LAST month the World Health Organisation issued a new warning about the spread of multi-drug-resistant bacteria across the world.
As well, a recent report in The Lancet identified a new gene that enabled some types of bacteria to be resistant to almost all antibiotics.
This has serious implications for Australia, where 7000 people die each year from drug-resistant bacteria such as golden staph infections. That’s almost 20 Australians a day.
There’s growing concern in the US and Europe that the pharmaceutical industry isn’t developing enough new antibiotic medicines to combat these superbugs. That’s a serious issue, as drugs now used to combat bacteria are 30 or 40 years old and the bacteria have become resistant to them.
Indeed, Thomas Gottlieb, president of the Australian Society for Infectious Diseases, told this newspaper last month that antibiotic resistance was one of the foremost issues that would affect health care worldwide, including in Australia, in the coming decades.
So why are there so few new antibiotics on the market and why can’t the pharmaceutical companies just quickly whip up a new batch in response to the growing threat of superbugs?
The reason is simple. With the long lead times, costs and commercial risks involved in developing new medicines, companies need to make long-term decisions about which potential cures they will commercialise years in advance of those medicines reaching the market.
Company decisions during the past two decades have led to the situation today, where antibiotics play only a minor part in their portfolios of new medicines.
A study released last year by the London School of Economics highlighted the reasons the pharmaceutical industry isn’t commercialising enough new antibiotics.
It found that while some problems reflected the nature of antibiotics, such as the short-term nature of a medicine’s effectiveness, several barriers to investment had been caused by governments in countries such as Australia.
To try to limit the growth in antibiotic resistance, governments have restricted the use of antibiotics generally, keeping new antibiotics as a treatment of last resort. While justified on public health grounds, this limits the size of the market for a company developing a new medicine.
Cold, hard, fiscal realities also have played their part in dissuading the industry from investing in new drugs.
The availability of old, cheap, generic antibiotics has meant governments typically have used these relics as the benchmark for assessing new ones.
Driving down the cost of new antibiotics by referencing them to the price of older cheap generic antibiotics may help reduce health expenditure in the short term. However, during the course of a couple of decades it has meant that companies can no longer justify the costs of developing new antibiotics.
In other words, what may be seen as efficient in the short term is actually inefficient for the overall economy and society in the long term. Governments have failed to recognise that the decisions they make today about what they’ll pay for different therapeutic treatments have a knock-on effect 15 or 20 years later on the number of new treatments being developed by the medicines industry.
You need only to compare the situation with cancer treatment to appreciate the role that governments have in influencing where the industry puts its investment dollars.
For cancer, governments are prepared to pay for new treatments as they’re developed. The result is that today the industry has more than 800 new cancer medicines in development compared with 83 antibiotics.
This trend — cutting costs now at the expense of future therapeutic development — is occurring in several areas such as cardiovascular disease, but with infections there’s the risk of superbugs overpowering older drugs.
So what should we do about it? We could fund more basic research into new antibiotics, but that will only half fix the problem. Although driving new scientific discoveries in antibiotic treatment may be desirable, the problem is as much about commercialising what is discovered in the laboratory.
Incentives for commercialising promising technologies are one option to encourage companies to invest more, but incentives are no panacea. That’s because they’ll end up funding research for effective and ineffective medicines.
Other one-off incentives such as extending patent terms, tax credits and commercialisation funds could help in providing financial incentive to antibiotics after they’ve proved to be effective.
Again, it’s critical that governments recognise that their decisions about what price to pay for new medicines today have implications for the medicines that will be brought to market in 15 to 20 years.
What’s more, comparing new medicines against inexpensive generics can discourage industry from further investment in a therapeutic area such as antibiotics while encouraging them to invest in areas where the return is greater.
It may be alarming that the present generation has to make do with the same antibiotics our parents used 30 years ago. In the end, though, the lack of new antibiotics to treat the superbugs comes down to the old adage: you get what you pay for.
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