GoKawiilCredit: David Parkins
Antimicrobial resistance (AMR) is an inevitable evolutionary process — resistance will occur, and it will spread globally. We are in a race to maintain a portfolio of effective antibiotics, and we are falling behind.
Creating an antibiotic has become a daunting task. Development is long and expensive, yet antibiotics are used for short durations and sold at relatively low prices. Newly developed antibiotics are often also reserved for use as a last resort, to protect the drugs’ efficacy. This combination of factors makes it difficult for a company to recoup their investment, and has led to an exodus of organizations and scientific talent from antibiotic research and development. The pipeline of drugs has been reduced to a trickle, and deaths resulting from antibiotic resistance are increasing.
To keep pace with AMR, the flawed economic model of antibiotic development must be addressed. Some governments and biopharmaceutical companies have already begun to do so.
Push and pull
Governments can help to remove economic barriers in two ways. The first is by funding the development of antibiotics. Known as a push incentive, the aim is to reduce the cost of research and development for companies.
Nature Outlook: Antimicrobial resistance
One example is the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X), funded by governments and non-governmental organizations. CARB-X provides funding to companies and institutions during the early, high-risk stages of antibiotic development, and has helped to progress several drug candidates into clinical trials.
The US Biomedical Advanced Research and Development Authority (BARDA) provides push incentives that support development all the way through to drug approval, and in some cases beyond. And the AMR Action Fund, mostly sponsored by the pharmaceutical industry, provides push funding to help companies run clinical trials for promising antibiotics.
The other, even more crucial way that governments can invigorate antibiotic innovation is by creating a predictable and attractive market for antimicrobial drugs. Numerous companies have failed in the early stages of commercializing an antibiotic, when costs are high and revenue is low — not least because their drug might be reserved for use in people with only the most resistant infections. These ‘pull incentives’ can sustain companies through this period.
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