Saving the world, one antibiotic at a time

Jim O’Neill leads the Antimicrobial Resistance Review for the UK Government. They just issued their third report, now focused on how to bring effective antibiotics to the market.

He calls for two new global institutions: an Antibiotic Innovation Fund, partially funded by the companies, to jump-start basic research. The target is US$2 billion over five years, which would be a very significant increase over existing funding levels (US NIH funding for non-TB antibiotic resistance has averaged only $90 million per year in 2013 & 2014; most NIAID funds go to viruses, retroviruses, parasites and mycobacteria). Given the flat funding environment for basic research, this is a very welcome step.

But ideas will never move from the lab to the patient unless commercialization occurs. How do we incentivize companies to bring excellent antibiotics to market? For most products, the new features sell themselves, but for antibiotics, for very good reasons, a novel drug is mostly put on the shelf and reserved only for extreme cases. And this is the right thing to do, since we need to exhaust the older antibiotics first and conserve the new ones for emerging infections. Makes perfect sense for medicine and public health, but it undermines commercial incentives for the companies. Imagine if Apple had to prove that all previous generations of iPhones were defunct before customers were allowed to buy or use the latest phone? Phone innovation would grind to a halt.

The emerging solution to this unique problem with antibiotics is called delinkage, which severs the link between antibiotic sales volumes and company profits. The O’Neill report embraces two versions of delinkage, paying companies for value of the antibiotics delivered to the market as opposed to mere volume of sales. Both would require a global coordinating institution. Antibiotic delinkage has been my major research focus for a decade, so this is a happy moment.

Many details remain to be worked out – and a major Chatham House report on this topic is due next month – but this AMR Review report marks a watershed event as an authoritative endorsement of the principle. I also welcome the decision to focus public funds on the areas of greatest need (currently, Gram-negative bacteria, per the CDC).

Background: a call for similar global institutions in the WHO Bulletin; and the US domestic issues in Health Affairs 2015; and my comments on the US National Strategy.

Also, for model geeks, the AMR Review hired IMS Health to update the parameters in the Eastern Research Group model of antibiotic R&D expenses and revenues. The full model in Excel and data will be open access (!) is here.


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