In 2016, a landmark report was issued on the global problem of antimicrobial resistance. The paper, commissioned by the U.K. government and the Wellcome Trust, sought to quickly grab the attention of policymakers — by tapping a former high-profile Goldman Sachs economist named Jim O’Neill to lead the effort. He issued a particularly dire warning of what was to come if the issue was ignored.
“It is fair to assume that over 1 million people will have died from antimicrobial resistance since I started this review in the summer of 2014. This is truly shocking,” O’Neill wrote at the time, adding that the cost in terms of lost global production between now and 2050 would be an enormous $100 trillion if action was not taken.
A new STAT Report finds that five years later, the prognosis remains sobering. An estimated 700,000 people die annually from antimicrobial resistance, a number that could rise to 10 million by 2050, according to a World Health Organization report issued in 2019. In the U.S. alone, there are more than 2.8 million antibiotic-resistant infections and 35,000 deaths from those infections each year, according to data from the Centers for Disease Control and Prevention.
The real numbers may be still higher. Surveillance data systems exist in U.S. hospitals, but follow-up is piecemeal or sometimes lacking altogether after patients are discharged, making it difficult to fully understand the scope of the problem. The issue has taken on still more urgency during the Covid-19 pandemic, which prompted widespread use of antibiotics to help patients fend off secondary infections or before a viral infection was confirmed in some cases.
A number of issues have fueled resistance and stunted development of new antibiotics. And while there are various efforts underway to address those challenges, creating incentives to change the trajectory of antibiotic resistance takes commitment and imagination. There are several experiments under way that aim to spur development of new products while still ensuring profit.
In the U.K. and Sweden, pilot programs are testing a pull incentive, which involves a subscription-style business model in which a government offers upfront payments to drug makers in exchange for unlimited access to their antibiotics. The idea is to enable drug companies to recover their costs and make an appropriate profit without having to sell large volumes of antibiotics. Last week, U.S. lawmakers re-introduced legislation to create a similar mechanism.
“The marketplace is fragile and failing,” said Evan Loh, chief executive officer at Paratek Pharmaceuticals, which markets an antibiotic in the U.S. for treating community-acquired bacterial pneumonia and skin infections. “If investors don’t see a path to profitability, they will not invest in the sector. We don’t have an infinite amount of time relative to our capital base. Generally, there’s a two-to-three-year window to get to profitability.”