Big private pharma companies have failed by profiting money over health public ownership is key

Antibiotics are among the most important medicines known to humankind, but we are of this crucial resource. Decisive action is needed if we are to retain access to them. This includes rethinking our reliance on private companies and of crucial parts of the antibiotic pipeline. Since the 1930s, antibiotics have transformed the way we treat diseases, ranging from syphilis to . They have enabled increasingly complex forms of surgery and organ transplantation. They have protected people with weakened immune systems, such as those undergoing chemotherapy for cancer treatment, from life-threatening infections. And they have facilitated the industrialisation of . So important have antibiotics become that some researchers compare essential infrastructure, such as hospitals and ambulance services. But this infrastructure is at risk. After decades of increasing use, our antibiotic workhorses are worn out. The reason for this is : every use of an antibiotic can select for bacteria that are resistant to antibiotics’ effects. Because their competitors are killed by antibiotics, these resistant bacteria can proliferate rapidly and pass on their resistance genes to their offspring and often to other, unrelated bacteria. Over the last 80 years, human antibiotic use has that are increasingly effective at resisting our drugs.Penicillium mould producing spores. , Antibiotic development has not kept pace with this rapid microbial evolution. After a golden age of innovation between the 1930s and 1970s, the 1980s saw global investment in antibiotic research and development (R&D) – just when old scourges, such as and were becoming harder to treat. The reason for this was . Don’t let yourself be misled. Understand issues with help from experts Get the newsletter Despite , private companies were unwilling to invest in drugs that would only be taken for a short time and be subject to usage restrictions because of their selection for antimicrobial resistance. Instead, contemporary experience showed that investment in cancer drugs and , which would be taken for long periods, or in treatments for so-called lifestyle diseases, such as , would be far more lucrative than sponsoring further antibiotic research. The pipeline for new antibiotics has become drier ever since. In fact, it has been since a new class of antibiotics with a distinct new mode of antibacterial action has entered the market. All the while, bacteria have honed their defences. By 2016, a major commissioned by the British government predicted 10m deaths annually resulting from antibiotic resistance by 2050 if no action was taken, and exhorted both the global community as well as private companies to reinvest in new antibiotics research. These warnings of an international emergency have since been echoed by organisations ranging from the to . But development , despite many attempts to make commercial antibiotic development more attractive. Recent years have seen substantial public of private development, with widespread subsidised research and clinical trials, along with incentives, such as , quicker licensing, supplemented prices for new antibiotics , and NHS England’s new “” for antibiotic access. Despite this, no new antibiotic class has emerged. Even worse, the injection of since 2016 has not prevented the industry from further contracting. Between 2016 and 2019, major producers, such as Sanofi, Novartis and AstraZeneca shuttered their . This resulted in the closure of well-financed industrial research departments and a critical global loss of human capital and expertise in antibiotic R&D. According to a , there is “now a shortage of experts qualified to lead research programs employing promising new antibiotic discovery methods”. Although international non-profit organisations are to subsidise for-profit development, it is questionable whether this public-private model will bear fruit. After over three decades of market failure and in the face of a critical contraction of remaining industry activity, alternatives beyond the market should urgently be explored. The public is already sponsoring the high-risk phases of drug discovery and trialing by university researchers and private companies but own none of the intellectual property once antibiotics go to market. There has also been little public pay-off either in terms of new antibiotic classes or increased access to effective drugs in low-income countries. The market is broken. It is time to apply recent of “public money for public goods” to areas beyond farming and seriously consider public ownership of antibiotic research, development and production.