How and why capitalists made antibiotics ineffective, and what they plan to do about it
A post-antibiotics era in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century." That was the warning last month from the World Health Organization in its first global report on the growing ability of bacteria to resist antibiotics.
One more thing to panic about! But wait!
The WHO wants to fix the problem by backing unprecedented controls on the pharmaceutical industry – and the industry, mostly, agrees. "There really is a consensus emerging," says John-Arne Røttingen of the Norwegian Institute of Public Health.
This week, the WHO's 194 member states are meeting in Geneva, Switzerland, to endorse a proposed action plan to save antibiotics. It includes a modest-looking call for "new business models to encourage investment in and preservation of new products". Translated, that means we cannot solve this problem if antibiotics research and marketing continue to be governed solely by market forces.
"Governed by solely by market forces." Let the literal meaning of that sink in.
Last week at another meeting in Geneva, healthcare researchers and pharma representatives agreed that companies must be paid more to invent antibiotics – but in a radical departure, profits cannot depend on drug sales.
There are no big profits in antibiotics, says Kevin Outterson, an expert in health law at Boston University, whose report on the issue was presented at the earlier meeting. Normally a company invests a great deal of money in research and development to get a drug to market, then recoups that, and profits, by selling it.
The problem, says Outterson, is mainly that older antibiotics that still work are off-patent and therefore cheap, so new ones that must compete cannot be priced very high. The only profit is in maximising sales – but this inevitably speeds up the development of resistance. So companies have deserted antibiotics in droves: 18 big companies were doing antibiotics R&D in 1990, but only five of those were still doing it in 2011.
Antibiotics could be a nice little business; just not nice enough?
Two remedies are now on the table. One is to jump-start R&D with government money. Both the US BARDA fund, initially intended to foster otherwise unprofitable biodefence drugs, and the EU's New Drugs for Bad Bugs (ND4BB), aim to do this. The WHO wants to push this approach.
The second idea is more novel: de-linkage. This means a company's profits from a drug would not be linked to sales, but instead to prizes, grants or other incentives. To keep resistance from developing as fast as the new drugs are produced, some may not be sold at all until they are absolutely needed, says Outterson.
Leading antibiotics makers broadly support the idea, he says. James Anderson of UK-based pharma giant GlaxoSmithKline backed it in Geneva – as long as the sales limits do not extend to other drugs.
There is little consensus on how to proceed but no lack of proposed schemes. These range from awarding companies cash prizes or extended patents, to "public-private partnerships" in which the government pays for the R&D, then controls sales. De-linkage has wide support in Europe, but not in the US, which resists interference in free markets.
"Interference in free markets.... " BWA-HA-HA-HA-HA-HA-HA!!!! Except when they're rigging or looting them!
Anyhow, I love the idea of "Win cash prizes!" and I wonder what else it could be applied to.
NOTE I hope Riverdaughter sees this and comments or even posts on it.