Antibiotics have saved countless lives in the last 80 years, but they’re not as effective as they once were. We use too many of them, and so bacteria are developing resistance more quickly than we can come up with new drugs. The result is a growing spate of untreatable infections. In the U.S. alone, 23,000 people die from “superbugs” each year, according to the Centers for Disease Control and Prevention.
The graphic here shows antibiotic development and resistance over time. The drugs are on the top, starting with penicillin in the 1940s. The bacteria are on the side, with the size of bubbles indicating growing resistance. The timeline was put together by the Information is Beautiful design group and is based on data from the CDC, the World Health Organization, and the Center for Disease Dynamics.
You’ll see that there’s a big hole in the bottom right-hand corner–“the development gap”–which indicates how little antibiotic development we’ve seen in the last 20 years. The problem isn’t just that we use too many drugs. It’s that there’s little pharmaceutical industry interest in the area.
“Antibiotics are less lucrative than other kinds of drugs,” says Allan Coukell, an antibiotics expert at the Pew Charitable Trusts. “They’ve historically been cheap and a new antibiotic is often competing against something that’s been around a long time and is off-patent.”
That reduces financial incentives for companies, especially as new drugs are normally held in reserve for when the current treatments don’t work, rather than used right away. In the last decade, a string of major companies have left the antibiotic space. Just recently, AstraZeneca announced it was spinning off its research unit because of the low margins on offer.
Coukell says more needs to be done to carry promising treatments from academic to commercial research. Pew advocates “impact” type public-private investments, where financial returns may be relatively low. Others have called for public prizes worth billions of dollars to spur interest.
Pew is pushing Congress and the F.D.A. to make development more attractive. In 2012, it lobbied Congress to pass the GAIN Act, which lengthened the patent periods for new drugs. Coukell is now trying to persuade legislators to take up the PATH Act, which would speed approval for “limited patient populations” who are resistant to current treatments.
“There’s a need for a sustained investment that the industry isn’t prepared to do and that isn’t the traditional kind of science that academics do either,” he says.
At the same time, Pew wants more careful use of antibiotics, so drugs become resistant less quickly. Coukell says every hospital and health system should have an “antibiotic stewardship program” that requires doctors to only prescribe drugs when they match the exact pathogen involved. That would stop the classic situation where they hand out pills for viruses like the flu.
Agriculture, which accounts for 70% of all antibiotics consumed by volume, could also be more responsible in its use of the drugs. Coukell is encouraged that food producers like Purdue have committed to using less antibiotics and that drug producers have agreed to stop labeling drugs for growth promotion.
There’s been a bit of positive antibiotics news of late. A team at Northeastern University in Boston recently announced a new antibiotic for tuberculosis, septicaemia and C. diff infections–the first new drug in 30 years. It could be on the market in as little as five years, but a lot more needs to be done. Without a more efficient drug pipeline and more careful prescribing, the drug resistance problem could escalate to biblical proportions.