Antibiotics have been a mainstay of western medicine for the better part of a century, although margins have been low, and volumes sky-high. As a result of overuse some bacteria have become resistant to the effects of antibiotics, leading to the emergence of superbugs.

With this issue in mind doctors are wary of prescribing new antibiotics until they are absolutely needed. Agricultural pursuits worldwide have fed vast amounts of antibiotics to livestock and food-producing animals, not just to reduce infection, but also to increase growth. Whilst humans do not ingest those antibiotics, they do ingest and handle the bacteria that resides within animals.
By 2050, if the problem continues, it is estimated that resistant infections could kill approximately 10 million people per year, and more will die from resistant microbes than from cancer and diabetes combined.

So, what are pharmaceutical companies doing to counter the problem?

To stay ahead of superbugs, we urgently need new medicines to fight them, but pharmaceutical firms are reluctant to invest in developing drugs as the science behind the development process of antibiotics is so complex and lengthy; they cost huge sums to develop and taking them to the market requires significant investment. Also, commercial potential and return on investment for companies developing new antibiotics are significantly lower than drugs to treat chronic conditions such as diabetes or heart disease.

It can take over 12 years to develop a new antibiotic and can cost more than £1 billion to gain approval to licence.          

A significant number of major pharmaceutical companies have exited research due to lack of profit, leaving GlaxoSmithKline, Merck, Roche, and Pfizer as some of the remaining larger pharmaceutical companies with active antibiotic programs.

GSK state that developing new and quicker tests to diagnose bacterial infections will help clinical trials be more efficient. Faster diagnostics would also help in removing the need for doctors to make decisions based on patients’ symptoms alone, ensuring that antibiotics are only prescribed to people with bacterial infections, minimizing their misuse.

 What could encourage companies to invest in antibiotics?

Anthony Coates, co-founder of Antibiotic Discovery UK, when describing what the promising strategies for tackling resistance could be said, ‘Joint efforts from patients, prescribers, individuals, international regulators and policy makers are needed to fight against the global spread of antimicrobial resistance. Unfortunately, the epidemic of highly resistant bacteria continues to increase.’

Merck supports a variety of incentives to stabilize the market for last resort antibiotics. “They’re made to be used as little as possible, so therefore companies aren’t making any return,” says Joan Butterton, a doctor who heads antibiotic development at Merck. “Having some of these pull incentives where investors would be guaranteed a return would make it more palatable.”

Public health experts are also calling for new incentives to reward companies for bringing drugs that are effective against resistant strains to market. A few ideas have been thrown about, for example hospitals to pay a subscription fee for key new antibiotics. Other ideas that have been floated are for Governments to give a cash reward to companies that develop a drug effective against deadly resistant strains or to grant the company additional years of patent exclusivity for another more lucrative drug.

 What does the future look like?

There have been talks in the UK on how antibiotic production could be nationalised. In March 2019 Jim O’Neill revealed that he floated the idea of a publicly owned pharmaceutical company in his first month as the government’s “superbug tsar”. ‘It’s what happened in finance in the end. If you’re not going to do it yourself, we’re going to turn certain parts of your business into being a utility.’

The UK government has also launched a public awareness campaign asking people not to harass their GP for antibiotics and to take them as prescribed.

So, some actions are being taken to fight antibiotic resistance by Companies and Governments, but will it be fast enough to prevent a serious impact on public health and the economy?