Dec 28, 2019, 2:56 PM ETPanel

Reducing the Cost of Antimicrobial Resistance

The World Health Organization identified antimicrobial resistance (AMR) as a top public health priority for 2019.
Prior to the 1937 introduction of antibiotics, the standard of care for infectious diseases like sepsis was limited to bed rest and nursing.
For decades, society took antibiotics for granted, but current trends show resistant infections are increasing while the number of companies developing new antibiotics is shrinking.
Experts employ a "fossil fuels" analogy: the strategy requires both reducing consumption of existing antibiotics and generating new treatments.

Antibiotics present a poor return on investment compared to chronic disease drugs (e.g., Hepatitis C at $11B or cancer drugs at $30k+) due to low volumes and strict stewardship requirements.
Major pharmaceutical companies like Merck remain in the antibiotic space due to historical commitment and diversified portfolios, but most lack the resilience to absorb high R&D risks without offsetting revenue.
A recent approved antibiotic company went out of business in 2019, signaling the fragility of the current market model.
Small biotech firms successfully develop early-stage assets but face a "valley of death" where they cannot raise funds to advance to Phase 2 and 3 trials or find buyers in big pharma.
Current push incentives (e.g., CARB-X, BARDA, GAIN Act) have successfully stimulated early research but have not solved the late-stage commercialization barrier.

Pull Incentives (Subscription Models): The UK is piloting a novel subscription model where the NHS pays a fixed, multi-year sum for the value of an antimicrobial rather than volume sold, aiming to decouple revenue from usage.
Valuation Challenges: Health technology assessments (HTA) must evolve to capture "diversity value," including benefits like slowing resistance rates in existing drugs and enabling better stewardship cycles.
Risk Sharing: Proposals include pooling risk between public, private, and philanthropic actors to make late-stage R&D an investable proposition without relying solely on public funds.
Global Coordination: While the US and UK lead in funding and policy, there is a critical need to expand this engagement to G20 nations to ensure a global solution, as AMR knows no borders.
Pharmaceutical Industry Role: Big pharma remains the only entity with the capability to handle late-stage clinical development and global commercialization; removing private sector involvement risks killing the innovative ecosystem.

Successful antibiotic development is inextricably linked to robust stewardship; without usage limits, new drugs will quickly lose efficacy.
A U.S. regulation recently mandated antibiotic stewardship programs in hospitals for Medicare payment eligibility.
Rapid diagnostic testing is identified as a critical bottleneck; current delays in identifying pathogens force the use of broad-spectrum antibiotics, accelerating resistance.
In low- and middle-income countries, a lack of supply chain sophistication and counterfeit drugs creates a major stewardship gap requiring new models of industry-government collaboration.

Traditional small-molecule antibiotics are being supplemented by alternative approaches like phage therapy (using viruses to target bacteria), which a cystic fibrosis patient utilized after failing traditional treatments.
The Cystic Fibrosis Foundation has launched a $100 million Infection Research Initiative to fund novel therapies like nitric oxide inhalers.
Current regulatory frameworks (e.g., GAIN Act) often exclude non-small molecule therapies, creating a need to broaden definitions of what qualifies for AMR incentives.
Communication Gap: A major barrier to political action is the lack of public outrage; current messaging about AMR is too abstract (e.g., "10 million deaths by 2050") and fails to convey immediate, personal risk.
Effective communication requires framing AMR as an immediate, tangible threat to individuals and families rather than a distant global statistic.

There is no single "silver bullet"; solving AMR requires a continuum of push funding, pull incentives, stewardship, and diagnostic innovation.
The window to act is closing; once scientific expertise and industry capacity leave the sector, it may become impossible to regenerate it.
Collaboration between sectors (public, private, philanthropy) is essential, as each has distinct capabilities, limitations, and incentives that must be aligned.
Stakeholders urge policymakers to move beyond discussions to concrete action on reimbursement models that make antibiotic development financially viable.