Sofiya Bidochko: Antibiotic Resistance
During the 1918 influenza pandemic which lasted until 1920, 50 million people died from the H1N1 virus. It was not until the monumental discovery of antibiotics in the 1920s when humans could have a new level of control over that time period’s leading cause of death—infectious disease. It is estimated that Penicillin and its similar derivatives saved 100 million lives by the end of the 20th century. Antibiotics are not just used for killing infectious bacteria but have enabled the existence of new medical treatments such as organ transplantation, cancer chemotherapy, and major thoracic surgeries. Even during the present pandemic, antibiotics have been prescribed as treatment for COVID-19. As such, effective antibiotics have been critical in supporting human health.
There are different classes of antibiotics that target different parts of the bacteria. For example, beta-lactam antibiotics, like penicillin, attack bacterial cell wall synthesis. Sulfa drugs target bacterial metabolic pathways, a completely different part of the cell. It is critical to have different classes of antibiotics to ensure there are multiple mechanisms to overcome antibiotic resistance. For example, if beta-lactam antibiotics face antibiotic resistance whereby they become ineffective at stopping cell wall synthesis, an antibiotic that targets bacterial metabolism could be used instead.
However, with problems of overuse, growing antibiotic resistance has become a major threat to the world. A 2019 report by the CDC states that antibiotic-resistant bacteria cause more than 2.8 million infections per year in the US and at least 35,000 deaths. The World Health Organization states that antibiotic resistance is one of the biggest threats to global health. This threat is real, and it's exacerbated by the fact that no new antibiotic classes have been discovered since 1984. The problem is not purely that it is difficult to invent biomolecular mechanisms for new antibiotics, but rather that few companies want to pursue it. In 2004, a study of fifteen major pharmaceutical companies including Merck, Pfizer, and Johnson & Johnson reported that only 5 out of 506 drugs being researched and developed were antibiotics.
This sparse statistic can be explained by various factors. The process of researching and developing a new drug is incredibly expensive even before the costs incurred when obtaining federal regulatory approval. As a result, major pharmaceutical companies choose to invest their money into drugs that have high profit margins. Due to their treatment period, antibiotics lack the profitability of long-term treatment options as antibiotics are short-term therapies that can cure the target infection. Hence, this short-length of treatment prevents high profitability. Additionally, the purchase of antibiotics has to be highly limited and regulated to prevent antibiotic resistance, already decreasing the quantity sold. Antibiotic manufacturers also face large pressure from the government and public to keep their costs low to increase consumer access, as everyone at some point needs antibiotics.
Therefore, it is incredibly important to create incentives for pharmaceutical companies to develop new antibiotics. One potential incentive option involves reexamining the length of patent inclusivity for antibiotics. Drugs are highly profitable during their patent period of 20 years when they hold a monopoly in the market. Once the period of patent exclusivity ends, other similar antibiotics enter the market, driving sales prices down. Hence, a way to incentivize antibiotic development is by extending market exclusivity for a longer amount of time. However, antibiotics are generally still sold at a relatively cheap price, poorly counteracting the enormous sums to develop them. Another proposed solution is the “wild card” patent exclusion. This is where a pharmaceutical company that develops a new antibiotic can extend market exclusivity for one of their other more profitable drugs. For example, if Pfizer develops a new antibiotic, the antibiotic would have patent exclusivity in the market for the standard 20 years, but one of their more profitable drugs like Eliquis could have its patent period extended to 25 years. Having five additional years where Pfizer can hold a monopoly on a high-profit generating drug can incentivize Pfizer to take on the development of antibiotics which are sold far more cheaply.
Another solution mirrors the government’s investment strategy in COVID-19 vaccines. To support the rapid development of COVID-19 vaccines, the government budgeted 9 billion dollars for vaccine development. The government should be willing to similarly invest money into antibiotic research and development since antibiotic resistance is a pressing issue facing the country and the world. This would take a significant cost burden off pharmaceutical companies, hopefully removing a barrier to antibiotic development.
While the problem of antibiotic resistance is serious, it can be mitigated and prevented by actions taken in the present. The pandemic has shown the world how important it is for governments to have predeveloped toolkits of materials and technology when responding to global health crises. Hopefully, governments truly learn from COVID-19 and incentivize pharmaceutical companies to develop novel antibiotic solutions. It is a matter of the public to call for action and for the government to listen.
Sofiya Bidochko is a Sophomore at Yale University in Silliman College