Antibiotic Resistance: We Need Bigger Sticks & Fewer Carrots

from Nature 5/25/16
Pressure from the public must force firms to develop new drugs that treat resistant infections, says Carlos Amábile-Cuevas.

http://www.nature.com/news/society-must-seize-control-of-the-antibiotics-crisis-1.19969

What are we to do about antibiotic resistance? Last week, another government report repeated stark warnings about the crisis, and offered some suggestions to improve the situation. The UK report, prepared by a panel chaired by the economist Jim O’Neill, naturally focused on financial incentives, including US$1-billion prizes for pharmaceutical firms that develop new antimicrobial drugs (see go.nature.com/a8auos).

O’Neill, who in a previous job coined the term BRIC for the fast-growing economies of Brazil, Russia, India and China, suggested a different approach. As well as rewards for companies that invent new antibiotics, his report suggests punishments for those that do not try. Such firms, he writes, should pay a small fraction of annual sales into a fund to support rivals that invest in antibiotic research.

This is a welcome idea, but O’Neill does not go far enough. For too long, government moves to address the antibiotic-resistance crisis have focused on lucrative incentives: patent extensions, market exclusivity and higher prices. These mainly work to transfer public money into private hands, much in excess of what the research and development (R&D) actually costs. While we wait and see whether any of these interventions work, bacterial resistance continues to grow and spread, causing illness and death worldwide.

We need to take O’Neill’s idea of a punitive levy and build on it. When it comes to the pharmaceutical industry and antibiotics, we need more sticks and fewer carrots.

Antibiotics are not like other drugs. The medical effects of prescribing and taking them are not restricted to one patient. In the words of the scientist Stuart Levy — one of the first to raise the public alarm over bacterial resistance — antibiotics are “societal drugs”. This societal impact justifies an approach to the development, marketing and use of antibiotics that is different from those of other medicines and consumer goods.

Ideally, governments would wield the sticks that would encourage this different approach — for example, by delaying or denying the approval of ‘me-too’ drugs from companies that do not invest in antibiotic research. That seems unlikely, but society can step in and act instead.

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