens that are resistant to at least one antibiotic
drug on the market. Most worryingly of all, as reported in Vol.
16 of the Lancet Infectious Disease, even last line of defense antibiotics, such as Colistin, are now ineffective against some strains.
As a result, we risk losing the advances in medicine developed over the last century that we currently take for granted.
Life-threatening bacterial infections such as pneumonia and
tuberculosis could become untreatable, while routine surgical
procedures such as caesarean sections and organ transplants
that require antibiotics to prevent infection may, in the future,
become too high risk to perform.
A drug pipeline that’s run dry
Despite the scale and severity of this problem, there exists a
significant and well-recognized gap between the demand for new
antibiotics and the financial incentives for their development.
The established economic model for pharmaceutical drug prod-
ucts is to recoup the costs of R&D through sales revenues during
a period of patent-based exclusivity. However, for antibiotics,
As a result, the number of large multinational companies
funding basic research in antibiotics has fallen substantially over
the past two decades as many have turned their expertise and
resources to more profitable ventures.
To address this challenge, many experts believe a combination
of “push” and “pull” strategies toward incentivizing antibiotic
drug discovery and development are required, as proposed by
Dutch researchers in “The need for a One Health – One Europe
– One World Framework.”
“Push” approaches, such as increasing access to scientific
resources, providing research grants, offering tax incentives and
establishing public-private partnerships to reduce the financial
risks associated with R&D, could help overcome the barriers to
drug development in the early stages.
“Pull” strategies, on the other hand, reward successful drug
development by ensuring future revenue, through monetary
prizes, advanced market commitments or patent buyouts. One of
the “pull” strategies put forward by the Review on Antimicrobial
Resistance is the establishment of a global system of market entry rewards of around $1 billion per drug for treatments in areas
of most urgent need.
Can Fight Antibiotic Resistance
International stakeholders, including pharma, healthcare,
governments and the global population, need to work together to
stop antibiotic resistance in its dangerous track.
by Antonio Felici, Director & Head of Microbiology, Drug Design and Discovery, Aptuit, Greenwich, Conn.