New drugs way to avoid an antibiotic apocalypse

Microbiologists have been warning for years of a coming "antibiotic apocalypse", in which drug-resistant superbugs turn common infections into untreatable killers. At last public health leaders and politicians are beginning to listen - and bring forward practical proposals to tackle the crisis. Draft plans will be on the agenda of the World Health Assembly next week and the G7 summit next month.

Several causes of antimicrobial resistance must be addressed, from overuse of existing antibiotics in agriculture and medicine to the absence of quick diagnostic tests to tell whether an infection is susceptible to drug treatment. A particularly important factor is the pharmaceutical industry's failure for almost 30 years to produce any new classes of antibiotic to replace the old ones to which bacteria are becoming resistant.

This failure is not so much rooted in science as in the lack of commercial incentives for companies to develop products that would not have a large market: novel, resistance-free antibiotics would be reserved for use sparingly against the most recalcitrant infections.

The most imaginative ideas for refilling the global antibiotics pipeline with new drugs are coming from the independent review commissioned by the UK government and led by the economist Jim O'Neill. Its latest paper, released yesterday, shows how incentives running to many billions of dollars could translate 21st-century science into a flow of new drugs reminiscent of the great days of antibiotic discovery in the mid-20th century.

The commendable O'Neill plan has two main elements. To rejuvenate the earliest stage of research, a $2bn antimicrobial resistance innovation fund would seed lab work around the world. Although public bodies and charities would contribute, the pharmaceuticals industry itself would have to make substantial payments in cash or in kind into the fund.

The second part of the plan is less straightforward but gets to the heart of the market failure in antibiotics. A global body, its shape and governance still to be defined, would make huge lump-sum payments to companies developing drugs that meet pre-agreed specifications. These upfront payments - prizes in effect - might be worth as much as $3.5bn each. Recipients would commit themselves to make the winning drugs available to healthcare providers worldwide at no additional profit. De-linking profitability from sales would remove the commercial motive to sell new antibiotics in resistance-inducing quantities.

Though at first these proposals may sound like tickets in the world's most generous lottery, the payments would need to be calibrated so that the expected returns to the industry as a whole do not exceed those from more orthodox pharmaceutical research and development.

Indeed some industry leaders, including Sir Andrew Witty, chief executive of GlaxoSmithKline, recognise that companies have a social responsibility to invest seriously in antibiotics. It would be good to see a revival of the spirit that led companies in the 1980s to pour substantial resources into drugs against Aids, a disease seen as a public health crisis, although the commercial pay-off was then far from clear.

The O'Neill proposals are still rudimentary but they represent the best starting point so far in developing new weapons to see off the threatened antibiotic apocalypse. Governments, health agencies and the pharmaceuticals industry should now engage seriously in drawing up a detailed, practical plan to put them into effect.

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