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Antibiotic resistance: would we need an Antibiotic Drugs Fund similar to NHS England’s Cancer Drugs Fund?

Edmund Stubbs, 21 January 2016

Antibiotic resistance poses an immediate threat. In the near future developed health systems around the world could well be devastated by such resistance, causing a regression in infection control towards standards similar to those of the late 1800s; before the benefits of penicillin and other antibiotics became taken for granted.

The process by which drugs lose their bactericidal properties is, essentially, the mechanism of natural selection. Patients take antibiotics, often not fully finishing their prescribed courses. Bacteria sensitive to the antibiotic are killed off rapidly, within the first few days of treatment (leaving the patient feeling much, if not completely, better), but some of the bacteria causing the infection are more, or extremely, resilient to the particular antibiotic. It is these that the whole prescribed course of the antibiotic, aided by the patient’s immune system, is intended to eradicate.

If more resistant bacteria in each patient’s body are not destroyed they infect someone else, and so, gradually, these bacteria become the most common strain in the population, causing increased resistance to antibiotics, eventually on a global scale. Largely unaware of this process, patients rarely heed the advice of their doctors to finish courses of perhaps too readily prescribed antibiotics (in some countries available without prescription), advancing the speed of antibiotic resistance worldwide.

As a result, antibiotic resistance will add to the ever-increasing financial demands on our health services, so far caused by diseases of excess such as sugar consumption, fatty diets, sedentary lifestyle and excessive alcohol and tobacco consumption.

Pharmaceutical companies are demanding that governments fund their research into new antibiotics. They reason that new antibiotics, in all likelihood, will be used as a last resort, and so are unlikely to be profitable. As is regrettably the case with diseases affecting lower income populations, treatments for common diseases affecting these populations cannot generate a profit, due to the poverty of those who suffer from them, and so are developed extremely slowly, if at all. What little research is aimed at such diseases is funded by governments through NGO grants and by charities. Drug development is costly, with an average of £1.83 billion needed to produce and test a drug to meet medical approval and is far beyond the capacities of such NGOs and charities. Similar costs would apply to antibiotic development

Economist Jim O’Neill advocates major grants of between $16-37 billion should be given to pharmaceutical companies who successfully develop an effective new antibiotic as an incentive to carry out such research. With such enormous sums involved, governments around the world may need to establish  a joint body that could assess new antibiotics and then award such grants. Such a multinational body could also act as a legitimate authority to regulate the prescription of antibiotics around the world, sanctioning those countries which give out such precious drugs too readily.

Without such an initiative, pharmaceutical giants might still develop new antibiotics as demand inevitably rises, but these new antibiotics could easily be as expensive as many cancer drugs are now to ensure developers realise a return on their investment.

NHS England’s existing Cancer Drugs Fund attempts to enable expensive cancer therapies to be available to some NHS patients. Would a similar initiative have to be inaugurated to keep antibiotics available in the UK if no rapid action is taken internationally?

Edmund Stubbs is Healthcare Researcher at Civitas, @edmundstubbs1

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