And why the Government and big pharma don’t seem to care.
It would be good to think someone is in charge of fixing this and that a host of amazing new drugs is not far away. But the latest report from the WHO is a stark reminder that this is not the case. It has warned that of the 50 or so antibiotics in the pipeline, most bring little benefit over existing treatments and few target the most critical resistant bacteria. Those few innovative drugs are years away from reaching patients. And the bigger pharmaceutical companies have stepped away from developing antimicrobials, leaving the smaller and medium-sized companies to fill the gap.
“Never has the threat of antimicrobial resistance been more immediate and the need for solutions more urgent,” says Tedros Adhanom Ghebreyesus, director-general of the WHO.
In 2017, the organisation published a list of priority pathogens that were resistant to most existing treatments. These included Klebsiella and E coli, which are spreading rapidly and can cause severe and often deadly infections that are a particular threat in hospitals.
A New Zealand scientist searching for solutions is microbiologist Siouxsie Wiles of the University of Auckland. She is focused on several of the pathogens on the WHO hit list, including Klebsiella and E coli. Her team at the Bioluminescent Superbugs Lab spend their time trying to kill these enemy organisms using native fungi collected by Manaaki Whenua Landcare Research.
“It’s really long and arduous work,” she says. “The problem is only about one in five drugs that make it to clinical trials succeed, so we need to be identifying hundreds of compounds to have a chance of getting one new drug. We’ve identified a handful at the moment, but it’s not enough.”
Perhaps her biggest challenge has been getting Government funding to continue. “I don’t know why,” she says. “Is it that the project is just not exciting enough?”
For a time, she was reliant on grants from the charity Cure Kids, through its “Fight Against Superbugs” appeal and crowdfunding campaign. Then New Zealand Carbon Farming provided enough money for three years’ work.
“We’ve got two years left and we’re doing our best,” says Wiles, “but it’s all at the early discovery phase and we don’t know what we’re going to find or how useful it will be.”
In a 2016 report, economist Jim O’Neill – dubbed the UK’s “superbug tsar” – called for incentives for the development of new antibiotics. Other measures he has suggested include taxing companies that opt out of antibiotics and creating state-run companies so that the production of these medicines isn’t subject to market forces. A review last year found there has been little progress with any of these ideas.
The predictions, if we don’t act, are dire – 10 million deaths linked to antimicrobial resistance a year by 2050 and an accumulated cost to the global economy of $100 trillion.
“Fundamentally, the model we have for the development of drugs is broken,” says Wiles. “How can our health be a for-profit industry?”
A focus on preventing resistance by not overusing antibiotics in human health and agriculture has had limited success. High-income countries may have made advances but less affluent ones have struggled. And, says Wiles, although the prevention message is a good one to get out there, on its own it’s not enough of a solution.
“When we use antibiotics, we give those organisms that are resistant a kind of niche to live in that the sensitive ones can’t,” she says. “So, absolutely, by reducing the overall number of these drugs in circulation, the hope is that we can extend the life of the existing drugs and bring down the levels of resistant organisms. But there are a lot of caveats in that; it will work for some organisms and not others.”
This article was first published in the February 29, 2020 issue of the New Zealand Listener.