Insuring the world against antibiotic resistance

Written by Patrick Vallance, Chief Scientific Officer & Committee Member

We should all be encouraged by the emerging global response to antibiotic resistance. This issue has, quite rightly, climbed the political agenda and recognition has increased across the globe of the potential debilitating consequences if we don’t act now. The notion of reverting to a pre-antiobiotic era is truly alarming.

There is already a significant focus on encouraging responsible prescribing of antibiotics. This is key. Along with this, generous levels of public funding – from the EU’s Innovative Medicines Initiative, the US Biomedical Advanced Research Development Authority (BARDA) and others – have created research partnerships that are enhancing understanding of bacteria and antibiotics and supporting the development of new tools to tackle resistance.

These efforts have also created a momentum that’s inspiring other novel ways of fostering innovation and incentivising the scientific community – like the Longitude Prize which, by encouraging the development of a cost-effective, accurate, rapid and easy-to-use test for bacterial infections, has the potential to revolutionise the way infections are diagnosed and antibiotics used. With global entries to the Longitude Prize now open, the race is on.

But despite all this, we need to do more to ensure a long term and sustainable supply of new medicines to fight bacterial infections.

First, we need to encourage more investment in research directed towards therapeutics. The company I work for, GSK, continues to be active in this field. In the past decade we’ve spent around $1bn on research to discover new antibiotics, and we’ve worked alongside other research bodies in the key research partnerships mentioned above. But overall, the number of large pharmaceutical companies doing antibiotics R&D has dwindled.

Why is this? Simply put, it’s because developing new antibiotics is very challenging, both scientifically and financially.  Bacteria have evolved over millions of years to avoid attacks by chemicals. They live in hostile environments and have mastered the art of evasion and resistance. It’s little surprise, then, that failure rates are higher in antibiotics R&D than in most other areas. Often very large doses of antibiotics are required and that in turn brings problems for the host being treated (us!). Discovering and developing any medicine or vaccine is tough, but antibiotics is a phenomenally difficult area to be involved in.

Even when a company succeeds in bringing a new antibiotic to patients, a thorny question remains. How will that company be rewarded for its innovation and recoup the hundreds of millions of pounds it invested? Antibiotics present an unusual commercial conundrum. New antibiotics shouldn’t be used widely; they should be used sparingly to avoid resistance. So sometimes the new antibiotic might sit on the shelf, only to be used as a last resort. But how can companies be encouraged to invest if the ideal scenario is that these medicines should be very inexpensive and not used much? This is an economic model that needs a rethink.

We need to create a model that encourages investment in research while discouraging unnecessary use of new antibiotics. It makes no sense for anybody to have incentives to use more of an antibiotic when, to protect future health, we should be trying to use less.

But what should a new economic model look like? There are various different ways that antibiotic R&D could be incentivised, the most obvious being simply pushing up the price of these medicines, to compensate for low volumes of sales, and to encourage sensible prescribing. This seems unlikely to work globally.

I favour a different approach. What if governments committed to a series of guaranteed payments to the company developing the medicine over a period of years once the medicine was made? These purchase agreements wouldn’t be linked to the volume of antibiotic sold, they would be paid to recognise the companies’ innovation and investment in the area of antibiotic development.

This would be like an insurance system where new, effective antibiotics would be available for patients if needed, but wouldn’t necessarily be used. And it would stop any commercial incentive to promote the use of large quantities of antibiotics.

There is a clear need for high-level discussion, on a global scale, to flesh out how such a scheme – or other similar proposals – would work in practice. But promising progress has recently been made towards this. With the establishment of expert groups in both the UK and US tasked with addressing the economics of antibiotics, and the development of a World Health Organization global action plan currently underway, the problem of antibiotic resistance has been elevated to the global political stage. I hope that here, it will continue to receive the focus it deserves.

At GSK we’ve a long heritage in anti-infectives and it’s an area where I want us to remain. We first began our research over 40 years ago and I’m proud that today we still have a dedicated R&D unit working to discover the next generation of medicines to treat bacterial infections. This isn’t just about developing conventional antibiotics – we also need to explore new ways of killing bugs, including boosting the body’s own defence mechanisms.

The world now has an opportunity to redesign the economics of antibiotics – a crucial step in ensuring the continued development of these important medicines. This is a tough challenge but it’s one that industry must become actively involved in.