Resisting an infection pandemic

Minor infections often turned lethal until the mid-twentieth century. Now this threat could return, as micro-organisms become more resistant to antibiotics, antifungals, antiparasites and other antimicrobial compounds.

“All of modern medicine is upheld by our ability to control infectious disease”, says Jonathan Stokes, a scientist at McMaster University in Canada. “If we can’t control infection, we can’t administer chemotherapy, do invasive surgery, and preterm birth becomes really, really challenging and risky”.

One-and-a-quarter million people worldwide died with antimicrobial-resistant infection in 2019 – more than from malaria or HIV. A 2016 World Bank review predicted this could rise to ten million by 2050 – about the number now dying each year from cancer. It’s now predicted the number of deaths could be double that. There are already signs the malaria parasite across Africa is developing resistance to the standard treatment.

The World Bank estimated the cost to the global economy of antimicrobial resistance could be up to $100 trillion by 2050 – similar to the 2008 global economic crisis. This includes a fall in global GDP from 1.1% to 3.8%, up to 28 million more people falling into extreme poverty, and increased healthcare costs of $300 billion to more than $1 trillion a year.

Fuelling antimicrobial resistance is overuse. Seventy-three percent of worldwide antimicrobial consumption in 2017 was not by sick humans or even sick animals, but fed to animals to increase growth, prevent disease in crowded factory-type production – and increase profit. Antibiotic use in animal feed is projected to grow 8% this decade with growing worldwide demand for meat.

Human antibiotic use is also too high, as in the USA where doctors often prescribe antibiotics for colds, not caused by bacteria. Unnecessary prescriptions cost the patient but boost profit-seeking health and pharmaceutical companies. In less developed countries, with few doctors, it’s often cheaper and easier to buy antibiotics over the counter, so they can be inappropriately used.

Air pollution increases antibiotic-resistant bacteria, a recent study has found. A UN report also blames pollution from pharmaceutical and chemical manufacturing industries, along with agriculture and healthcare. Herbicides to control weeds on farms and heavy metal contamination of soil increase the problem.

Pumping antimicrobials into the environment, directly through pollution or indirectly through human and animal overuse, allows ample opportunities for bacteria, viruses, parasites and fungi to develop resistant strains.

This is not a new problem – resistant bacterial strains emerged within ten years of penicillin’s mass production. But for half a century, new antibiotics were discovered and manufactured which, on their own or in combination, successfully treated most infections.

However, the development of new antibiotics fell off the agendas of most major pharmaceutical corporations years ago. Only 15 new antibiotics have been approved for clinical use since 2000, compared to 63 between 1980 and 2000. Only four of the 15 represent new classes of antibiotics, targeting bacteria in new ways.

The cost of bringing a new antibiotic to market is about $1.5 billion. After laboratory tests and safety tests, expensive clinical trials can take years, at the end of which the new drug might be shown not to be effective or to produce unacceptable side-effects. Neither venture capitalists nor large corporations want to fund these costly clinical trials.

To stay effective for longer, any new antibiotic should be saved for when it is the only line of treatment possible – keeping sales low. But pharmaceutical companies want to recoup their investment and make profit so charge very high prices for new antibiotics, making cash-strapped health services reluctant to use them.

In the capitalist ‘free market’, companies supposedly see a gap in the market and invest to produce new drugs to meet this need. But the system is failing, as even the capitalists themselves can see. To try and find a way around this, instead of competition between companies some are trying to collaborate.

Drug companies invested about $1billion in an Antimicrobial Resistance (AMR) Action Fund in 2020, aiming to launch two to four new antimicrobials in the next decade. Describing itself as “the world’s largest public-private partnership investing in the development of new antimicrobial therapeutics” it has investment from 27 corporations, including most of the world’s biggest, as well as the European Investment Bank and the Wellcome charitable foundation.

Much hype has been given to the use of AI to speed the discovery of new drugs. However, even the chief executive of the AMR Action Fund, says AI is “helpful, certainly, but not transformative” because it does little to address the high cost of clinical trials. He says his fund is “at best, a stop gap, partial solution”.

The chief executive of Phare Bio, a smaller company, hopes charity offers an alternative. “Because we have philanthropic investment to help us get through this highest risk phase, we feel that will enable us to succeed and in ways that companies that are only commercially funded even at the earliest stages may not be able to”.

However, “the reality of the private sector means that these organisations need to see the money before they get to work”, wrote the editor of Hospital Times. “For many, making antibiotics is not the most lucrative path. While some companies still pursue antibiotic development, others exited the market long ago and in the last two years, at least four smaller antibiotic-focused companies have gone bankrupt”. (29 January 2021)

“Unless you can get governments to think about this in a more creative way than the traditional supply, pay on demand per unit model, you can really struggle with your cash flow”, says Mark Hill, a Japanese drug company executive.

The EU and US government are looking at a ‘subscription’ model, where manufacturers will be allowed to keep a profitable patent on another drug for longer in return for a new antimicrobial treatment. This could be worth €440 million in Europe, or $750 million to $3 billion in the US – although the new law has not yet passed through Congress.

Pfizer executive Patrick Holmes says this is “the only incentive large enough to drive a significant change in where drugmakers spend on research and development”. This is an industry where the combined profits of the top 20 companies were over $840 billion in 2022!

Instead of trying to bribe it with huge sums of public money or charity from the super-rich, the whole industry should be taken out of profit-seeking private hands and brought into public ownership. Its massive resources, alongside public universities and health services, could then be democratically planned by scientists, health workers and the community, with priorities set to meet need instead of greed.

As Covid showed, infectious diseases don’t recognise international boundaries. International socialist action is urgently needed to prevent a return to untreatable infection becoming a new pandemic.

Jon Dale