With medical experts warning of a "post-antibiotic apocalypse", UNCTAD legal officer Christoph Spennemann explains why joint public-private investment is the missing weapon in the war against the spread of antibiotic resistance.
Q: How big is the risk of antibiotic resistance?
A: Right now, around 700,000 people die each year due to drug-resistant infections. While this is tragic enough, some medical experts warn that the death toll could rise to 10 million a year by 2050.
In the future, as antibiotics lose their effectiveness, even common surgeries -- like caesarean sections -- would become life-threatening procedures.
Q: Why are antibiotics becoming less effective?
A: Bacteria adapt quickly to new conditions, and the drugs currently in use are outdated. Since the 1960s, only two new classes of antibiotics have entered the market.
And despite the current urgency of the situation, only 40 or so new antibiotics are in clinical development, compared to over 700 drugs for cancer.
Q: Why aren't companies developing more new antibiotics?
A: To put it bluntly, it's not financially attractive, in addition to being scientifically challenging.
The pre-clinical and clinical trials are very costly, and the investment would only pay off if the company could either sell the new drug at high volumes or at a high price.
But public health officials want to limit the use of antibiotics to ward off the spread of antibiotic resistance, and they try to keep prices low to make sure the new drugs are affordable.
Q: So what's the solution?
A: The public sector is going to have to find a way to make it financially viable for companies to develop new antibiotics, independent of sales volumes and market price.
This will likely require paying some sort of a "reward" to the pharmaceutical industry for successfully bringing the new antibiotics to the market.
Q: Why is UNCTAD taking up this issue?
A: Because it's high-time someone looked at the issue from the investment perspective, which is one of our fields of expertise.
Also, as the new antibiotics are developed, questions about access and intellectual property ownership will come up, especially if a government has provided funding. And we've been doing extensive work on these issues over the past decade.
Ultimately, we want to make sure the specific needs of developing countries don't get lost in the discussions.
Q: What has UNCTAD done so far?
A: As a first step, we held a meeting earlier this month with public health officials, pharmaceutical industry professionals, researchers and civil society representatives to see what could actually be done from an investment perspective to improve the situation.
There are a number of ideas circulating in academia and public policy debate on how to get more public investment in antibiotics, but most of these ideas haven't really been put to the test.
Q: What were the main takeaways from the meeting?
A: First, although there are already public-private-partnerships to develop new antibiotics, these are mostly ad-hoc and focus on making drugs for very specific diseases and treatments.
One example discussed at the meeting was the Global Antibiotic Research and Development Partnership set up in 2016 by the World Health Organization and the Drugs for Neglected Diseases Initiative. This product-development partnership has already received funding from various governments -- Germany and some others recently gave around 60 million euros.
While this is a step in the right direction, these partnerships are addressing very specific diseases, not the broader issue of global resistance. For this you need government commitment to provide the industry -- or the product-development partnership in charge of making the antibiotics -- with a constant stream of funding. And for now that doesn't exist.
We also learned that although there are public investment incentives for basic research and development and the phase of clinical trials, such incentives are missing for the phase after a new drug hits the market, when the pharmaceutical company has to continue investing in things like follow-up quality control tests to ensure patients aren't developing unforeseen side effects.
The lack of public funding for the phase after a new drug is approved -- the "stewardship" phase -- may explain why fewer and fewer companies continue to invest in the old class of antibiotics, those already on the market.
In fact, the World Health Organization recently reported on how an explosion earlier this year at a factory in China led to a shortage of lifesaving antibiotics. This was because the factory was one of only a few producing the raw materials for a common antibiotic given to hospitalized patients to treat severe infection.
At the meeting, companies that make generic drugs confirmed that it's no longer financially attractive to keep producing old antibiotics. Unfortunately, this issue is not gaining the same traction in the media and public debate as the need to produce new antibiotics.
This means we seriously need to rethink the business model for the generic producers as well.