Antibiotic resistance is a growing menace – we must act before it’s too late
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Version 0 of 1. In early 1941, Albert Alexander, a 43-year-old policeman from Oxfordshire, scratched the side of his mouth while pruning roses. This seemingly trivial wound led to a life-threatening bacterial infection – a not uncommon occurrence in the pre-antibiotic era – with abscesses affecting his eyes, face, and lungs. Alexander’s case came to the attention of Howard Florey, who, with colleagues at Oxford University, was advancing Alexander Fleming’s 1928 discovery of the bacteria-killing powers of penicillium mould by trying to purify large quantities of the active compound, named penicillin. Alexander’s condition improved dramatically after intravenous treatment with penicillin, but supplies of the drug soon ran out and a month later he died. Seventy-four years on, and, after an era when miraculous cures became the norm, we are again running out of effective antibiotics. Related: Antibiotic resistance: sometimes knowledge is not enough | Imran Khan Profligate use of antibiotics has provided the evolutionary driver for bacteria to develop resistance to the drugs. Introduction of every new class of antibiotics has been followed by bacteria becoming resistant (something Fleming warned of for penicillin in his 1945 Nobel prize lecture). For the first 40 years or so of the antibiotics era, doctors compensated for the failing of one antibiotic by using another, newly developed, drug. However, since that golden era, the stream of new antibiotics has turned to a trickle as pharmaceutical companies realised greater returns on investment by developing drugs for lifelong diseases rather than acute illnesses such as infected cuts or pneumonia. Indeed, the last entirely new class of antibiotics to reach the market was discovered nearly 30 years ago. Ways to boost the research and development pipeline for new antibiotics are the focus of the latest report, released last week, from the Review on Antimicrobial Resistance (AMR), chaired by economist Jim O’Neill. The AMR review was announced by David Cameron in July 2014, and will produce its definitive recommendations in the summer of next year. The latest paper suggests ways to revitalise the research and development pipeline to produce about 15 new licensed antibiotics every 10 years. First, O’Neill proposes a global innovation fund of $2bn over five years to boost research into new drugs and diagnostic tests, with most of the money going to universities and small biotechnology companies. The big pharmaceutical companies would be asked to make substantial contributions to the fund. For too long research into new antibiotics has been chronically underfunded. Take, for example, the $142.5bn research spending from the US National Institutes of Health for 2010–14, of which just $1.7bn was for AMR research, compared with $26.5bn for cancer and $14.5bn for HIV/Aids. This underfunding was highlighted by Ellis Bragginton and Laura Piddock from Birmingham University, who found that of almost £14bn research funding for bacteriology in the UK from 2008 to 2013, just £95m (0.7%) was awarded for work on new antibiotics. As Professor Piddock has pointed out, with such scarcity of funding, research teams tend to compete against each other rather than collaborate. If anything, O’Neill’s proposed $2bn fund seems rather conservative given the amount of catching up that needs to be done. The report recommends payments of $2–3bn to companies that create proven new antibiotics The report also recommends payments of $2–3bn to companies that create proven new antibiotics. The rationale here is that it can take up to 23 years for pharmaceutical companies to see a profit on billion-dollar investments in new antibiotics; by guaranteeing payments for drugs that meet pre-specified criteria, return on investment would be realised sooner, and the company would not have to push for large volumes of sales – reducing the chances of early development of resistance. This scheme would cost $16-37bn over 10 years, with the money coming from a new global purchasing and supply body financed by national governments. The sums involved seem huge, but pale by comparison with the $20bn that AMR is estimated to cost in the US every year, or the $40bn per year currently spent worldwide on antibiotics. The proposal for a guaranteed market for new antibiotics builds sensibly on previous experience with global drug-funding initiatives such as the Medicines for Malaria Venture, the Gavi alliance (which has revitalised the worldwide availability of vaccines), and the TB Alliance. However, progress can be glacially slow: I attended the kick-off meeting of the TB Alliance in Cape Town early in 2000, when the target of licensing one new antibiotic to treat tuberculosis within five years was set; in reality, that target was not achieved for 13 years. AMR will contribute to 10 million annual deaths worldwide by 2050, more even than cancer. By boosting the antibiotic pipeline – one of several measures needed to combat this crisis – we can start to take our fate into our own hands; otherwise, within our lifetimes, we will all know an Albert Alexander. |