Learning from our mistakes: using key opportunities to remove the perverse incentives that help drive antibiotic resistance

ABSTRACT

Introduction: Governments need to do far more to help curb the emergence and transmission of antibiotic resistance and help protect the efficacy of any new antibiotics that come to the market. Industry is an important stakeholder that must be brought on-board such efforts given its influence on the direction and scale of antibiotic sales. Financial incentives supporting industry R&D of novel antibiotics should structurally remove the drivers of superfluous sales and encourage access to newer antibiotics where infections are otherwise resistant to treatment. Indeed, the use of public money provides an important opportunity to prioritize these public health goals within market structures such that we both adequately reward industry for their efforts and prolong antibiotic efficacy for as long as possible.

Areas covered: This work discusses possible financial ‘pull’ incentives that fully delink the reward paid to the developer from unit sales, examining their primary advantages and limitations.

Expert opinion: Pharmaceutical companies need to be rewarded generously for their efforts to develop new, badly needed antibiotics. But the current marketplace does not provide a sustained financial lure and its reliance on unit-sales for profitability jeopardizes the efficacy of antibiotics both new and old. Fully delinked models can make antibiotic R&D more financially appealing and create a market environment that is far less threatening to public health.

KEYWORDS:

• Antibiotics
• antimicrobial resistance
• incentives
• research and development (R&D)

Acknowledgements

The authors would like to thank the bright minds of Work Package 2 who helped with this work.

Article Highlights

• In relying on unit sales to reward companies the traditional market approach has an inherent perverse incentive that contributes to the growth of antibiotic resistance.

• Numerous delinked reward models exist that can improve the financial attractiveness of antibiotic R&D without the risk of maximizing antibiotic consumption.

• Brokered mechanisms help ensure appropriate product distribution, stewardship, and administration, which is crucial in jurisdictions with limited procedural and oversight capacity.

• Delinked reward frameworks will be expensive to fund and manage but this cost pales in comparison to the sums needed to deal with infections rendered untreatable by continued inappropriate consumption and the sales-driven incentives of the current business model.

• Governments considering R&D subsidies should use them as a vehicle for this badly needed change in the antibiotic business model.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the Innovative Medicines Initiative. The work was undertaken as part of Work Package 2 of the initiative Driving re-investment in R&D and responsible antibiotic use – DRIVE-AB (www.drive-ab.eu). Resources for the overall initiative were composed of a financial contribution from the European Union’s Seventh Framework Programme (FP7/2007–2013) and EFPIA companies’ in kind contribution. This work does not necessarily represent the view of all the Work Package members nor all of the DRIVE-AB partners.