Recognising the value of anti-infectious drugs

The COVID-19 pandemic has been a major wakeup call for the world that our battle with infectious diseases is far from over.  The average lifespan in both the U.S. and Europe in 1850 was 36 years!  Our advance since then has principally been from better hygiene, antibiotics, and vaccines.  We now die mostly from cardiovascular disease and cancer.  Improved treatments in these areas have made very meaningful but comparably vastly smaller contributions to average life expectancy and the wealth of the world.

Because washing your hands, antibiotics and vaccines are cheap, we forgot about the enormous value that they bring.  We now have a single pathogen for which we were unprepared, and the cost is in the trillions of dollars.  We were also not prepared for Ebola, Candida auris, SARS, MERS, Zika and several other new pathogens that have appeared over the last decade, but we were lucky that they had relatively minor impact.  But what about all the pathogens that we thought we already had overcome decades ago?  Unfortunately, they are all making major comebacks due to antimicrobial resistance or AMR.  The effectiveness of such miracle drugs as cephalosporins is quickly being eroded.  At least 700.000 people die every year from drug-resistant infections.  Compare that to the about 120.000 deaths from the COVID-19 virus so far.  AMR is also on a dangerous growth curve although a much slower one.  Certain experts, such as Jim O’Neill’s global antimicrobial review, estimate that the number of deaths from AMR may rise to 10 million per year in 2050, once again eclipsing cancer.

Making matters worse, the business model for development of novel (resistance-free) anti-infectives is broken.  We expect to pay only a few dollars for these life-saving treatments and if we get a new one, we appropriately want to hold it in reserve.  Companies that have developed new antibiotics are going out of business one after the other: Achaogen, Melinta, Aradigm, Tetraphase in the last 2 years alone.

It is long past time that we recognize the value of anti-infectives.  We are happy to pay for fire stations because the cost of a city burning down is catastrophic. We build them and train the fire department years before the fire breaks out.  We call this “preparedness.” The corona virus is showing us that being unprepared for a pandemic is catastrophically expensive to the tune of trillions of dollars.  Being prepared for both the next virus and AMR requires more rapid diagnostics, available vaccine production capacity, public health investments, and a healthy pipeline of new drugs.  The price tag to do a great job for all of the above is a less than ten billion dollars per year.  It is a lot, but comparably cheap and necessary.

Let’s reward success, namely the FDA approval of entirely novel antibiotics that meet serious medical needs.  Only pay for success and never for volume of use.  A subscription is one way to do this, with governments offering contracts for novel, high-quality antibiotics after FDA approval. Just like Netflix, the price is the same whether you use it reasonably in normal times or binge in a pandemic. Antibiotic subscription programs are being piloted in Sweden and England.  The U.S. is considering a more comprehensive subscription, the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act of 2020, sponsored by Senator Bennet (Colorado), which may be included in the 4th COVID-19 Supplemental bill very likely to pass Congress later in April. The size of the proposed subscription payments is appropriate for both public value and incentivizing R&D. I wholeheartedly support this effort and urge everyone else to do the same thing.  Consider it an excellent and necessary investment in your future life and welfare.

Finally, the Corona virus has shown us that we live in a completely interconnected world.  Pathogens travel around the world in days.  Our future solutions must be global as well and we all need to pay for them.  If subscription programs are put in place in the U.S., England, and Sweden, other wealthy countries will soon be asked to step up as well and pay their fair share for international preparedness against AMR.

By Aleks Engel

Partner, Novo Holdings (Novo Seeds) and Director, REPAIR Impact Fund

By Optimum

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