Commentary: Larger, Sinister Pandemic Lurks Beneath COVID-19

GENEVA: More than one in five Americans hospitalized with COVID-19 also contracts a bacterial infection.

In the absence of effective antibiotics, those lucky enough to beat the coronavirus could be killed by these not-so-new pathogens.

Unfortunately, the portfolio of new antibiotics is running low. Less than 100 years after the development of penicillin, drug-resistant superbugs threaten to gain the upper hand in our fight against bacterial infections.

Superbugs already take a huge toll on healthcare systems around the world. Approximately 700,000 people around the world die each year due to antimicrobial resistance (AMR).

Without new and better treatments, that number could rise to 10 million by 2050.

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BROKEN MARKET FOR ANTIBIOTICS

Researchers are currently developing more than 550 innovative treatments and vaccines for COVID-19, an unknown pathogen just a year ago.

But although RAM has been a known and growing problem for decades, only a new class of antibiotics has been discovered since 1984.

The hugely successful biopharmaceutical industry, whose expertise and resources are responsible for most of the drugs we use today, has not been able to take on this vital challenge.

The reason is simple: While the industry has built its robust and unprecedented COVID-19 response on a robust innovation ecosystem, the market for antibiotics is broken.

Companies that successfully develop a new, cutting-edge antibiotic face great challenges. Navigating regulatory approval and potential safety issues is costly and time-consuming, requiring skills that smaller drug manufacturers often lack.

But potential sales pose an insurmountable problem. New antibiotics must be used very sparingly to prevent bacteria from evolving and becoming immune to them.

Ideally, they should serve as weapons of last resort against bacteria resistant to the most common antibiotics.

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Therefore, the likely sales of any new antibiotic will be very low; Hospitals will have only a few doses, all locked up, for emergency use only.

Unfortunately, this means that the potential market return is too low to justify the necessary investment in research and development.

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AS FIRE EXTINGUISHERS

At the heart of this upside-down economy is the question of how to recognize the value of a treatment that should be used infrequently.

John Rex, the medical director of British biotech company F2G Ltd, compares advanced antimicrobials to fire extinguishers: Absolutely essential, but ideally rarely needed.

A handful of companies are still doggedly pursuing this line of investigation against all odds. These include Merck, GlaxoSmithKline, Shionogi and Roche, as well as Pfizer, which recently acquired Arixa Pharmaceuticals, a small California-based company developing new antibiotics for drug-resistant infections.

But many drug manufacturers have dropped antibiotic research. Big firms like Novartis, AstraZeneca and Sanofi went out of business a long time ago, and in the past two years, at least four smaller antibiotic-focused companies have gone bankrupt.

FINANCING THE DEVELOPMENT OF ANTIBIOTICS

Although, fortunately, the global health community is beginning to recognize the urgent need for new antibiotics, so far much has been said and little acted upon.

Some players are experimenting with some alternative ways to finance the development of new drugs. But overall, unsurprisingly, so far political leaders find it easier to subscribe to declamatory statements at high-level meetings than to sign multi-billion dollar checks to fix the bankrupt market.

That’s why many of the world’s largest drug makers helped launch the AMR Action Fund in July.

The Fund will invest $ 1 billion in smaller biotech companies, aiming to bring two to four new antibiotics to patients by 2030, helping to bridge the so-called “valley of death” between laboratory research and clinical trials.

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The initiative took a year to establish, and politicians and the public health community, including the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, as well as scientists already researching treatments to combat bacteria resistant to the drugs, have embraced it widely.

While we wait for new antimicrobials, doctors, governments and the public can buy time by further curbing the overuse of existing antibiotics in medicine and agriculture, which is part of what caused the problem.

Government regulation has controlled the worst excesses, reducing use, including in cleaning products and farm animals.

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Still, more careful use of the more widely adopted antibiotics is needed to slow the spread of AMR. For example, we should not expect our doctors to give us antibiotics to fight viruses, against which they are useless.

ASSESSMENT OF NEW ANTIBIOTICS

But ultimately, slowing down the spread is not enough. We must fundamentally change the way we value new antibiotics.

Instead of tying their price to the amount used, we should consider them as an insurance policy for drugs and health services.

The UK’s 2014-2016 Independent Review of Antimicrobial Resistance, chaired by economist Jim O’Neill, estimated that avoiding the worst-case scenario of 10 million annual AMR deaths by 2050 would require an investment of $ 42 billion. dollars over the course of a decade. .

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But that would represent a mere fraction of the huge economic cost of RAM between 2015 and 2050, which according to the review could exceed $ 100 trillion.

The United States Senate is considering a possible legislative remedy. The proposed Pioneering Antimicrobial Subscriptions to End Growing Resistance Act (PASTEUR) would award federal contracts of up to $ 3 billion each to drug manufacturers in exchange for innovative antibiotics.

Companies would be paid by subscription, regardless of the amount of drug used.

Other countries are experimenting with different models to support antibiotic research. But one way or another, as the WHO has pointed out, governments will need to establish incentives that reward biotech companies for successfully developing antibiotics.

Next year’s G7 summit in the UK is expected to produce long-awaited real engagements rather than just more talks and some pilot initiatives.

The world is caught in an arms race against superbugs.

For now, the mistakes are winning. But by fixing long-standing problems in the antibiotics market, we can begin to turn the tide.

Thomas Cueni, CEO of the International Federation of Pharmaceutical Manufacturers and Associations, is president of the AMR Industry Alliance and founder of the AMR Action Fund.