Melissa Gong Mitchell, the Secretariat Lead at the AMR Industry Alliance, sheds light on the obstacles hindering the creation of urgently needed new antibiotics and the sustainable solutions required to tackle these issues.

The hurdles in antimicrobial development

Antimicrobial resistance (AMR) poses a significant health threat in today's world, with nearly five million deaths attributed to it annually. Without intervention, this number could skyrocket to ten million by 2050. Despite the impending crisis, policymakers are struggling to foster the innovation necessary to address the issue. This is primarily due to a gradual decline in the scientific workforce and the malfunctioning market designed to support it.

Last year, the AMR Industry Alliance released a report titled 'Leaving the Lab,' which highlights the diminishing talent pool in antimicrobial research. Currently, there are only 3,000 active AMR researchers globally, compared to approximately 46,000 in oncology and 5,000 in HIV/AIDS. Over the past two decades, the number of AMR publications, patents, and researchers has significantly decreased. The AMR R&D pipeline is not just flawed; it's losing its most crucial resource: human capital.

This decline is not due to a lack of dedication or passion among scientists. The primary reason for their departure is the economic challenges they face. The market for antimicrobials is fundamentally flawed. These drugs must be used sparingly to maintain their efficacy, which limits sales. Additionally, they are usually priced low and frequently replaced by generic alternatives. This results in an unsustainable business model where even successful ventures can lead to bankruptcy.

For instance, Achaogen obtained approval for a new antibiotic, plazomicin, after years of research and substantial investment. However, the company filed for bankruptcy less than a year later. This scenario is not unique, as major pharmaceutical companies have reduced their involvement in the field, leaving smaller biotech firms struggling to fill the gap. According to a survey by the BEAM Alliance, more than half of SMEs in this sector cannot sustain their operations for over a year.

The impact of inaction

Push and pull incentives

Government officials and policymakers have started to recognize the urgency of the situation, leading to progress in push and pull incentives. Push incentives, such as research grants and initiatives like CARB-X, offer crucial early-stage support for small enterprises. Pull incentives, such as market entry rewards or subscription models like the UK's pilot program, aim to reward successful development and ensure commercial viability.

Despite these advancements, the incentives are still limited in scope and scale. Without consistent and predictable support, they are unable to reverse the talent drain. Research indicates that when companies shut down AMR programs, 90% of affected researchers leave the field after their second job change. The innovation pipeline is only as robust as the individuals driving it, and currently, we are losing them.

This crisis is particularly severe for infectious disease specialists, whose expertise is vital for late-stage drug development. In the US, almost half of infectious disease fellowship positions remained vacant in 2022. Many physicians are deterred by lower pay and high training costs. Without improved incentives, fewer professionals will choose this career path.

A sustainable strategy for AMR

A strategic and long-term approach is urgently needed. This involves expanding pull incentives and ensuring that governments view antibiotics as essential infrastructure, similar to vaccines or emergency response systems. It also requires investing in the workforce. The private sector cannot address this issue alone, and collaboration among governments, academic institutions, non-profits, and industry is crucial to revitalizing the R&D ecosystem. Organizations like ICARe and Future Leaders Against AMR are playing a key role in training the next generation of researchers, and these efforts must be expanded and maintained.

While there is no shortage of scientific talent globally, talent requires opportunities, stability, and support. Without these, we risk losing the individuals best equipped to tackle the AMR crisis. The repercussions of inaction are evident in lost innovation and lives.

It's time to reinvest in the individuals behind the development of new antibiotics. To bring effective, equitable, and accessible antibiotics to the market, we must address the underlying issues in the system supporting their creation. This begins with recognizing the value of researchers who pave the way for a healthier future.