The ability of bacteria and fungi to develop resistance to antimicrobial treatments isn’t a new phenomenon; we’ve observed the effects since the discovery of the first antibiotics almost a century ago. Antibacterial resistance is an inevitable consequence of natural selection – and it shouldn’t be a problem, provided we have a ready supply of new and effective drugs at our disposal. Yet the number of new antimicrobial agents in the pipeline is at worryingly low levels. This isn’t because we’ve run out of ideas or are unable to discover new drug molecules; it comes down to the financial incentives for their development.
We need to incentivize antimicrobial research
The established funding model for drug discovery is based on recovering the costs associated with development through sales revenues during a period of patent-based exclusivity. For antimicrobials, this approach is flawed, as the need to use these drugs sparingly inherently limits sales potential. At the same time, healthcare payers are less willing to pay more for drugs to support R&D investment due to increased demands from an aging population. As a result, the number of multinationals engaged in antimicrobial research has dropped significantly.
To properly fund research into novel antimicrobials, many key opinion leaders within the industry now recognize the need for a new economic model where investment in R&D isn’t rewarded by sales revenues alone.
Here, potential strategies to overcome the financial barriers in the early stages of drug development could include the greater provision of research grants, tax incentives and new public-private partnerships to reduce the financial risks associated with R&D. Greater funding of university research, through government grants or entrepreneurial investment, could help academic groups partner with contract research organizations and pharmaceutical companies to put bright ideas into practice.
These measures could be further supported by rewarding successful drug development through advanced market commitments, patent buyouts or monetary prizes. One model recently put forward by the Review on Antimicrobial Resistance is the establishment of a global system of market entry rewards for treatments in areas of most urgent need. As these rewards would be only be paid once a new drug reaches the market, pharmaceutical companies would still take the upfront risk, but would be suitably incentivized to engage in their development.
Global co-operation on antimicrobial resistance
Antibiotic resistance is a global problem that demands an international response. To ensure the benefits of new research are felt around the world, the Review on Antimicrobial Resistance is clear that an international body is required to coordinate research efforts, and to ensure funding is focused effectively and used efficiently.
Good progress towards this goal is already being made through international partnerships such as the European Innovative Medicines Initiative and the Global Antimicrobial Resistance Innovation Fund (GAMRIF). Programs such as these are helping to accelerate advances in our understanding of drug targets and antimicrobial agents by bringing together academic research groups, commercial sponsors, and contract manufacturing and development organizations, to share resources and make the best possible use of funding.
Antimicrobial resistance is one of the world’s most pressing challenges, and requires new ways of thinking to ensure we don’t repeat the same mistakes that led to where we are today. To find out more about our options and how we can all play a role in tackling this challenge, read our article in full.