In case you missed it, ABC’s 4 Corners ran a story on multi-resistant organisms. The NDM-1 plasmid featured. The NDM-1 metallo-carbapenemase gene is capable of hydrolysing carbapenems. Other elements on the plasmid and within the bacteria create an almost pan-resistant phenotype. To further complicate it, the resistance mechanism is transmissible to other gut colonising Gram negatives. The few drugs available to treat these organisms are toxic.
The antibiotic pipeline is currently thin. With few new drugs being produced. These drugs belong to existing classes, including the β-lactams. If past experience is a guide, existing enzymes will mutate to more efficiently degrade these new targets. Even if such mechanisms do not exist, other mechanisms may confer partial protection. As a direct consequence, antibiotics are not as profitable as other classes of drugs. Further, to increase return on investment for antibiotics volume must be achieved. This of course has led to functional groups being substituted to enable bulk sales for agricultural use. It’s no surprise that this in turn has driven resistance.
Remaining cognizant of the public health crisis posed by a lack of suitable antibiotics, strategies are being proposed to encourage pharma R&D. The leading proposal so far has been to give the drug companies “wild-card” patent extensions. The proposal allows the drug company developing an antibiotic to extend the patent on any other drug it has developed. Whilst this would allow them to recoup some of their capital, the cost will be borne by other members of the community. Typically, these extensions will be applied to drugs taken for chronic conditions. Is this right? To stress the point again, this is a public health issue. The threat of MROs is community wide. The response therefore shouldn’t penalise any one sector of the community. As this problem requires strict control to limit abuse, and further funds to develop new chemotherapeutic agents, investment should come from government. The removal of the profit motive also removes temptation to abuse. Further, no one loses from investing in these desperately required agents. We must also assist third world countries in improving santiation to break transmission and stop amplification of MROs. This is an equitable solution and meets all strategic objectives. The question that remains, do we have the drive to fix a problem prior to its becoming an existential threat?
The BBC also ran an interesting SuperBug article back in September