Economic and financial challenges to the development of new antimicrobials

Antibiotics Waw2020

Antimicrobial resistance (AMR) is a growing public health problem which requires global strategies and solutions. Almost all of the antibiotics that are used in the clinic today were discovered in the 20th century, and while many of them are still effective, the rise and spread of resistance mechanisms has made several of them obsolete.

The continued spread of resistance threatens the effectiveness of existing therapies; doctors are increasingly faced with infections caused by multi-drug resistant bacteria for which our therapeutic tools are limited. One of many strategies to combat this problem is the development of novel antimicrobial compounds.

However, unlike the discovery of new medications for other diseases and conditions such as diabetes and heart disease, novel antimicrobials are faced with several unique challenges:

  • Antimicrobial resistance is a natural phenomenon
  •  Resistance can be identified soon after a drug is introduced into clinical use
  • Drug development is very costly; a conservative estimate of bringing a new drug to market is around $1 billion
  • The emergence of drug resistance limits the clinical utility and market potential of new drugs
  • Pharmaceutical companies struggle to recuperate the costs of developing new antimicrobials
  • This limited return on investment disincentivizes companies from investing in antimicrobial research and development

While our current antimicrobials are becoming less effective and there is a relative lack of novel candidates in the pipeline, we are faced with a rather tricky question: what is a new antibiotic worth?

The scope of the AMR challenge clearly requires a new financial approach. One such approach is to disconnect revenues from sales in a subscription model. Thus, health systems would pay a flat fee for the availability of antibiotics and drug producers would generate revenues independently of antibiotic sales volume.The National Health Service in the UK is set to become the first health system to try such a payment model.

The plan is an ambitious attempt to incentivize drug companies to invest more heavily in developing new antibiotics; however, it is only one of many strategies that are required. For meaningful reductions in AMR, healthcare systems need to be adequately financed, and numerous related global health and development challenges need to be addressed, including poverty, education, and sanitation. Nonetheless, new approaches are welcomed and offer some much needed optimism.

This piece was written after attending the AMR in Latin America and the Caribbean: innovations and challenges webinar hosted by the World Health Organization and Florida International University Global Health Consortium during World Antimicrobial Awareness Week 2020 where several stakeholders came together and discussed the promises and pitfalls of new financing models for antimicrobial research.