Take inspiration from the entertainment industry
A world without antibiotics is horrible to contemplate. They underpin much of modern medicine and are essential for patients undergoing chemotherapy for cancer, organ transplants or common surgeries such as caesarean sections. Yet the global rise of antimicrobial resistance, exemplified by the spread of Candida auris—the latest infection terrorising hospitals—and super-resistant gonorrhoea, is alarming. Resistance could kill 10m people a year by 2050, up from 700,000 today. This week a UN commission recommended immediate and co-ordinated action to avoid a calamity whose economic cost, the World Bank reckons, could rival that of the financial crisis of 2008-09.
That the pharmaceutical market does not always work well is hardly news. It has failed to develop many kinds of drugs, including new vaccines and treatments for diseases that mainly afflict the poor. But when it comes to antibiotics, matters are particularly bad. To prevent microbes from developing resistance to them, novel antibiotics tend to be reserved for use by doctors as a last line of defence and used for short periods. Hence volumes are meagre. That would not matter if prices were high. But unlike new drugs for cancer or rare diseases, prices of antibiotics are kept low in many countries, creating little incentive for drug companies to develop new ones. As a result, investors avoid new antibiotic firms and are fearful that they will run out of cash. The recent bankruptcy of Achaogen, a biotech firm, suggests they are right to fret. Big drug companies have largely bowed out of the game.
Governments and charities have scrambled to stimulate activity by putting money into basic research, giving grants to drugs startups and taking equity stakes in them, but that has not been enough. Bringing a drug from the laboratory to the clinic typically takes a decade and costs around $1bn. A more extreme option would be to nationalise antibiotic production, but that would only cause private-sector innovation to shrivel even further. Instead, stimulating the development of new antibiotics requires governments to embrace two ideas.
The first is that the antibiotics business needs to offer the prospect of decent profits. Asking people to pay more for drugs at a time of public outrage over the cost of medicines, from insulin to cystic-fibrosis treatments, is hard. But there are already moves in this direction. In America Medicare is paying more for some new antibiotics. And Britain’s notoriously tight-fisted drug-reimbursement agency has agreed to look at how its method for assessing value can be adjusted to incorporate the broader societal benefits of having a new antibiotic.
The second idea is to accept some unusual new ways to generate those higher profits, other than selling by the dose. Economists, including Jim O’Neill, have recommended that “market entry” prizes of $1bn or more should go to drugmakers that launch the most valuable new antibiotics. Split between G2O countries, a prize kitty even ten times as large would be affordable—and value for money.
But the most promising idea is for drugs firms to change how they charge governments and health insurers for antibiotics, by switching to a Netflix-style subscription model. Just as Netflix subscribers pay the same each month, whether they binge-watch boxsets all day or watch nothing at all, so health-care providers would pay a flat rate for access to an antibiotic, regardless of the volume. When the drug is new and being saved as a last line of defence, the drugs company still gets paid. And if the antibiotic has to be more widely used, the price does not go up. It may sound crazy, but subscriptions are already being tried in America to pay for hepatitis C drugs. Using this model for antibiotics can square the circle of incentivising drugs companies to develop a treatment that doctors will then try to use as little as possible.
This will not solve antibiotic resistance all on its own. Reducing the misuse of existing antibiotics, in medicine and agriculture, is also necessary. And more could be done to improve sanitation and processes, in hospitals and elsewhere, to minimise the risk of infection in the first place. Fixing the pricing model is not a silver bullet, then. But it is a vital part of the answer.
转载自：The antibiotic industry is broken
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