Serious lack of new antibiotics in the pipeline, says WHO
Almost everyday I see hopeful stories about new antibiotics in the media. As Digital Editor of the Longitude Prize, my daily Google search for news is teeming with exaggerations: 'Magical antibiotic brings fresh hope', 'There's a new antibiotic you should know about', and the very common 'Antibiotic being developed from [insert surprising source here]' (i.e. honeybees, breastmilk, fungi, soil, sharks, in the human nose and even from medieval medical texts).
The discovery of a fresh, brand new antibiotic class, however, has not happened in the past 30 years.
Let that sink in.
A WHO report released today found very few potential treatment options for those antibiotic-resistant infections identified as posing the greatest threat to health. Out of the mere 51 new antibiotics in clinical development, they state that only eight are considered innovative enough to add value to the current antibiotic treatment stockpile.
Most of these development projects are actually using existing, but modified antibiotic classes, just repurposed.
And even then, development takes years, often a decade... The hopeful stories in the media all of a sudden become less so.
A lack of options
WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – which are increasingly resistant to existing antibiotics and urgently in need of new treatments.
“There is a serious lack of treatment options for multi-drug and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes,” states the report.
A WHO report released today found very few potential treatment options for those antibiotic-resistant infections identified as posing the greatest threat to health
“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” says Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.
New antibiotics alone will not be the end-all of antibiotic resistance. Existing and new antibiotics will need to be used more sparingly through antibiotic stewardship programmes. The targeted use of antibiotics will also depend on the development of new diagnostics, including point-of-care tests.
The challenge of developing new antibiotics is clear and some new funding streams have been developed to incentivise drug discovery and development, but many companies are still struggling with the pull part of the equation. Who will buy these products at what price? Will there be increased investment in basic science to create new opportunities for drug development?
Will new ways of incentivising development of antibiotics bring more players into product development?
How can products be viable if public health authorities ration them, keeping sales low? There is growing acknowledgement of the need for creative schemes to ensure the purchase of new antibiotics and at prices that will make them both viable and accessible.
Last week, the US Presidential Advisory Council on Combating Antibiotic Resistant Bacteria unanimously endorsed a report that promotes delinkage for antibiotics. Delinkage is a model to incentivise the development of new drug products in which profitability is separated from sales volume.
So will new ways of incentivising development of antibiotics bring more players into product development?
While we wait hopefully for creative schemes, product development interest and new antibiotic classes to surface, I think we will need to look towards the speedier developments of diagnostic testing, as well as what we can do as individuals to reduce our own contribution to the resistance problem.