Comment: A larger, more sinister pandemic lurks under COVID-19

GENEVA: More than one in five Americans admitted to hospital with COVID-19 also contract a bacterial infection.

In the absence of effective antibiotics, those lucky enough to beat the coronavirus could die at the hands of these not-so-new pathogens.

Unfortunately, the pipeline of new antibiotics is running out. Less than 100 years after the development of penicillin, drug-resistant superbugs threaten to take over in our fight against bacterial infections.

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

Without new and better treatments, that figure could rise to ten 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 while AMR 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 address this vital challenge.

The reason is simple: While the industry has built its strong and unprecedented COVID-19 response on a solid ecosystem of innovation, the antibiotic market is broken.

Companies that successfully develop a new, state-of-the-art antibiotic face major challenges. Navigating regulatory approval and potential safety issues is costly and time-consuming, requiring skills that smaller drug manufacturers often lack.

But potential sales are an insurmountable problem. New antibiotics should be used extremely sparingly to prevent bacteria from evolving and growing immune to them.

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

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The likely sales for any new antibiotic will therefore be very low; hospitals will only have a few doses – all locked up – for emergency use only.

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

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LIKE EXTINGUISHERS

At the heart of this reversed economy is the question of how to recognize the value of a treatment that should only be used rarely.

John Rex, the chief medical officer of the British biotechnology company F2G Ltd, compare with the advanced antimicrobial extinguishers: absolutely essential, but ideally rarely necessary.

A handful of companies are still stubbornly pursuing this line of research against the odds. They include Merck, GlaxoSmithKline, Shionogi and Roche, as well as Pfizer, which recently acquired Arixa Pharmaceuticals, a small, California-based company that develops new antibiotics for drug-resistant infections.

But many drug manufacturers have abandoned the search for antibiotics. Large companies like Novartis, AstraZeneca and Sanofi exited the market a long time ago, and in the past two years at least four small antibiotic-focused companies have gone bankrupt.

FINANCING ANTIBIOTIC DEVELOPMENT

While the global health community is, fortunately, beginning to recognize the urgent need for new antibiotics, there has been much talk and little action so far.

Some actors are experimenting with some alternative ways to finance the development of new drugs. But in general, it is not surprising that so far the political leaders find it easier to take out declamatory statements in high-level meetings to sign checks for a billion dollars to repair the market crisis.

This is why many of the world’s largest drug manufacturers helped launch the AMR Action Fund in July.

The Fund will invest $ 1 billion in small biotech companies, with the goal of bringing 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 launch and politicians and the public health community, including World Health Organization Director-General Tedros Adhanom Ghebreyesus, as well as scientists already researching treatments to fight drug-resistant bacteria, l ‘have warmly welcomed.

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 partly to blame.

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

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However, 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.

ENHANCE NEW ANTIBIOTICS

But, in the end, slowing the spread isn’t enough. We need to fundamentally change the way we evaluate new antibiotics.

Rather than link their price to the quantity used, we should instead look at them as an insurance policy for medicine and health services.

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

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But that would only represent a fraction of the huge economic cost of AMR between 2015 and 2050, which the review says could exceed $ 100 trillion.

The US Senate is considering a possible legislative remedy. The bill Pasteur (Pioneering Subscriptions to End upsurging Antimicrobial Resistance) would award federal contracts up to $ 3 billion each to drug manufacturers in exchange for innovative antibiotics.

The 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 pointed out, governments will need to establish incentives that reward biotech companies for successfully developing antibiotics.

Next year’s G7 summit in the UK will hopefully produce long-awaited real engagements rather than simply more speeches and some pilot initiatives.

The world is locked in an arms race against superbugs.

For now, the bugs are winning. But by solving long-standing problems in the antibiotic market, we can begin to reverse the trend.

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