Incentivizing Corporate Humanitarianism

"It basically shows us that the end of the road isn't very far away for antibiotics -- that we may be in a situation where we have patients in our intensive-care units, or patients getting urinary tract infections for which we do not have antibiotics."
Centers for Disease Control and Prevention Director Tom Frieden

"The return on investment based on the current commercial model is not really commensurate with the amount of effort you have to put into it." 
David Payne, head, GlaxoSmithKline PLC's antibiotics drug group

The mcr-1 plasmid-borne colistin resistance gene has been found primarily in Escherichia coli, pictured.     Reuters/Courtesy CDC

Pharmaceutical companies are in business to make money. Big money, lots of it. Which is why they are jealous of their patent protection rights, and fight shortening the time of those rights' expiration before they fall into the public realm legally, and generic drug manufacturers who have not invested time and funding in research to produce those successful drugs that sell so well, can produce cheaper versions, more financially accessible to the health care system and patients.

Because the principle upon which they operate is investment for research and profitability very little attention is paid to orphan diseases which do not strike many people in a society, or chronic illnesses which, because of their rarity mean there will be a limited audience for new drugs launched on the market to treat them, at great cost. That cost, of course, is passed on to the consumer. And if that consumer happens to suffer from a health malady that not many do, they will either go without and suffer the dread consequences or pay handsomely.

But what to do when there is a daunting health crisis of extreme proportions that, in theory, can strike anywhere at anyone and any time, and the consequences are so dire that without that investment in discovery and manufacture of a remedy many will die, but pharmaceutical companies stick to their investment/gain game plan because this is their winning formula in a free enterprise, capitalist system? They are not moved by humanitarianism because this is not the philosophy that drives them.

And at this juncture in the history of human health and the science of medicine this represents a shocking wake-up since what is described as the "nightmare" of all superbugs, a prospect which has had epidemiologists on the edges of their beds, awake at night in a suspension of anticipation, has finally appeared. Researchers have discovered an individual carrying bacteria resistant to antibiotics; not just any antibiotics, but those of last resort, used when all others fail.

This most fearful of all bacteria was discovered in the urine of a 49-year-old woman in Pennsylvania; a strain of E. coli resistant to the antibiotic colistin. Colistin represents that last-resort antibiotic used for extremely lethal types of superbugs, which include a family of bacteria known as CRE, dubbed by health officials "nightmare bacteria". A nightmare bacteria has the capacity to destroy the lives of up to 50 percent of infected patients.

According to the Centers for Disease Control and Prevention, CRE is among the most urgent public health threats in the United States, which is a leader in medical science and technology.  According to American health officials, antibiotic-resistant bacteria are the cause of two million serious infections country-wide, and 23,000 deaths on an annual basis. And they will be on the rise with the introduction of this latest morbid bacteria.
 
Ironically, it is the overuse of antibiotics that has led to the rise of these resistant bacteria. And of course, those same profit-greedy pharmaceuticals who have made a literal killing off the sales of antibiotics used both properly and to excess. It is not only doctors who err in prescribing their use when they are counter-indicated, but patients suffering from viral conditions demanding them. Anti-bacterial soap, so widely used by an infection-wary public has added to the situation.

When antibiotics began showing up in livestock feed, the humans who eat the table meat that results end up ingesting additional antibiotics. They also end up in water systems and agricultural run-off, exacerbating an already dire situation of antibiotic surfeit. And while pharmaceutical companies are not entirely averse to spending research dollars to create more powerful antibiotics they feel entitled to financial compensation.

At the turn of the year 80 drugmakers and companies specializing in diagnostics inclusive of
Pfizer Inc, Merck & Co, Johnson & Johnson and Glaxo, signed a declaration calling for cooperation between government agencies and drug producers for the creation of incentives to make research and development of new antibiotics more attractive to the pharmaceutical companies. A new business model was recommended.

Profit not to be linked to higher sales. Governments and health groups to be prepared to proffer lump-sum payments for the development of successful new antibiotics. As a prelude to this potential future alliance between government and private industry, a panel representing the British government suggested drug companies be offered up to $1.5 billion for successful development of a new antibiotic.