Fatal Decisions

An announcement by the pharmaceutical giant Novartis was largely lost in the headlines and yet has implications for claiming far more lives than any other story this week.  The Swiss company revealed its intentions to cease the development of antibiotics, shuttering ongoing research efforts and cutting employees focused upon this critical work.  Novartis is not alone as similar decisions recently made by most companies, which had previously delivered new antibiotic wonder drugs, including Pfizer, Eli Lilly, Bristol-Myers Squibb, Bayer and Johnson & Johnson, to name but a few.

These decisions are occurring in the context of a rapidly-expanding crisis of antibiotic resistance. Our work at Washington University in St Louis has demonstrated, of the more than 150 different antibiotics introduced since the Second World War, more than a third have already been discontinued, primarily due antibiotic resistance. Looking back to the 1990s, three antibiotics have been withdrawn from the market for each new introduction. Such trends are not good news for public health and has caused many experts to declare we now live in a post-antibiotic world.

Compounding the problem is rising ambivalence about infectious diseases. Although occasional outbreaks of exotic diseases, such as Ebola or Zika viruses, briefly capture the public’s interest, our society has largely forgotten the horrors of whooping cough and diphtheria. This selective amnesia is evidenced by declining rates of immunization to prevent childhood diseases and an upswing in the incidence of diseases. As I detail in Between Hope and Fear, the increasing ferocity of the anti-vaccine movement has caused a re-emergence of preventable diseases, such as measles, which is running rampant in Europe and beginning to gain momentum in the United States. 

The rise in infectious killers is an unfortunate combination of nature and business. An overuse of antibiotics in the past allowed bacteria in nature to gain resistance to these wonder drugs and to communicate this resistance around the planet. At the same time, declining profits led most established antibiotic pioneers to leave the space in search of more lucrative markets. Indeed, our work at Washington University reveals the number of companies researching antibiotics has declined by more than 75% since the late 1980s. 

Some have argued a perceptive financial market will recognize new opportunities and address the crisis. There are two problems with this view. First, a new drug requires at least a decade of development whereas a drug-resistant superbug can hop from one continent to another with the speed of a modern jetliner. The second problem is that as bad as the public health situation has become, the market is clearly not yet positioned to recognize the impending disaster, as evidenced by Novartis’ announcement last week. 

As I have elaborated previously in A Prescription for Change, what is needed is a comprehensive approach to incentivize the development of new antibiotics and to responsibly steward the distribution of future wonder drugs. Regarding the former, the governments of the world must go beyond recognizing the problem and implement their full power, both as the source of research funds, but more importantly as the key regulators of the pharmaceutical industry, to create new mechanisms to reward innovation.  

Such as outcome seems remote in a week when the American government pressured Pfizer to climb down from its plans to raise prices but did not utter a peep in response to Novartis’ decision. These contrasting aftermaths reflect the fact drug pricing issues caused the pharmaceutical industry to utterly destroy goodwill developed over the twentieth century resulting from the delivery of life-saving medicines for infection, heart diseases and cancer. This self-inflicted damage renders the industry unlikely to encounter a public sympathetic to financial incentives to re-start antibiotics development. Other approaches, likely entailing creative regulation of antibiotics, will be needed. 

Responsible leadership is urgently needed to engage the extraordinary resources and expertise available to the private and public sectors to prevent the looming return of infectious killers. The science and the medicine are not the challenge. Rather, the will to prioritize infectious disease remains a persistent hurdle. Our continued failure to see the bullet racing towards us threatens a return to incessant waves of otherwise preventable and treatable plagues with the potential to hobble societies and economies throughout the world.