How to Prevent the Next Pandemic: Antimicrobial Resistance

Shawn O'Neail  | July 9, 2020

As COVID-19 swept from China to the rest of the world, early reports showed half the people dying from the virus had developed secondary bacterial infections – many of them caused by “superbugs” that are resistant to antibiotics. So it’s timely that U.S. lawmakers – from both parties – are moving to address the problem of antimicrobial resistance.

  • Rep. Diana DeGette (D-Colorado) and Rep. Fred Upton (R-Michigan) are calling for commercial fixes for new antibiotics in a version 2.0 of the 21st Century Cures Act. We strongly support their efforts.

  • Sen. Bob Casey (D-Pennsylvania) and Sen. Bill Cassidy (R-Louisiana) are advancing legislation known as the DISARM Act, which would create higher reimbursement for new antibiotics.

“Superbugs” kill an estimated 35,000 Americans each year and more than 700,000 people worldwide. And one prominent report estimates 10 million deaths each year by 2050.

Yet the problem is vastly bigger than that. Antibiotics underpin much of modern medicine, enabling doctors to safely perform organ transplants, chemotherapy, major surgeries and care for babies born prematurely. If “superbugs” proliferate, it puts the care of tens of millions in jeopardy.

Need for Innovation

Such a looming public threat requires new treatments by pharmaceutical companies – the kind of innovation the industry has generated in response to COVID. Just six months after the pandemic began, pharmaceutical companies are already testing more than 400 unique therapies in more than 1,200 clinical trials. Yet there are only 41 new antibiotic therapies currently in clinical trials.

Why such a contrast? Because the current ways we pay for medicines makes new antibiotics a certain money-losing venture for pharmaceutical companies. It costs more than $1 billion in scientific research and careful human testing to bring a new medicine to patients. Usually, pharmaceutical companies can make up for those expenses over several years by selling a new medicine to thousands or even millions of people who need it.

But a new antibiotic would be like a fire extinguisher – something you put on the wall but hope to never use. It’s hard to offset $1 billion in development costs with only a volume of sales that, everyone hopes, remains close to zero.

Lilly helped pioneer the modern age of antibiotics, beginning by manufacturing penicillin-G during World War II and continuing for many decades. In the 1950s, we discovered vancomycin, which is still used to help people who develop who get the antibiotic-resistant infection known as MRSA. And in the 1960s, Lilly developed the first cephalosporins, many of which are still used today. But now our industry needs new incentives to develop new breakthroughs against “superbugs.”

Need for Incentives

Governments and policymakers have long recognized the problem of antimicrobial resistance and provided assistance to try to help. They have created special funding for antibiotic research and development. They have given accelerated regulatory reviews to new antibiotics. But as the high number of COVID deaths from secondary infections makes clear, it hasn’t been enough.

That’s why the pharmaceutical industry is working toward a solution. As announced on July 9, more than 20 pharmaceutical companies have collectively invested nearly $1 billion to create the AMR Action Fund, which put money into the most promising companies developing new antibiotics. Lilly has contributed $100 million to the fund, which aims to bring two to four new antibiotics to patients in the next decade.

But the industry can’t do it alone. We also need help from governments here in the U.S. and around the world to reward new antibiotics with different kinds of payment. Two kinds of policies are key:

  • Market-entry payments: These would to reward a company for bringing a new antibiotic to market.

  • Subscription-style payments: The government would pay the company making a new antibiotic an annual subscription payment, which would give that government access to a drug.

The PASTEUR Act, which has yet to be formally introduced in Congress, would move in the right direction by paying a company for bringing a novel antibiotic to market and giving a guaranteed level of reimbursement to qualified new antibiotics.

As COVID has shown us, infectious disease remains a deadly threat – one that requires more innovation and collaboration. Just as pharmaceutical companies and governments have come together to find scientific breakthroughs to beat this pandemic, we need that same public-private partnership to beat the next one.