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Antibiotic-resistant infections are killing 23,000 Americans each year because bacteria are evolving to outsmart our drugs. And new drugs to replace them aren't coming out like they used to either. Somehow, we need to get more new antibiotics.
And this is one area where better policy might help. A new analysis published in Science argues that current federal incentives for companies aren't targeting the right parts of the drug development process to create more antibiotics.
Fewer new antibiotics are getting approved
The chart below is the one that freaks everyone out — and with good reason. At the same time that current antibiotics are ceasing to work, new drugs just aren't coming out of the pipeline like they used to:
How to get more antibiotics on the market
The conventional wisdom has been that big drug companies have stopped making new antibiotics because the financial incentives haven't been high enough. So, in 2012, the US passed legislation that gives companies an extra five years' monopoly on any new antibiotics they produce. That would essentially guarantee them a higher profit — since other companies will have to wait longer to produce cheaper generic versions.
But the authors' analysis suggests that the slowdown in new antibiotics isn't just a matter of big companies lacking profit motive. It's that the smaller companies involved in most drug development these days simply aren't doing enough R&D in the first place.
The analysis shows that small and medium sized companies are doing the majority of all drug clinical trials these days. And, they say, the government could better incentivize these smaller companies with benefits that come earlier in the process, way before the market. That's because they need financial help from the very start to find more possible drugs in the laboratory.
Percentage of small and medium companies' drugs in Phase 3 clinical trials
Hwang, TJ et al. Science, May 30, 2014.
The authors have three suggestions for what the government needs to do to prevent impending doom:
1) Increase tax credits for drug companies to do research and development. There's a precedent here. The 1983 Orphan Drug Act created a 50 percent R&D tax credit for drugs for certain rare diseases, which are riskier for companies to invest in because the markets are so small.
2) More public-private partnerships. Some of these are already underway. For example, the Department of Health and Human Services has a $200 million contract with GlaxoSmithKline to work on a bunch of possible antibiotics.
3) Have the military fund research. The authors note that only about 5 percent of the National Institutes of Health budget is for infectious diseases and suggest "given the possible national security threat from multidrug-resistant infections, the U.S. Department of Defense would represent a logical additional source for increased support."
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