July 2, 2014 7:39 pm

Keep medicine out of the dark ages

Global action is needed to avoid an antibiotic apocalypse

David Cameron has added his voice to increasingly urgent warnings by the world’s public health leaders about the growth of antibiotic resistance. Besides talking about a return to “the dark ages of medicine” if we lose our power to kill microbes, the prime minister announced an internationally focused commission to come up with solutions to the crisis.

Although several medical and scientific bodies around the world have recently looked at ways to tackle drug-resistant infections, the Cameron initiative stands out because economists and policy experts will lead its deliberations with Jim O’Neill, formerly of Goldman Sachs, in the chair. This is the right priority: while there are formidable scientific obstacles to discovering safe new antibiotics, the necessary research will take place only if governments can provide sufficient incentives for the pharmaceutical and biotechnology industries to do the work.

The principal reason for the dearth of drugs – no new class of antibiotic has reached the market since 1987 – is the industry’s withdrawal from research in favour of more lucrative pharmaceutical fields. Like much of the medical world, companies were lulled into a false sense of security at the end of the 20th century, regarding antibiotics as yesterday’s challenge; they could not see much potential profit in new drugs to tackle bacterial infections.

Now that antibiotic resistance has emerged as an impending apocalypse for the 21st century, the industry must be drawn quickly back into the field. To some extent companies do respond to crises in a way that goes beyond their direct responsibility to maximise shareholders’ returns, as demonstrated by the huge sums spent on developing Aids treatments in the 1980s and 1990s, but we cannot rely solely on their sense of corporate social responsibility. More incentives are needed.

Direct public support for research and development is one route. Public-private partnerships are already beginning to stimulate antibiotic R&D, with the EU Innovative Medicines Initiative leading the way. These should be extended.

Another contribution should come from measures to ease the path to regulatory approval for new antibiotics, with better collaboration between authorities around the world, so that companies have to carry out no more animal testing and clinical trials than the minimum needed to demonstrate safety and efficacy. Carefully targeted patent extensions for innovative drugs might provide an incentive, too.

But the most difficult task of the O’Neill commission will be to design a market incentive to reward companies for developing medicines that would be used as little as possible, so as to prevent their microbial targets developing resistance. They would be held back for short-term administration in patients whose infections resist all existing antibiotics. Unlike other drug categories, where companies try to sell as much as possible, antibiotics need a system that decouples payment from prescriptions. An advance purchase scheme or market commitment, in which governments and health providers undertake to buy and distribute new antibiotics that meet agreed criteria, could provide the necessary financial incentive.

Some see a role for prizes. Britain’s £10m Longitude prize is on offer for the development of a cheap, simple and accurate diagnostic test for bacterial infections, which could be an invaluable tool for better targeting of antibiotics. But any prize for drug development would have to be huge to provide a serious incentive.

Whatever the O’Neill commission recommends, action is urgent. Next year should mark the start of a concerted global campaign to prevent medicine returning to the dark ages.

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Letter in response to this editorial:

Other causes of drug resistance / From Dr Leon Fay

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