[{"command":"openDialog","selector":"#drupal-modal","settings":null,"data":"\u003Cdiv id=\u0022republish_modal_form\u0022\u003E\u003Cform class=\u0022modal-form-example-modal-form ecl-form\u0022 data-drupal-selector=\u0022modal-form-example-modal-form\u0022 action=\u0022\/en\/article\/modal\/6729\u0022 method=\u0022post\u0022 id=\u0022modal-form-example-modal-form\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cp\u003EHorizon articles can be republished for free under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.\u003C\/p\u003E\n \u003Cp\u003EYou must give appropriate credit. We ask you to do this by:\u003Cbr \/\u003E\n 1) Using the original journalist\u0027s byline\u003Cbr \/\u003E\n 2) Linking back to our original story\u003Cbr \/\u003E\n 3) Using the following text in the footer: This article was originally published in \u003Ca href=\u0027#\u0027\u003EHorizon, the EU Research and Innovation magazine\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003ESee our full republication guidelines \u003Ca href=\u0027\/horizon-magazine\/republish-our-stories\u0027\u003Ehere\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003EHTML for this article, including the attribution and page view counter, is below:\u003C\/p\u003E\u003Cdiv class=\u0022js-form-item form-item js-form-type-textarea form-item-body-content js-form-item-body-content ecl-form-group ecl-form-group--text-area form-no-label ecl-u-mv-m\u0022\u003E\n \n\u003Cdiv\u003E\n \u003Ctextarea data-drupal-selector=\u0022edit-body-content\u0022 aria-describedby=\u0022edit-body-content--description\u0022 id=\u0022edit-body-content\u0022 name=\u0022body_content\u0022 rows=\u00225\u0022 cols=\u002260\u0022 class=\u0022form-textarea ecl-text-area\u0022\u003E\u003Ch2\u003EWe need a new way to pay for antibiotics \u2013 Dr David Payne\u003C\/h2\u003E\u003Cp\u003E\u003Cstrong\u003EHow urgently do we need new antibiotics?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018A \u003Ca href=\u0022https:\/\/amr-review.org\/\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003Ereport\u003C\/a\u003E for the UK government estimates that without decisive action, antimicrobial resistance (AMR) will cost 100\u0026nbsp;trillion dollars and cause 10\u0026nbsp;million deaths per year (by 2050). It\u2019s hard to predict the precise impact but it\u2019s on that scale. It would mean that a lot of the advances we\u2019ve seen in modern medicine would be compromised. If we can no longer manage infections we wouldn\u2019t be able to do open heart surgery, for example, and the benefits of transformational medicines for cancer and heart disease would be lost for many.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EWhy is the search for new antibiotics more challenging than drug discovery in other\u003C\/strong\u003E \u003Cstrong\u003Eareas?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018One of the really fundamental challenges comes at the very beginning of the drug discovery process. A lot of investment has been made in running high throughput screening experiments (which allow researchers to quickly conduct millions of tests) to look for early chemical starting points for novel antibiotic targets. Larger pharmaceutical companies \u2013 mainly GSK, Pfizer and Astra Zeneca \u2013 have put hundreds of millions of dollars into this without seeing much return at all. We have a huge problem finding promising early chemical starting points\u0026nbsp;for the first phase of research.\u003C\/p\u003E\u003Cp\u003E\u2018In addition, some complex infections require high doses of antibiotics, up to 7.5 grams a day. This is much higher than most medicines where doses are measured in milligrams. As a result, we often lose promising drug molecules to toxic side effects. We are looking for something that is really safe at very high doses and that makes our task distinct from drug discovery in other areas.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EWhat are the commercial barriers to developing new antibiotics?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018It takes a lot of effort, time and funding to get a new antibiotic to the approval stage. Then the big challenge is that there is no real commercial reward for licensing a new antibacterial. Antibiotics are used for perhaps seven to 14 days rather than for the rest of a patient\u2019s life. That\u2019s a good thing but it means the use of the product is short-lived.\u003C\/p\u003E\u003Cp\u003E\u2018While the demand and urgency are high, the market can be quite small. Take urinary tract infections, for example. Millions are affected but we would only want to use a new antibacterial in a small subset of the patient population. So if we create a new antibiotic \u2013 which is the right thing to do for society \u2013 the number of prescriptions will be low. The return on investment is just not there.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cblockquote class=\u0022tw-text-center tw-text-blue tw-font-bold tw-text-2xl lg:tw-w-1\/2 tw-border-2 tw-border-blue tw-p-12 tw-my-8 lg:tw-m-12 lg:tw--ml-16 tw-float-left\u0022\u003E\n \u003Cspan class=\u0022tw-text-5xl tw-rotate-180\u0022\u003E\u201c\u003C\/span\u003E\n \u003Cp class=\u0022tw-font-serif tw-italic\u0022\u003E\u2018Antibiotics have been taken for granted \u2013 they are not priced in a way that matches their lifesaving potential.\u2019\u003C\/p\u003E\n \u003Cfooter\u003E\n \u003Ccite class=\u0022tw-not-italic tw-font-normal tw-text-sm tw-text-black\u0022\u003EDr David Payne, Head of the Antibacterial Discovery Performance Unit, GSK\u003C\/cite\u003E\n \u003C\/footer\u003E\n\u003C\/blockquote\u003E\n\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EDo you think antibiotics are underrated? \u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018I think we tend to think the miracle of antibiotics happened a long time ago when Fleming discovered penicillin, but the life-saving role of antibiotics continues everyday \u2013 I think we have forgotten that. We tend to take antibiotics for granted \u2013 they are not valued\u0026nbsp;in a way that matches their lifesaving potential, unlike some other new medicines.\u003C\/p\u003E\u003Cp\u003E\u2018It\u2019s the perfect storm: a very challenging research problem coupled with limited incentive to solve it. That is why many companies have stopped working in this space.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EHow can that be overcome?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018A new commercial model is needed. Academics and people from biotech or pharma companies have been saying this for years but now we are hearing multiple governments and other global stakeholders calling for the same thing.\u003C\/p\u003E\u003Cp\u003E\u2018There are lots of alternatives to the current approach. For example, instead of companies getting a return based on the number of prescriptions sold, there could be lump sum payments. That would also remove the incentive to try to sell more antibiotics. This would encourage appropriate use of new antimicrobials and attract investment.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EHow can collaborations between public funders and industry help?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018Public-private partnerships (PPPs) are propping up the antibiotic pipeline by helping to share the risks associated with drug development in this space. One of the most important PPPs is the Innovative Medicines Initiative\u2019s (IMI) New Drugs for Bad Bugs (ND4BB) which is working on just about every aspect of the problem.\u003C\/p\u003E\u003Cp\u003E\u2018The ND4BB project, TRANSLOCATION, focuses on the very early stages of antibacterial drug discovery and looks to improve our understanding of designing molecules to optimally penetrate bacterial cells. (Another element called) ENABLE\u0026nbsp;provides a platform for running antibacterial discovery projects, COMBACTE\u0026nbsp;has developed clinical trial networks to support clinical trials of new potential antimicrobials (and) DRIVE-AB is a group of economists, academics, public health researchers and experts from industry, working to find a more viable commercial model. The DRIVE-AB group will report in the coming months and will make proposals which could be embraced in Europe and elsewhere.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EHow can the US and the EU join forces to tackle\u0026nbsp;AMR?\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018There is some discussion between clinical trial networks in the US and the ND4BB networks which aim to overcome the challenge of running global trials. We have also seen progress on harmonisation between regulators in the EU and US. The European Medicines Agency and US Food and Drug Administration are working towards aligning\u0026nbsp;the requirements for bringing a new antibiotic to patients.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Ca href=\u0022http:\/\/bit.ly\/newsalertsignup\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003E\u003Cimg class src=\u0022https:\/\/horizon-magazine.eu\/research-and-innovation\/sites\/default\/files\/hm\/news-alert-final.jpg\u0022 alt width=\u0022983\u0022 height=\u0022222\u0022\u003E\u003C\/a\u003E\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EAre you optimistic for the future of antibiotic development?\u0026nbsp;\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003E\u2018I\u2019m really impressed with what has been achieved in several areas. Ten years ago, the PPP approach was non-existent but is now accepted as absolutely critical to the pipeline we have today, fragile though it may be. Without the IMI and some US initiatives we would be in an even worse position. Progress in the regulatory areas has also been very encouraging.\u003C\/p\u003E\u003Cp\u003E\u2018My big concern is around the commercial model. If we don\u2019t work out a solution to that we\u2019ll push investment away from this area and have even fewer companies working on the problem. If we manage to create a new commercial model, I would be very optimistic about the future.\u2019\u003C\/p\u003E\u003Cp\u003E\u003Cem\u003EIf you liked this article, please consider sharing it on social media.\u003C\/em\u003E\u003C\/p\u003E\u003C\/textarea\u003E\n\u003C\/div\u003E\n\n \u003Cdiv id=\u0022edit-body-content--description\u0022 class=\u0022ecl-help-block description\u0022\u003E\n Please copy the above code and embed it onto your website to republish.\n \u003C\/div\u003E\n \u003C\/div\u003E\n\u003Cinput autocomplete=\u0022off\u0022 data-drupal-selector=\u0022form-wcw1q-jenbsr6njrp-hta4n7i99yczvqaznwb-j968\u0022 type=\u0022hidden\u0022 name=\u0022form_build_id\u0022 value=\u0022form-Wcw1q_jEnbSR6njrP-_HTA4n7i99YcZvQaznwB_j968\u0022 \/\u003E\n\u003Cinput data-drupal-selector=\u0022edit-modal-form-example-modal-form\u0022 type=\u0022hidden\u0022 name=\u0022form_id\u0022 value=\u0022modal_form_example_modal_form\u0022 \/\u003E\n\u003C\/form\u003E\n\u003C\/div\u003E","dialogOptions":{"width":"800","modal":true,"title":"Republish this content"}}]