The antibiotics argument

There is a key issue in drug discovery. New antibiotics. Or rather, the lack of new antibiotics. England’s Chief Medical Officer, Professor Dame Sally Davies spoke to Chris Smith about the issue.

Sally - We’ve had no new classes of antibiotics since the late 80s. It’s difficult work, the low hanging fruit has been found, and people have disinvested because, as a world, we thought we’d cracked infection. We’re in this situation because we let across the world infection prevention and control, things like washing hands slip all too often. We don’t look after our antibiotics in the health system as effectively a we should, which is called stewardship.

And then, of course, we have to remember the rest of the system, and more than 70% of antibiotics across the world are used in agriculture and the food chain. So it’s not surprising that drug resistant infections can occur in the food chain and then be transmitted to humans.

Chris - You’ve said, rather shockingly, that we haven’t invented anything new in this space since the 1980s - whyever not?

Sally - I would argue that people thought we’d cracked infection. We had vaccines, we had infection prevention control and antibiotics. I think HIV should have woken us up to the fact that we hadn’t. And you know, it’s difficult science, even when you think you've got a candidate antibiotic, you’ve then got to take it into humans and the failure rate of antibiotics is much higher in that development period. It’s said to be one in five compared with a failure rate of one in three for other drugs, and it’s a very slow process

Find a new antibiotic - it takes a minimum of 15 and generally 20 years to get it into practice and we haven’t funded it effectively. There’s a market failure. The companies that invest in this don’t make any money. They all argue that they’re doing it at a loss if they’re still in the business. Even in academia, we’ve disinvested in having a critical mass of experts who can really drive this forward.

Chris - So, given that problem, how big is the threat facing the world because of the dwindling supply of antibiotics that still work?

Sally - We already know that the young, the old, the pregnant, the immunocompromised - think people on cancer treatments - are prone to getting infections. I can imagine the day where the cancer doctor says well Sally, I could give you something which would probably cure your cancer, but you’re sure to get an infection and I’m not sure we’ll be able to treat it. And yet, we pay billions for new cancer drugs and we haven’t invested in new anti-infection treatments.

Chris - Many of the people who are in the position to invent these drugs are arguing it’s just not financially viable for them to do so. What do you think governments could do to try and help them because this is, obviously, not going to be a problem where you just wield a big stick and say to pharmaceutical companies go an make us some more antibiotics because they’re not going to do that?

Sally - I think Europe has really led the way with the IMI programme DRIVE-AB. They’ve done some very nice work about what needs doing and how and that’s a private/public partnership, and we need to go on with private/public partnerships. Clearly, if you look at the work of Lord O’Neal and his special review for our Prime Minister, you can see that there are arguments from many people. I think DRIVE-AB support this that you need to de-link doing the research and making a profit. No-one wants drug companies to make a loss, but do they need to make a massive profit? And if we can find a way of reimbursing for the R & D then maybe we don’t have to use the drugs, we can keep them for when they’re truly needed. All of this needs working out further; it needs pilots and experimentation. I think people are beginning to move, but we’ve got to keep the pressure up and that’s the value of this UN inter-agency coordination group.

Chris - Do we have time or are we running out of time?

Sally - Well, with at least 25,000 dying each year in Europe, and a similar number or more in the States, for them we’ve run out of time and that goes on year after year. But, there is no shirking it that if we do it now, then we can make a difference.