No new class of antibiotics has been introduced to the market for more than 30 years, a “shocking” lack of innovation in a field that drugmakers have neglected because it is not very profitable.
However, bacterial infections are becoming increasingly resistant to antimicrobials, due to overprescription or misuse, making the healing process more complicated, as is the case for Gram-positive bacteria, particularly responsible for urinary tract infections, pneumonia and Staphylococcus aureus, according to a report published by Agence France-Presse.
One person dies every 25 seconds from infection with resistant bacteria, according to a study published in The Lancet in 2022. For several years, a large portion of major pharmaceutical companies have stopped research focused on antibiotics, which are considered long, complex and have a high risk of failure, in favor of developing treatments for tumors or rare diseases that generate higher profits.
“The need is there, but there is not enough investment,” says Pierre Dubois, professor of economics at the Toulouse University of Economics.
Of the small group of biotech companies that continue to work to find new antibiotics, “very few have managed to raise enough money to invest in research and innovation,” says Frédéric Perrin, secretary general of the BEAM Alliance, which aims to encourage the development of new treatments for drug-resistant diseases.
dilemma
When a lab succeeds in inventing a new antibiotic, sales are not “huge” because health professionals want to “save the innovative antibiotics for the toughest cases,” or as Dubois explains, when common antibiotics become ineffective.
This limited use is intended to slow the development of bacterial resistance, but the harmful effect is to reduce the return on investment, creating a “dilemma” for manufacturers who “have to invent new antibiotics that are not being used,” said Catherine Renaud, director of public affairs at Pfizer, during a discussion on antibiotic therapy in June.
The field of antibiotics is different because newer treatments do not replace older ones, which still meet most therapeutic needs.
Maintaining these new products is “complicated because prices are constantly falling,” according to Renaud, whose group has set a goal of launching 2-4 new antibiotics by 2030.
In addition, antibiotics are consumed for a specific period of time, unlike treatments for chronic diseases.
Difficulty of Profit
“This sector is not very attractive,” Beran acknowledges, noting that 80% of the antibiotics portfolio currently being developed is in the hands of small and medium-sized companies.
It is difficult to make new antibiotics profitable, at a time when drug companies’ profits are calculated on sales volume, which is prompting a number of experts to call for another payment model for this family of drugs and economic incentives to encourage research.
England has set up a subscription mechanism with antibiotic manufacturers to make the drugs available on demand, somewhat similar to the video-on-demand (VOD) model.
The advantage for the company is that it has a guaranteed income, while for the health system, its positive aspect is the ability to control the use of antibiotics to avoid promoting the phenomenon of resistance.
In Europe, discussions are underway on the possibility of transferring exclusivity that would allow pharmaceutical companies working on developing new antibiotics to extend exclusivity for one year on other medicines in their portfolio that are already on the market.
“Whoever gets an exclusivity can either apply it to a product in their portfolio or sell it to a third party,” Biran told AFP.
Pierre Dubois believes that the alternative is “the European Union agreeing to fund this research,” considering that in both cases it would be “very costly” in the end.