Why you should care
The biotech industry is battling not just antimicrobial resistance but also fears over the spread of superbugs.
Science journalists generally hear two contrasting opinions on the growing threat from antimicrobial resistance (AMR). On the one hand are dire warnings of a coming antibiotic disaster as germs become resistant to existing drugs while market failure blocks the development of new ones. On the other hand is a stream of cheery press releases from universities and biotech companies around the world describing advances in research. Science writers probably get more emails with positive news about AMR than any other medical issue apart from cancer.
These contrasting impressions are not contradictory. The spread of superbugs resistant to most or all existing drugs seems relentless — but at the same time there has been intense activity in the early stages of research, supported by governments, charities and a few brave financial institutions. The leading funder is Carb-X, a global nonprofit based at Boston University that is investing more than $500 million, provided by public and philanthropic sources between 2016 and 2021, to take projects into the first stage of clinical testing. The Carb-X portfolio already includes 29 projects in five countries, with the aim of “accelerating the development of lifesaving products in the fight against superbugs,” as executive director Kevin Outterson puts it.
The trouble is that the pharmaceuticals industry has little financial incentive to pick up promising projects in early clinical trials and take them through the later stages required for regulatory approval, which may cost too much for a smaller biotech company. This market failure has several causes, including the very low price of existing generic antibiotics, the fact that the drugs are taken for only a short time — and the possible need to keep effective new antibiotics in reserve to treat the most serious infections and prevent resistance emerging through overuse.
We are not going to have an antibiotic apocalypse.
Glyn Edwards, CEO, Summit Therapeutics
Several authorities have analyzed the problem, notably economist Jim O’Neill, whose review of AMR for the U.K. government suggested solutions such as a “pay or play” levy on sales of other drugs to fund a reward pot worth up to $1.2 billion for effective new antibiotics created. This levy might need to be supplemented with public money, O’Neill suggested. This year the U.K. government announced that the National Health Service would test a “subscription-style model” that pays pharma companies upfront for access to antibiotics, based on their usefulness to the NHS.
That would guarantee an income from a successfully developed drug even if it was held in reserve. Although details of this pilot scheme, its timing and funding remain unclear, people involved in antibiotic development welcomed the announcement as a first step that could be a model for the rest of the world. “We in the U.K. should be proud of having made the first move but fixing the market failure requires global action,” says Mike Ferguson, a professor of medicine at the University of Dundee, who was instrumental in setting up its Wellcome Centre for Anti-Infectives Research.
Investors in antibiotic-focused biotechs have lost money recently — one of them, Achaogen, filed for bankruptcy earlier this year — but the few financial institutions still prepared to back AMR companies are determinedly optimistic. One is Novo Holdings of Denmark, which launched its Repair Impact Fund last year with the aim of investing $165 million in 20 AMR startups, early-stage companies and corporate spinoffs in Europe and North America. It has already put $30 million into six companies. Aleks Engel, the fund’s director, gives several reasons for the bright outlook. “The proposals reaching us now are much more innovative than the products that have disappointed recently,” he says. “We are very focused on making money with this fund, because if we don’t, it will exacerbate the perception that you can’t make money from AMR.” Novo has given the fund more time to achieve its benchmark return than other investments “because the market is so hard,” Engel says.
Glyn Edwards, CEO of Summit Therapeutics, a U.K. antibiotics company, takes a similar view. “The last four or five antibiotic launches from biotech companies have had poor sales, but I believe they were very poor product packages,” he says. For Edwards, the future lies in antibiotics that kill a specific pathogen without harming other bacteria, such as Summit’s lead product, ridinilazole, which is in phase three trials for treating C. difficile infection. “I doubt that anyone will find a new broad-spectrum antibiotic,” Edwards says. “Narrow spectrum, combined with new diagnostic technology, is the place to be because it leaves the patient’s microbiome intact.” The doom and gloom has been overdone amid all the innovation underway, Edwards concludes: “We are not going to have an antibiotic apocalypse.”
OZY partners with the U.K.'s Financial Times to bring you premium analysis and features. © The Financial Times Limited 2019.