What could the future antibiotic pipeline look like: IFPMA releases its latest report

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has recently released a report, which talks about different scenarios with regard to the future of antibiotic development. The report, titled From Resistance to Resilience: Reinforcing the Response to Antimicrobial Resistance, was launched at an event last week organised by magazine Foreign Policy.

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IFPMA partnered with Airfinity, a United Kingdom-based disease forecasting company, on a new modelling technique to build an understanding of how the antibiotic development pipeline might evolve over the next 10 years, starting in 2023. 

It is now widely acknowledged that the current status of the pipeline is weak, fragile and insufficient to protect against increasing resistance. Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines.

The World Health Organization (WHO) has identified AMR as one of the biggest global health threats facing humanity. This phenomenon is directly responsible for approximately 1.2 million deaths around the world and is associated with approximately 5 million deaths annually. 

As a result, there is an urgent need to identify incentives and approaches to accelerate the development of new antibiotics.

The report discussed two scenarios for the impact of incentives on the antibiotic development pipeline:

• Scenario I, where no new incentives are introduced that could encourage investment in antibiotic research and development (R&D). Under this scenario, the report predicts that in 10 years’ time, the pipeline is expected to contain 26 treatments, of which only six are in the late stages of development and eight are approved. 
• Scenario II, where effective pull incentives are successfully introduced in 2025: In this scenario, in 10 years’ time, it is expected there will be 19 new antibiotics approved and a pipeline consisting of 72 treatments in different stages of clinical research, of which 41 are in the late stage.  

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The report additionally highlighted the impact of a stronger antibiotic pipeline, modelling the expected disability-adjusted life years (DALY) burden from four WHO critical priority pathogens.

Without new incentives and without new antibiotics to treat resistant infections, the burden in high-income countries is expected to increase by approximately 35 per cent on average over the next 10 years compared to today.

However, if effective incentives are introduced, and new antibiotics against these pathogens are approved as a result, these are expected to help deliver a reduction in the DALY burden of more than 50 per cent compared to no new antibiotics.

The  analysis didn’t cover low- and middle-income countries, however, the report did mention that a similar benefit would be expected globally.

James Anderson, executive director, Global Health, IFPMA, released a statement on the report: 

This analysis demonstrates why urgent action is needed if we are going to reinforce our pipeline of antibiotics and protect the world from rising drug resistance.

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The report reached its conclusions by considering several assumptions. For example, it assumed that pull incentives would be substantial enough to attract the investment needed to avoid delays in the progress of all antibiotics that successfully pass the previous phase of development.

Within antibiotic development incentivisation, there are broadly two types of approaches: Push and Pull. Pull incentives provide a known return on investment to those who have successfully developed a novel antimicrobial, helping to bring it into the market.

These incentives apply when an antibiotic has passed through the clinical trial stages and is ready for market entry. 

Unlike push incentives, which fund the early stages of antibiotic development, pull incentives do not address the risk of failure in early-stage development. These incentives are largely driven by national governments and involve significant financial commitments.

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Researchers from Delhi-based think tank Centre for Science and Environment (CSE) wrote an article, ‘A Developing Crisis’, for the July 16-31, 2023 edition of Down to Earth. In the assessment, the researchers have highlighted how the global antibiotic pipeline is weak across the pre-clinical and clinical development stages. 

The authors analysed the clinical pipeline of 15 high-earning pharmaceutical companies to understand their R&D focus and the role of small and medium pharmaceutical companies. The assessment also covered incentives to support antibiotic R&D and what needs to be done further.  

In 2023, CSE also conducted a series of webinars on this issue and released a report, which culminated the findings of the webinars.

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