The problem with antibiotics

TY - JOUR

T1 - The problem with antibiotics

AU - Darrow, Jonathan

AU - Minssen, Timo

PY - 2019/5

Y1 - 2019/5

N2 - Your article, The Antibiotic Industry Is Broken (May 2, 2019) rightly directs attention to the serious problem of antimicrobial resistance. But the premise on which the article appears to rest -- that an unending supply of antimicrobial agents are simply waiting to be discovered, if only the proper funding model can be devised -- is assumed without evidence. Like pipelines transporting oil away from an underground deposit, the antibiotic pipeline may not have an infinite reserve of raw material on which to draw. For example, selective evolutionary pressure caused by the use of antibiotics could push microbes to resemble their host environments in important ways that frustrate targeted approaches to treatment, raise development costs, or increase toxicity. While greater incentives and new funding models may be needed in the short term, it is unclear whether a system dependent on endlessly churning out new and ever more expensive medicines will be either economically feasible or scientifically possible in the long term. Greater priority should therefore be given to implementing more permanent solutions that are not limited to slowing resistance, which at best merely shifts the problem from today’s generation to the next, an ethically murky result. While no single approach is likely to be sufficient, governments should begin by reviving the moribund vision of using the vaccines, treatments, and other tools that are already at hand to eradicate disease and thereby stop -- not slow -- the development of resistance. Due to non-human disease vectors and other challenges, eradication may not currently be possible for every disease, but for those diseases amenable to it, the window of opportunity may fast be closing. Jonathan and Timo Dr. Jonathan J. Darrow, S.J.D., LL.M., J.D., M.B.A.Faculty, Harvard Medical School, Boston, USAAssociate Scientist, Brigham & Women's Hospital*Division of Pharmacoepidemiology & PharmacoeconomicsDepartment of MedicineTimo Minssen, Jur. Dr., LL.M., M.I.C.L.Professor of Law Director of the Centre for Advanced Studies in Biomedical Innovation Law (CeBIL)European lead, Stakeholder Consortium of Social Science Research Centres at Global AMR R&D Hub, BMBF, Berlin.University of Copenhagen, Denmark

AB - Your article, The Antibiotic Industry Is Broken (May 2, 2019) rightly directs attention to the serious problem of antimicrobial resistance. But the premise on which the article appears to rest -- that an unending supply of antimicrobial agents are simply waiting to be discovered, if only the proper funding model can be devised -- is assumed without evidence. Like pipelines transporting oil away from an underground deposit, the antibiotic pipeline may not have an infinite reserve of raw material on which to draw. For example, selective evolutionary pressure caused by the use of antibiotics could push microbes to resemble their host environments in important ways that frustrate targeted approaches to treatment, raise development costs, or increase toxicity. While greater incentives and new funding models may be needed in the short term, it is unclear whether a system dependent on endlessly churning out new and ever more expensive medicines will be either economically feasible or scientifically possible in the long term. Greater priority should therefore be given to implementing more permanent solutions that are not limited to slowing resistance, which at best merely shifts the problem from today’s generation to the next, an ethically murky result. While no single approach is likely to be sufficient, governments should begin by reviving the moribund vision of using the vaccines, treatments, and other tools that are already at hand to eradicate disease and thereby stop -- not slow -- the development of resistance. Due to non-human disease vectors and other challenges, eradication may not currently be possible for every disease, but for those diseases amenable to it, the window of opportunity may fast be closing. Jonathan and Timo Dr. Jonathan J. Darrow, S.J.D., LL.M., J.D., M.B.A.Faculty, Harvard Medical School, Boston, USAAssociate Scientist, Brigham & Women's Hospital*Division of Pharmacoepidemiology & PharmacoeconomicsDepartment of MedicineTimo Minssen, Jur. Dr., LL.M., M.I.C.L.Professor of Law Director of the Centre for Advanced Studies in Biomedical Innovation Law (CeBIL)European lead, Stakeholder Consortium of Social Science Research Centres at Global AMR R&D Hub, BMBF, Berlin.University of Copenhagen, Denmark

KW - Faculty of Law

KW - vaccines

KW - antimicrobials

KW - resistance

KW - incentives

KW - law

KW - regulation

M3 - Letter

SN - 1821-3715

VL - 431

SP - 20

JO - The Economist

JF - The Economist

IS - 9144

ER -