New types of antibiotics need to be developed to treat infections, now and in the future, since resistant bacteria that today's antibiotics are ineffective against are becoming ever more common.
Photograph: Matton
More than 30 years have passed since a new class of antibiotics was last discovered. The world's antibiotic consumption is rising, and the problems of antibiotic resistance are growing. The politicians now need to act globally, just as they have done during the COVID-19 pandemic, says Helle Aagaard, Expert at the Department of Medical Sciences, ReAct - Action on Antibiotic Resistance.
of the report.
ReAct is a global network concerned with antibiotic resistance, based in Uppsala. In March, it published a report that shows a worrying trend: more and more pharmaceutical companies are moving out of the antibiotic market. At the same time, new types of antibiotics need to be developed to treat infections, now and in the future, since resistant bacteria that today's antibiotics are ineffective against are becoming ever more common.
"For 34 years, we haven't seen any new classes of antibiotics being developed. To put it bluntly, Big Pharma — the multinational pharmaceutical industry — has chosen to redirect its investments into other, more profitable areas. That's not surprising: it's their business model and the system we've created. The problem is that this system isn't working for drugs that may be of high value in terms of public health, but have limited commercial value," says Helle Aagaard, ReAct expert and lead author of the report.
What do we need to do about it?
"It's ultimately a government responsibility, for various reasons. Only governments can change the rules of the game. They're in charge of early-stage funding for companies, and they fund university research. The system of intellectual property rights is also a government creation. So if we have to change the rules of the game, it's the politicians that have to step in and make the necessary changes. There are no other players that can make them."
Can we learn anything from the COVID-19 pandemic?
"Our hope is that people now fully realise what it means when a disease breaks out and we don't have anything to treat it with — no vaccines, no drugs. In the past, it's been difficult to get governments to invest in something that's seen as a future threat. We hope this will be a game changer, now that there's a clear understanding of what it means not to have medical treatments and vaccines, and everything available when we need it."
Long way to go
It took nine months to develop a new COVID-19 vaccine. Developing new antibiotics would not be nearly such a rapid process, even if the same amounts of money, focus and political will were devoted to the task, Aagaard believes.
"I'm not a microbiologist or researcher, but my impression is that it's not that straightforward. Right now, the WHO is saying it'll probably be ten years before a new class of antibiotics reaches the market – and that's if we start doing something now. If we postpone it, then obviously the timeline will be extended."
And meanwhile the problems of antibiotic resistance are increasing?
"Exactly. That's why we have these problems today. Over the last 30 years, global consumption of antibiotics has just kept rising – for humans, animals, plants and crops, for many different purposes. Meanwhile, development of new drugs has slowed down. So we've had this 30-year gap when we really allowed resistance to develop."
Is the situation worse than ever?
"Yes, in the sense of global consumption trends and the emergence of resistance. Of course, we're also seeing greater awareness of the problem and measures being put in place. Maybe we're starting to see the effects of that in some places. But unfortunately we don't have monitoring tools that would give us a full understanding of how it's really developing. That's a huge barrier to political action, so when the policymakers ask how big the problem is, it's hard to answer that question."
Hubs all over the world
The ReAct network has hubs in Europe, the US, Asia, Latin America and Africa. The emphasis is on developing solutions that work worldwide, not only for high-income countries but also for those with low and medium income. Countries work in different ways, Aagaard says.
"In North America and Europe, we're focusing more on policymaking, and trying to exert political influence. The hubs in Latin America, Africa and Asia are also concentrating on supporting governments in implementing national plans, by being out there in hospitals and being a bit more hands-on. We're trying to merge the two, of course, so that our global, political recommendations are solidly based on reality in the countries where we have our hubs. And vice versa – so that the hubs are also aware of what's happening on a global level."
Annica Hulth
Sustainable access to antibiotics
The ReAct report identifies five challenges that must be solved to achieve sustainable access to effective antibiotics for all:
- Prioritising the most significant and unmet global health needs.
- Overcoming obstacles in the early phases of innovation and research.
- Funding late-stage clinical research and development without relying on the end-product prices and sales revenue.
- Ensuring sustainable production, quality, procurement and registration of new antibiotics.
- Securing countries' sustainable access to new antibiotics.
