Antibiotic resistance rising, will market cope?

2014-07-08 08:40

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Why do doctors over prescribe antibiotics?

2014-07-03 08:30

There is a global growing resistance to antibiotics. One of the main reasons for this resistance, is the over prescription of antibiotics by doctors, here's why a doctor might over prescribe. Watch.WATCH

London - The drugs don't work, and neither does the market, when it comes to antibiotics.

When sophisticated bugs that medicines used to kill within days start to fight back and win, all of healthcare, and the people it keeps alive, is in trouble.

Take gonorrhea, a sexually transmitted disease contracted by more than 100 million people a year: it used to be easily treatable but has now developed superbug strains that are drug-resistant and are spreading around the planet.

Tuberculosis is a similar tale. Totally resistant forms of the lung infection emerged in India just a few years ago and have now been detected worldwide. Hospital patients in Africa with untreatable TB are often simply sent home to die.

It's a glimpse of what Britain's chief medical officer Sally Davies calls the "apocalyptic scenario" of a post-antibiotic era, which the World Health Organisation says will be upon us this century unless something drastic is done.

Waking up to the threat, governments and health officials are getting serious about trying to neutralize it. It may seem like a question of science, microbes and drugs, but in truth it is a global issue of economics and national security.

Tale of two drugs

Fixing the problem is daunting but past successes in rolling out drugs for HIV, vaccinating millions of children in the developing world and recalibrating rewards for medicines to treat rare genetic diseases suggest it is doable.

The debate moved to centre stage last week when British Prime Minister David Cameron launched a global review of the crisis, securing specific support from US President Barack Obama and German Chancellor Angela Merkel.

That builds on a resolution passed at the World Health Assembly in Geneva in May recognising the pressing need for the world to act in the fight to combat increasing resistance.

"We cannot contemplate failure", Davies said in an interview in her office in London's Whitehall. "We have to find something that works for the world."

What this demands, according to academic and industry experts, is a new business model that rewards drug firms for developing new antibiotics even if they are rarely used.

It is no accident that Cameron chose a big-hitting economic brain, former Goldman Sachs chief economist Jim O'Neill to head the review.

"This is not a science issue. This is an issue of markets and economics", said Davies. "A scientist would just get bogged down and not get it."

In recent decades, drug makers have slashed investment in antibiotics because of poor returns from a class of low-priced medicines that are only used for short periods, even as overuse of existing drugs has spurred the spread of resistance.

As a result, the world's biggest investor in the field today is a little-known US firm, Cubist Pharmaceuticals, with an annual research budget for antibiotics of $400m.

The industry complains its bug-killing medicines are severely undervalued - and they have a point.

Just over a year ago, Johnson & Johnson won approval for the first drug in 40 years that provides a new way to treat TB, yet sales of Sirturo are forecast by analysts to total just $75m this year.

Compare that to Gilead Sciences' new hepatitis C drug Sovaldi, carrying an eye-watering US price tag of $1 000 per pill, which is tipped to sell more than $8 billion in 2014.

The key challenge is how to reward companies for finding drugs like Sirturo that must be used as sparingly as possible to avoid resistance developing, in effect, breaking the traditional link between payment and prescription volume.

Since it typically takes 15 years to develop a new drug, smart companies are starting to think ahead now, even though any market revamp is at least two years off - perhaps requiring a special United Nations session sometime in 2016.

GlaxoSmithKline, for example, one of the few large drug companies still working in the field, already has teams working through the implications of such a shift.

A belief that the tide may turn has also encouraged Roche back into antibiotics. The Swiss firm last launched an antibiotic in 1982.

And self-interest comes into play as well: A post-antibiotic world would undermine sales of important drugs to fight cancer or prevent rejection after organ transplants, since these medicines cannot be given without the safety net of effective antibiotics for treating potentially deadly infections.

Patrick Vallance, a former academic who now heads up GSK's pharmaceuticals research, believes a system of advanced market commitments could be the answer, under which governments would agree to buy up new antibiotics for, say, a 10-year period.

A similar scheme for vaccines, known as Gavi, funded largely by donor governments and philanthropists, already works well and has helped buy shots to immunize hundreds of millions of children in poor countries against killer diseases.

But while Gavi guarantees firms big orders in exchange for low vaccine prices, an antibiotic purchase arrangement would need to turn that concept on its head by minimising the volume used, a challenge for manufacturers and governments alike.



Read more on:    us  |  environment  |  health  |  narcotics

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