Encouraging the Development of New Antibiotics: Are Financial Incentives the Right Way Forward? A Systematic Review and Case Study

Abstract

Antibiotic resistance is an urgent public health threat that has received substantial attention from the world’s leading health agencies and national governmental bodies alike. However, despite increasing rates of antibiotic resistance, pharmaceutical companies are reluctant to develop new antibiotics due to scientific, regulatory, and financial barriers. Nonetheless, only a handful of countries have addressed this by implementing or proposing financial incentive models to promote antibiotic innovation. This study is comprised of a systematic review that aimed to understand which antibiotic incentive strategies are most recommended within the literature and subsequently analyzed these incentives to determine which are most likely to sustainably revitalize the antibiotic pipeline. Through a case study of Canada, we apply our incentive analysis to the Canadian landscape to provide decision-makers with a possible path forward. Based on our findings, we propose that Canada support the ongoing efforts of other countries by implementing a fully delinked subscription-based market entry reward. This paper seeks to spark action in Canada by shifting the national paradigm to one where antibiotic research and development is prioritized as a key element to addressing antibiotic resistance.

Antibiotic Discovery and Resistance: The Chase and the Race

“…To identify novel hits and leads and nominate pre-clinical candidates, it may take from 1 to 7 years of research associated with a cost 5–10 million Euros, excluding the costs for attrition and lost opportunities of the increased cycle time to reach the next development phase [ 12 , 236 ]. In other terms, SMEs and the academic sector are driving innovation, since large companies are dropping out of the field [ 9 ]. This implies that SMEs are facing, with limited capacity, the risks and down-turns of product failure in the early stages, despite the fact that this research stage is the mainstay in R&D, to ensure the sustainability of new antibacterial drug candidates in the development pipeline.…”

“…It is time to shift the AMR research paradigm for innovation in antibiotic discovery, though this alone cannot be the only solution to this silent pandemic [ 5 , 6 , 7 , 8 ]. The spread of AMR is outpacing almost every counter measure, and the world has limited choices to treat infections [ 9 ]. Curbing AMR requires complex and specific multi-sectoral measures [ 10 , 11 , 12 ].…”

Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward

“…Financial incentives for antibiotic innovation should target drugs that will provide the most clinical benefit for patients with the most significant unmet medical needs. 197 The vast majority of antibiotics used clinically are broadspectrum. Broad-spectrum antibiotics are usually active against multiple bacterial species, not just the specific pathogen that might be targeted in a particular patient scenario.…”

NIMble innovation—a networked model for public antibiotic trials

“…9 Responding to market failures caused by low financial returns and stewardship requirements for new drugs, 10 the past 10 years have seen funders try to re invigorate commercial investment with economic push and pull incentives. 11 Increased funding by governments (eg, Innovative Medicines Initiative: DRIVEAB 12 and ENABLE; Biomedical Advanced Research and Development Authority 13 ), charities (eg, Wellcome Trust), private industry (eg, AMR Impact Fund: REPAIR), and nongovernmental bodies (eg, CARBX and Global Antibiotic Research and Development Partnership) means that earlyphase anti biotic R&D has yielded more promising compounds than in nearly 30 years, and some of these compounds are now in late stages of clinical trials. 14,15 This success shows that public incentives can increase R&D activity at this early stage in the pipeline.…”