(CN) — Calling attention to the critical lack of treatments for so-called superbugs, the World Health Organization warned the public Friday that new antibiotics are needed desperately.
Cornelius Clancy, an infectious diseases physician and researcher at the University of Pittsburgh, said part of the drop-off in new-drug development is economic.
“Larger pharmaceutical companies have more or less abandoned the antimicrobial space because it’s just so unattractive economically for them,” Clancy said in a phone interview Friday.
Because doctors should act judiciously when prescribing antibiotics, which in turn avoids the creation of more superbugs, “the slice of pie that’s out there for companies bringing those drugs out is small,” said Clancy, a member of the Infectious Diseases Society of America. The fewer drugs used, the better — but the fewer drugs companies sell, the smaller their profit margins.
“Never has the threat of antimicrobial resistance been more immediate and the need for solutions more urgent,” Tedros Adhanom Ghebreyesus, director-general of the the United Nations’ international public health agency, said in a statement.
“Numerous initiatives are underway to reduce resistance, but we also need countries and the pharmaceutical industry to step up and contribute with sustainable funding and innovative new medicines,” added Tedros, who has a doctorate in community health and a master’s in immunology of infectious diseases.
Two new reports released Friday by the agency show continued disinvestment by Big Pharma, leaving research and development for new antibiotics to smaller companies that face challenges in the market-driven drug development scene.
“The clinical pipeline remains insufficient to tackle the challenge of increasing emergence and spread of antimicrobial resistance,” says one of the reports, subtitled “an analysis of the antibacterial clinical development pipeline.”
Clancy said there are ways to work within the free-market system to develop new antibiotics.
The U.K., for example, is piloting a Netflix-style subscription system in which hospitals can purchase licenses for antibiotics, rather than paying per unit.
In the U.S., a bill called the Disarm Act is garnering bipartisan support with its promise to more fairly reimburse hospitals for the costs of using new antibiotics.
“We’re trying to get to a place where the ability to get a return on an antibiotic isn’t strictly related to the number of prescriptions that you write,” Clancy said.
Deaths from resistant infections are on the rise around the globe, the report says. More than 2.8 million people come down with a resistant infection annually in the U.S. alone, and 35,000 of those people die. Children are disproportionately affected.
Despite tuberculosis’ status as the top infectious disease killer in the world, only two new antibiotics to fight multi-drug-resistant TB have come to market in the last 70 years, the report says. Drug-resistant tuberculosis is airborne and kills a quarter-million people a year.
In 2017, the WHO published its “priority pathogens list,” a collection of 12 classes of bacteria plus tuberculosis that pose a particular and increasing threat to humans. Of 50 new antibiotics in the pipeline, 32 attempt to to address the priority pathogens, but most of those aren’t much more effective than drugs we already have, the agency says.
“I think most of us who are practitioners, I don’t care where the drugs come from,” said Clancy.
More than 252 drugs at an earlier stage of development also target the priority pathogens, but it’s too soon to tell whether they’ll work. The “optimistic scenario” is that the first handful of these will be ready in a decade, the WHO says, in one report calling the pipeline outlook “bleak.”
Developing new drugs isn’t the only thing we need to do to protect ourselves against antibiotic-resistant bacteria, the WHO added — health professionals around the world also need to be judicious about when and how they administer antibiotics, as well as helping to prevent infections in the first place.
Because medical procedures like transplants and cancer treatment leave people vulnerable to infection, Clancy said, all of modern medicine depends on antibiotics.
“If you make a public good argument for why we need to fix the antibiotic marketplace, that’s really it,” he said. “You can’t make a billion dollars selling a cancer drug if you don’t have antibiotics for the people you’re going to sell the cancer drug to.”