Open Source: How Can We Address the Threat of Antibiotic Resistance?
To sustain access to new antibiotics over time, governments must fix the broken system of R&D by priming the pump of scientific drug discovery, spreading risk across drug candidates and approaches, and transforming the ecosystem of how we innovate antibiotics. This will not come from business as usual—such as dangling excessive prizes to drug makers, pricing antibiotics like cancer drugs or making small bets—company by company or drug by drug.
I take a radical stance on this issue. There are national and international programs that have endorsed and funded research on new antibiotics. However, unless we take the pledge to ensure that the barn door of profligate misuse [of antibiotics] is closed, their products will go the way of all our current drugs.
Ellen K. Silbergeld, PhD, is a professor in Environmental Health and Engineering at the Bloomberg School and the author of Chickenizing Farms and Food: How Industrial Meat Production Endangers Workers, Animals, and Consumers.
We need to ask, “How can we maintain efficacy in the face of a rapidly evolving pathogen?” I’m skeptical that any single magic bullet or combination of bullets can achieve the twin goals of efficacy and long-term evolutionary robustness. In my view, a more promising avenue is a personalized medicine approach, tailoring treatment to the infection context, including the resistance diagnostic profile of the infecting organisms.
We need significant public investment in antibiotic R&D if we’re going to address the rapid increase in antibiotic resistance. And we need public-private partnerships that address R&D as well as sustainable access. But funding needs to be invested in public health priorities. Our work includes developing antibiotics for children and sexually transmitted infections—both urgent public health priorities and indications less likely to be addressed by others.
Manica Balasegaram, MD, FRCP, is executive director of Global Antibiotic Research & Development Partnership, a nonprofit R&D organization.
Bringing new antibiotics to market is not just the responsibility of nor the role for top pharma companies. We must enlist researchers, firms and patients from low- and middle-income countries in these efforts. And just as we source most of our generic HIV/AIDS medicines from companies in India, the approach to innovation that develops these lifesaving antibiotics must not place them beyond affordable reach of those in need.