"Drug-resistant infections are already costing lives all over the world. A problem of this scale can only be tackled through coordinated international effort to curb our massive overuse of existing antibiotics, and to accelerate the development of new ones.”
Those words were spoken by Jeremy Farrar, Ph.D., director of the Wellcome Trust, the U.K.-based organization that announced a dramatic new focus on global health challenges after last year’s shakeup. At the front of Farrar’s mind is a terrifying fact that's been getting a lot of attention lately: After a spectacular eight-decade run, antibiotics—maybe the most important medical breakthrough ever—have been losing their punch, with potentially catastrophic effects on human health and well-being.
Antibiotic-resistant strains of pathogens including staph, C diff, pneumonia and tuberculosis are emerging and spreading. The CDC estimates that antibiotic-resistant bacteria claimed more than 23,000 U.S. lives in 2015. A comparable number of people died in the E.U., and the global total is far higher still.
This summer, the sense of crisis has risen fast amid the discovery of a new "superbug" that can't be stopped by even the most effective antibiotics.
A number of foundations have been worrying about antibiotic resistance for a while, now. The Robert Wood Johnson Foundation has eyed this issue over the years and, among other things, funded an initiative based at the Center for Disease Dynamics, Economics & Policy that helped "raise broad awareness about the growing threat of antibiotic resistance and offered comprehensive solutions to address the problem." Last year, a RWJF-backed report argued that the U.S. "must redouble efforts to better protect the country from new infectious disease threats, such as MERS-CoV and antibiotic-resistant superbugs, and resurging illnesses like whooping cough, tuberculosis and gonorrhea."
The Pew Charitable Trusts is another foundation that works on antibiotic resistance, focusing on different aspects of this problem, including overuse of antibiotics in food animals like chicken.
As might be expected, the Gates Foundation is alarmed, too, and backs research and solutions in this area. Early this year, it opened a Grand Challenge competition on antimicrobial resistance, specifically focusing on creating better tracking data. Among its earlier efforts was bankrolling a push by Resources for the Future to reduce the overuse of antibiotics in developing countries.
There are two main tracks for grappling with the antibiotic resistance threat, and funders are backing both. One is trying to reduce the chronic overuse of antibiotics. The second is to accelerate the development of drugs that outsmart the superbugs and still get the job done. As an RWJF issue brief says, "Unless new drugs are developed—together with measures taken to slow the emergence of new drug-resistant microbes—previously treatable infections will become major public health concerns, posing grave threats to infected individuals and increasing the risk of spreading to others."
Last year, the Obama administration announced the CARB (Combating Antibiotic Resistant Bacteria) initiative, building a coalition including the Broad Institute of MIT and Harvard, the NIH’s National Institute of Allergy and Infectious Diseases, RTI International, the Massachusetts Biotechnology Council, and the California Life Sciences Institute, along with the U.S. Centers for Disease Control.
In July, the U.S. Department of Health and Human Services, the Boston University School of Law, the Wellcome Trust and the Antimicrobial Resistance (AMR) Centre announced a $350 million accelerator: CARB-X, designed to speed development of new antibiotics and swift diagnostics.
We wouldn't be surprised to see more private funders beyond Wellcome getting behind this initiative, given what's at stake here.
CARB-X is headquartered at BU Law, and while a law school might seem like an odd nexus for a global health partnership, bear in mind that the limiting factor of drug development isn’t often the science—it’s the legal and economic framework that gums up the works.
Up to $250 million in grants promised by HHS’ Biomedical Advanced Research and Developmental Authority and up to $100 million promised by the AMR Centre will seed a brand-new antibiotics pipeline, one that works smoothly to develop new drugs and save lives.
What will it look like? Well, according to BU health law director and CARB-X’s Executive Director Kevin Outterson, "The bulk of the money will go to research labs and small companies developing innovative products all over the world. We will fund the best science, wherever found. The goal is to invest money so that the products society needs will be ready in a decade. This is a social investment. We're trying to build a fire station before the buildings catch on fire."