It'd be great to see more investment in antibiotics, and we need world governments to lead the charge. It'd be even better to see our current drug prohibition regime pivot from recreational drugs to antibiotics. Development of new, fantastic antibiotics is only a matter of time and money. We as a species have the capabilities, we just need to make the move.
Investment is a problem because ABX aren't profitable relative to other opportunities (in biotech / pharma, think cancer or Hep C). ABX cure, rather than treat, which means you have a single revenue event rather than recurring (chronic) revenues. Even in that space, Hep C was way more profitable. And if you're successful with ABX in a public health sense, the number of new cases generally goes down. Compare to a cancer drug, or a urinary incontinence drug, where that doesn't happen. There have been precious few new ABX developed in recent years. One is daptomycin ("Cubicin" in American marketing-speak). It was a few tens of thousands per course of treatment when it came out, pitched (and approved) as a narrow treatment for a very few indications, because that's how you have to sneak a new antibiotic through the system these days--you won't command high enough prices otherwise. It is, in fact, a broad-spectrum drug and I'm sure it's used off-label.
I think what we need to do to fix this is recognize it is a public health problem that the market is not forward-looking enough to fix, and use government power to fix it. We could do this by subsidizing the cost of pushing a new molecule through the FDA. Or we could, you know, fix the FDA and make their review processes more utilitarian and less costly...but that's bigger fish. There are limited government programs trying to do this at the moment.
A lot of the reason we see new, ABX-resistant strains in SE Asia is unrestrained use of our better drugs, which are cheap in generic form (ciprofloxacin, for example). We should be regulating ABX use with the fervor we now reserve for so many low-harm recreational substances. Perhaps we could just pivot that whole industry rather than taking them apart...
It's the meat industry that's by far the worst offender in antibiotics, and they've got too much money to do anything about without an awful lot of screaming.
Investment is a problem because ABX aren't profitable relative to other opportunities (in biotech / pharma, think cancer or Hep C). ABX cure, rather than treat, which means you have a single revenue event rather than recurring (chronic) revenues. Even in that space, Hep C was way more profitable. And if you're successful with ABX in a public health sense, the number of new cases generally goes down. Compare to a cancer drug, or a urinary incontinence drug, where that doesn't happen. There have been precious few new ABX developed in recent years. One is daptomycin ("Cubicin" in American marketing-speak). It was a few tens of thousands per course of treatment when it came out, pitched (and approved) as a narrow treatment for a very few indications, because that's how you have to sneak a new antibiotic through the system these days--you won't command high enough prices otherwise. It is, in fact, a broad-spectrum drug and I'm sure it's used off-label.
I think what we need to do to fix this is recognize it is a public health problem that the market is not forward-looking enough to fix, and use government power to fix it. We could do this by subsidizing the cost of pushing a new molecule through the FDA. Or we could, you know, fix the FDA and make their review processes more utilitarian and less costly...but that's bigger fish. There are limited government programs trying to do this at the moment.
A lot of the reason we see new, ABX-resistant strains in SE Asia is unrestrained use of our better drugs, which are cheap in generic form (ciprofloxacin, for example). We should be regulating ABX use with the fervor we now reserve for so many low-harm recreational substances. Perhaps we could just pivot that whole industry rather than taking them apart...