Promoting research into new antibiotics - but how?

Since the beginning of the 20th century, the public has been able to rely on the effectiveness of antibiotics. They are an indispensable part of the healthcare system and successfully help with bacterial infections, surgical interventions, chemotherapy and other medical procedures. However, their medical success and low prices have led to their high use over a long period of time and the associated accelerated development of bacterial resistance. How can this problem be tackled?

In Switzerland, the National Action Plan Strategy on Antibiotic Resistance (StAR) was launched to tackle and counteract the challenge of resistance development. For example, the Information System Antibiotics in Veterinary Medicine (IS ABV) was introduced for antibiotic monitoring in veterinary medicine. The database can be used to closely monitor the use of antibiotics in pets and farm animals and appropriate measures can be taken depending on the reporting situation. This has revealed that the quantity of antibiotics sold in veterinary medicine has been declining for years.

Still, antibiotic resistance is a global problem. Every year, around 1.27 million people worldwide [1] die from an infection caused by resistant bacteria. However, the death figures do not show the full extent of the problem. Treatments for resistant infections often require several treatment attempts, each of which causes its own side effects. Longer stays in hospital or even in intensive care and a longer recovery period can also be associated with increased resistance. The consequences of this are manifold, ranging from constantly rising healthcare costs to economic losses due to illness and incapacity to work.

Why research into new products has been lacking for a long time
There is an urgent need for new, effective antibiotics. However, the question arises as to why there has been relatively little research in this important therapeutic area in the recent past. From a scientific point of view, the development of new, effective products is not trivial and if a promising therapy is developed, its effectiveness should be maintained for as long as possible. This requires restrictive use of the new antibiotic, which means that the development of new antibiotics represents a loss-making business for the industry in the long term. It is not just a question of covering the costs of research and development, but also of ensuring that the drug can be kept on the market in the long term. In order to counteract this situation, new, internationally harmonised remuneration models must be developed.

Incentives for the development of new antibiotics
There are various ideas as to how incentives can be created to promote development. Various countries are looking for ways to promote the research and development of new antibiotics and improve security of supply. For example, regulatory hurdles are being lowered or measures are being taken to ensure that the level of remuneration appropriately honours the value of new antibiotics for the supply of their healthcare systems. There are also proposals in Switzerland to create incentives - in this case so-called pull incentive models. These would be applied after successful market authorisation and are intended to motivate pharmaceutical companies and researchers to increase their commitment to the development of new, effective antibiotics.

scienceindustries sees a conceivable approach in the subscription model: the manufacturer of a new antibiotic receives a fixed annual payment, which should allow to amortise the development costs and make a reasonable profit. In return, the manufacturer commits to providing the new antibiotic to the required extent. The decoupling of revenues allows for restraint in prescribing, which limits the development of resistance. At the same time, an incentive would be created to supply the small Swiss market with new antibiotics without forcing proven products out of the market. According to legal experts, the Federal Act on Combating Communicable Diseases in Humans (Epidemics Act, EpG) would already provide a sufficient legal basis for the model described. Another advantage of this model would be that Switzerland could participate in the implementation of pilot projects such as those currently being set up in England and Sweden.

However, a Swiss subscription model would have to take international developments into account and align itself with them. The framework conditions for such a model would have to be weighed up accordingly: a special Swiss approach would have to be avoided at all costs.