I don’t know about you, but for me, this is the season of
low expectations. My brother-in-law
constantly reminds me to keep my expectations low and my standards high. In
this US campaign season, I find that it is increasingly hard to avoid feeling
blue by continually lowering those expectations.
A good example is the result of the UN General
Assembly. The opportunity to actually do
something concrete about the emerging crisis of antibiotic resistance in the
absence of a robust pipeline of new antibiotics was an exciting one. But as
often happens when multiple players with competing interests get together to
try and accomplish something, we now play a waiting game. Although what to
expect at the end of the wait is not really clear. Recently, Allan Coukell of the Pew Charitable
Trust wrote a summary
of the UNGA statement. 193 countries signed a political statement that is
extremely vague and does not include any commitment for financial resources to
spur innovation. 13 pharmaceutical companies signed a separate statement where
exploring new ways for the public and private sector to collaborate to spur
innovation was a goal. The divide between industry and government seems clear. The UNGA expects to revisit the issue in two
years.
What we need now is some way to assure antibiotic developers
that they will achieve a return on their investment. There are a number of ways
this could be funded. First, the savings
on health care provided by having the means to treat infections will be
enormous – it just requires a capital investment in our future. Second, if more immediate funding is
required, we could charge a very small tax on current pharmaceutical sales that
would be dedicated to an antibiotic market fund. This tax would be applied to
all pharmaceuticals without exception – but would need to be pennies or less on
the dollar.
A nagging worry for me is whether, at this point in time,
even if we identify a financial mechanism to assure a return on investment,
pharmaceutical companies will be interested enough to return to antibiotic
research. I have been asking the folks at DRIVE AB to investigate this – but
have heard nothing as yet. I recently heard that Merck
was skeptical of the market entry rewards that we have been discussing. They may be more interested in pricing and
reimbursement as the preferred market mechanism. That will likely remain the way forward in
the US in any case.
We need to train our antibiotic hunters of the future before
we lose all our expertise to the ravages of time and the current lack of
funding for antibiotic research.
And we need to continue working on new regulatory
pathways for antibiotic development – especially for pathogen-specific
products.
We need to raise the prices of key generic antibiotics like
penicillin to avoid drug shortages.
Beyond all this, we need to improve our surveillance
globally, control the use of antibiotics in agriculture, and improve our
stewardship of antibiotic use in humans. But even with these steps, we will
have a constant need for new, effective antibiotics and for that we need to
correct our current problem of the market failure for antibiotic discovery.
I find that I am unable to lower my expectations
sufficiently to avoid this current state of depression around the state of
progress in global antibiotic policies that is afflicting me. A sure cure would
be the commitment of at least a few national authorities to the market
entry rewards that Astra-Zeneca was negotiating before their antibiotics
business was sold
to Pfizer. But, alas, I fear that all this is now on hold.
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