Already, a shocking 23,000 people die in the US each year from bacteria that have evolved a resistance to existing antibiotics. These drug-resistant infections kill an estimated 700,000 people each year globally. That number is expected to increase, as bacteria become increasingly resistant to the drugs that have kept infections under control for decades. Terrifyingly, the World Health Organization (WHO) has said we may be entering a “post-antibiotic era.” In September of last year, the World Bank estimated that by 2050, 1.1 to 3.8 percent of the global economy could be lost to such a crisis, equivalent or greater than the losses from the 2008 economic crisis. UK Chancellor George Osborne said that without robust global action, the problem could become “an even greater threat to mankind than cancer.”
Health problems that we may think have been left in the past, like tuberculosis, or deadly infections from minor injuries, could become serious threats once again. Sexually transmitted diseases such as Gonorrhea could become untreatable. Routine surgeries could become much riskier, and hospital infections such as MRSA could become a much bigger threat.
Though some action has been taken, a more cooperative global effort will be needed, prioritized above other factors such as short term profit for pharmaceutical companies. So far, the profit incentive alone has not led companies to take the right approach to solve the problem. More likely than not, this will require decisive, and possibly expensive, action from governments, perhaps including both surcharges and incentives for drug companies. This may be the only way to avoid the worst-case scenario outcomes that the world could face from drug resistant microbes.
Some action has been taken already, but tension exists between public health needs and the needs of large drug companies to make a profit on their research and development. Many pharmaceutical companies have abandoned development of new antibiotics altogether, since the short-term incentive for profit is absent. For a new antibiotic to be effective in combating drug resistance, it must be allowed to sit on the shelf until the current antibiotics stop being effective. Only then can the pharmaceutical company bring that drug onto the market as a “new” solution. In other words, companies need to be investing in research and development, but would need to refrain from making a profit on that investment until a time when public health needs demand the rollout of a new antibiotic, to which bacteria has not yet developed a resistance.
The WHO has called for an entirely new class of antibiotics to be in development by 2019. But the companies with the resources to develop these drugs will need to be incentivized to do so. One 2015 review found it is, in general, more profitable to develop drugs to be used long term, such as for diabetes, than drugs like antibiotics that are only used for a few days.
Congress has already put some measures in place to combat these problems. The Generating Antibiotic Incentives Now Act of 2012 allows for an extended period of exclusivity to sell newly approved antibiotics, delaying the point when generic versions can come onto the market. The move was intended to encourage research and development. Unfortunately, the offer of a few more years of exclusive, yet overall poor, sales may provide little incentive, and could backfire, leading to continued over prescription of antibiotics. Also, the law fails to distinguish between tweaked antibiotics that are similar to existing compounds, and the entirely new types of antibiotics that will be needed to treat drug resistant microbes. This means companies can take advantage of the incentive without developing anything that really addresses the problem.
The patent system is less than optimal for incentivizing development of new antibiotics, which need to be held in reserve, with manufacturers unable to sell enough during the patent term to justify the investment. Instead of tweaking this system, Congress should consider a “market-entry” reward, incentivizing manufacturers to bring brand new, targeted antibiotics to the market, and removing the incentive to get the most out of the exclusive patent period. Such an incentive would require a considerable financial prize, costing the government as much as 4 billion dollars annually. But surely this cost is worthwhile to avoid a global health crisis that would take many lives, and carry its own substantial economic cost.
In the UK, a similar solution has been proposed, by former Treasury Minister and Goldman Sachs economist Jim O’Neill. In that plan, financial incentives of up to 1.3 billion dollars would be given to companies who develop new antibiotics, paid for by a small “pay or play” surcharge levied against other large drug companies who opt against developing antibiotics.
Of course, drug companies are not the only ones who may need to change course. The WHO has called on doctors to prescribe fewer antibiotics, using them only when absolutely necessary. England’s National Institute for Health and Care Excellence has estimated that as many as 20 percent of prescriptions for antibiotics, about 10 million, are most likely unnecessary.
However, the long-term solutions to the problem will ultimately come from governments and drug companies working together to meet public health needs. Other efforts, by doctors and the public, will only slow down a problem that will eventually need a large-scale solution. These solutions may not come cheap, but will ultimately be less costly than failing to address the problem.