The antimicrobial resistance problem

Antimicrobial resistance poses a challenge to normal incentives for invention. It’s driven by the overprescription of antibiotics, and so any new antibiotics we discover we might prefer to keep in reserve, to be used only in cases where existing treatments fail or when there is a pandemic from a mutant bacteria. But with clinical trials costing hundreds of millions, how do you incentivize a pharma company to invest in a drug that isn’t going to be used?

This would seem to be a good use-case for innovation prizes, which are well-suited to a situation where you want to encourage invention and discovery, but scaling up isn’t necessarily critical. Abi Olvera writes about a recent failed attempt in the USA to create such a mechanism, the PASTEUR Act, which would have enabled the government to pay pharma companies for access to new antibiotics, whether or not they are used. A similar program already exists in the UK, where the NHS can pay for access to new drugs, regardless of whether they end up being used (they call it Netflix for antimicrobials). And the EU is considering a related idea, wherein companies that develop new antimicrobials are rewarded with a data exclusivity extension that can be transferred (or sold) to another qualifying drug, staving off generic competition and raising profit. Olvera writes that the US’ PASTEUR Act was last defeated by skepticism about paying industry for drugs whose efficacy was uncertain.

I can see the argument for not overpaying for a drug whose efficacy in a pandemic is uncertain. But at the same time, neither would it be ideal to find ourselves in an antibiotic resistance pandemic without many options. I wonder if we could find a way to incentivize companies to build a pipeline of drugs that haven’t gone through the expense of a big clinical trial, and so can’t be used at this time, but where initial evidence is compelling. If we later find ourselves in another pandemic, as Saloni has written, it may well be easier to run a high-powered clinical trial fast.