Having saved millions of lives across the planet, antibiotics are beginning to fail us: indiscriminate use in humans and animals has led to a crisis of drug resistant infections. Antibiotic resistance is reducing the effectiveness of our treatment options and the speed of pharmaceutical innovation can’t keep up with bacterial evolution, making it arguably the biggest threat facing global health. In the U.S. alone, antibiotic resistance is causing at least 2 million difficult to treat infections and 23,000 deaths annually, with a $55–70 billion per year economic impact.
To prevent this looming global emergency, we must change the way we use antibiotics and develop new drugs, but prescription habits are hard to change. Scientists, physicians and policymakers around the world are challenging the overuse of antibiotics in an attempt to reduce their use.
Where are we going wrong?
Despite the national call to change antibiotic use, the system by which the NHS operates presents one of the biggest obstacles. The pharma model links drug prescriptions to revenue and drug companies across the globe, including the UK, are paid based on the volume of antibiotics sold. Thus, efforts by the NHS to reduce antibiotic use and preserve efficacy impacts pharma returns from antibiotic R&D. As drug discovery is hugely costly it is rational for pharma companies to focus their efforts on drugs with high-volume sales.
Consequently, the unforeseen consequence of efforts to guard against rising antibiotic resistance is a reduction in the revenue available to fund R&D for new antibiotics. How do we square this circle?
The UK’s new ‘subscription’ system
Starting in January this year, the UK is breaking the link between prescription volume and revenue by trialling a new and untested healthcare initiative to combat antimicrobial resistance. This trial is part of the Government’s National Action Plan, led by the National Institute for Health and Care Excellence (NICE)2, NHS England and NHS Improvement. A ‘subscription’ style payment model has been developed to incentivise pharmaceutical companies to focus their investments on antibiotic discovery to tackle the problem of resistant infections.
The system will offer upfront payment to pharmaceutical companies for access to their product for a specified period of time. The payment will be decided according to the value of the product to the NHS, such as a drug for a high-priority infection, meaning that pharmaceutical companies will receive payment regardless of product usage, whether it is used daily or stored as an emergency reserve. Crucially this allows pharma to generate revenue to fund R&D without medics needing to use the products. We can keep the most efficacious products back and reduce the risk of resistance.
The government is calling upon any R&D teams with products which might be suitable for the initial test phase of the programme to come forward and so, with ‘the UK at the forefront of the AMR fight4’, this 5 year-plan could provide a solution for the currently stagnant industry of antibiotic discovery.
Levelling the playing field
This change in policy will provide a great opportunity for start-up drug discovery R&D companies. The hope is that reducing reimbursement uncertainty will unlock great investor appetite for antibiotic development, encouraging more investors to support early stage companies such as Procarta, CHAIN and Nemesis from our own portfolio, as well as many other companies developing novel drugs to overcome antibiotic resistance.
Looking ahead towards global change
Dr Sheuli Porkess, from the Association of the British Pharmaceutical Industry (ABPI), stated that the scheme is an ‘example of how the UK can lead the world in this fight and hopefully brings us closer to fixing the problems that have hampered investment in antibiotics research for so long4.’
A crucial aim of this trial is to learn, evaluate and share information on the successes and obstacles of the process with the rest of the world. The UK hopes to lead by example for other countries wishing to overcome the rising threat of antibiotic resistance by demonstrating the success of a new, functional and importantly, replicable model. Although the prospect of global adoption of this new scheme is very exciting, the project will only address global market failure if other countries follow suit. Therefore, the involvement of as many countries as possible, as well as sharing our learning from this work, is just as important a goal as that of drug discovery.
As bacterial evolution continues to overtake the rate of pharmaceutical discoveries, scientists around the globe are striving to find alternative solutions for antimicrobial resistance. One such company, a small start-up known as Locus Biosciences, has discovered a new way to eliminate disease-causing bacteria from the human body using CRISPR, with no risk of resistance development. This is one of many examples, from the individual and team efforts of many scientists, attempting to tackle ‘one of the greatest threats to global health we face4.’
Author Oliver Sexton