Monday, March 27, 2017

Investing in Infectious Diseases

Sunday’s New York Times carried an editorial by Mike Osterholm and Mark Olshaker. In it, they decry the budget proposal by President (cringe) Trump to cut the NIH budget by 18 per cent, the State Department and AID budget by 28% and to repeal the ACA (luckily that didn’t happen). All of these proposals will further cripple our ability to prevent or respond to infectious disease crises both here in the US and abroad.

Osterholm and Olshaker remind us of congress’s failure to adequately fund the US response to local Zika outbreaks here in the US, and they wonder what would happen in the face of a real pandemic like the 1918 flu that infected about 500 million people – frequently young people – adding up to about one-third of the planet’s population at the time, and killed about 50 million.  With the 2017 world population of 7.9 billion,  something similar today would kill 260 million people. Could such  a thing occur?  Sure.  All we need is for one of the circulating bird flu strains of the virus become virulent for humans.  A few mutations here and there . . .

But, and you won’t be surprised here, a more immediate threat that is currently ongoing and building is that posed by antibiotic resistance. And this brings me to where I might have a quibble with the authors of the Times editorial.  They conclude that only government can produce the drugs and vaccines needed to repulse these infectious disease threats in the absence of a viable, existing market. Well – yes if you say that only government funding of competent companies and scientists can do this.  Government itself has a poor track record in the invention of antibacterial drugs after say the 1950s. But recent efforts through HHS have provided significant funding for companies and academics to spur these efforts.

For these government funding efforts to be successful, we still need to train scientists to carry out antibiotic drug discovery and development – a skill that is threatened with extinction given the continued loss of companies from this area of endeavor. On the training side, there are new efforts in this area. June 14-15 NIAID will be presenting a workshop on PK/PD for the development of antibacterial therapeutics. On September 5 there will be a workshop jointly sponsored by CARB-X and GARDP just prior to the ASM-ESCMID meeting in Boston that starts on the 6th. The workshop will begin what I believe will be an ongoing effort to provide exactly the kind of teaching I think we need.  Multiple media will be used including live conferences, webinars, written syllabi – all produced by that disappearing animal, the antibiotic drug hunter. Finally, I’m really excited about this effort!

At the same time, government can play a critical role in providing funding in terms of market entry rewards, patent vouchers and other key post-market incentives that will essentially create an attractive marketplace for new antibiotics that will be active in the treatment of resistant infections.

So here are two solutions to the problem both within reach. (1) Lets get our scientists trained. (2) Lets provide market incentives for new antibiotics.  All this takes is money, will and work!

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