The war against antibiotic resistance: Part 2, the good news

The threat posed by antibiotic resistance has finally got through to governments.  98 new formulations are being tested in animals, and nearly two-thirds attack bacteria differently from older drugs, increasing their chance of success.

In May this year, the UK government will  pay two companies to bring new anti-microbial drugs to market. The price of the drug will be “delinked” from what the company needs to recoup its investment, so there is no pressure to market the new drugs aggressively, and they can be saved for the cases that resist all other treatments.

The US Congress also plans to discuss such “market entry reward” schemes for new antibiotics, including an idea called “play or pay”, in which drug firms that aren’t working on antibiotics have to pay into a fund to reward companies that do. Existing legislation allowing government agencies to reward firms that develop biodefence drugs for which there is no market, such as anthrax vaccines, may also be pressed into service.

If that sounds like it will cost taxpayers a pretty penny, compare it with the cost of treating resistance – $2.2 billion a year in the US, according to a study last March. In a patented antibiotics market worth $700 million in the US, another $700 million might get things started, says Outterson.

We might not even need to pay directly. In November, a drug called zoliflodacin passed tests showing it was safe and effective in humans against gonorrhoea, which has become so antibiotic-resistant that some infections are now almost incurable.

Many promising new drugs get this far and no further, but this one is already set to enter the big, expensive tests needed before it can be licensed. The trials will be financed by Entasis, the US company developing the drug, and also by governments and other donors organised by GARDP, a global organisation promoting antibiotic development.

If it passes, Entasis will market the drug in 34 rich countries, while GARDP gets marketing rights in 166 poor ones. Entasis makes the profit it needs, while the gonorrhoea epidemic in poor countries gets an effective drug – under tight control.

Ultimately, if these schemes don’t work fast enough, governments will have to take over the business of providing antibiotics. It wouldn’t be the first time they have done this kind of thing. Until the 1980s, government agencies produced the public-health vaccines that defeated diseases such as polio, measles and smallpox, as a public good, like roads and schools.

Ideology has frowned on governments messing with markets. But it may take only a few more untreatable cases of gonorrhoea or urinary tract infection to make the critics change their minds.  (An abridged version of an article in the New Scientist,  Jan19-25, 2019).

This is something governments  should be involved in, something for the general good of the whole population that private enterprise simply cannot tackle and stay in business.

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