Bacterial diseases are becoming increasingly virulent and resistant to currently available antibiotics and are the second-leading cause of death worldwide. Within the European Union, it is estimated that 2 million patients every year catch hospital-acquired infections, of which 175,000 die.
Antibiotics differ from other drugs. Their lifespan is limited due to the inevitable development of resistance and this process is clearly linked to the volume of use. The need for restricted use of these valuable medicines and the short treatment courses are among several factors that make the return of investment for antibiotic R&D less than, say, for chronic diseases. During the last 35 years only a few new classes of antibiotics have been developed and the death toll due to resistant bacterial infections is now steadily increasing in the EU and globally.
According to the LSE report, Policies and incentives for promoting innovation in antibiotic research,
penicillin is becoming obsolete in France, Spain and Romania, partly due to over-prescription. Many doctors misdiagnose viral infections as bacterial infections because testing takes too long and because of a mounting tendency for litigation by patients.
The report, commissioned by the Swedish government, calls for a co-ordinated strategy of major reforms across Europe to avert a "potential health crisis." This includes support for the development of cost-effective rapid diagnostic tests that are quick and easy to use. It also calls for a major review of the financial, legal and clinical issues surrounding antibiotics to discourage over-prescribing.
The report highlights the fact that research into new antibiotics is not an attractive financial investment because of their potentially short clinical lifespan due to the rapid development of resistance. There is also a lack of awareness of how cost-effective antibiotics are in reducing mortality. This means that the price paid by public health providers is relatively low compared to some cancer drugs, which are very expensive but which offer only a few weeks or months of additional life.
The report recommends major EU investment, such as ricsk-sharing finance facilities and advanced market commitments to encourage research and development of new antibiotics. It is likely to pave the way for a European Union Council decision on antibiotics development.
Elias Mossialos, Professor of Health Policy at LSE who led the research, called for governments to take immediate action, saying:
"The development of penicillin and other antibiotics in the mid-20th
century prompted public health leaders to declare that the end of infectious diseases was approaching. But the rise of MRSA and other resistant infections is having a devastating effect, with increased spread of disease and risk of mortality, as well as longer hospital stays and higher treatment costs.
"This is one of the most pressing public health issues in the developed world, yet very little is being done about it. Governments must take immediate action to preserve the effective life of existing antibiotics and strengthen incentives for the research and development of new antibiotics."
As the net present value (NPV) for an antibiotic is about a tenth of that of a pain killer, Prof. Mossialos points out that "the greatest challenge is to persuade the [pharmaceutical] companies to invest in a market with lower returns."