I had an interesting discussion yesterday about the “antimicrobial pipeline” as part of the Global Leaders Group on Antimicrobial Resistance. When we talk about the antimicrobial pipeline, we’re referring to the dwindling number of new antimicrobial drugs that are currently in development. Antimicrobial research and development (R&D) has fallen by the wayside over the past decades as pharmaceutical companies focus on higher-profit drugs – typically those that are more likely to be used for chronic or lifelong conditions, not critically important antibiotics that will be used as sparingly as possible.

So, as antimicrobial resistance (AMR) continues to increase, we don’t have a wealth of new drugs to compensate for older drugs that are becoming less and less effective.

Discussion of the antimicrobial pipeline usually revolves around funding to support new drug development. That’s a complex area that I won’t get into much, but it’s a huge part of the issue. We need money to support new drug development, to get more drugs into the pipeline.

However, increasing the flow into the pipeline is only part of the solution. Another big problem is the holes that are in the pipeline.

Pumping more into the pipeline helps to some degree, but if we don’t plug the holes, we can’t maximize the benefits of all the time and money that go into the R&D of new drugs. If we put a few hundred million dollars into supporting a new drug without plugging those massive holes in the system, we may end up right back in the same position in the not-too-distant-future… more resistance and a need for more new drugs.

Yes, we need more funding for new drugs, to develop them, license them and get them distributed everywhere they are needed.

At the same time, we need to fill the holes in the pipeline. There are lots of them. For example:

  • Inappropriate antimicrobial use in humans
  • Inappropriate antimicrobial use in animals
  • Inadequate healthcare access
  • Inadequate animal/veterinary healthcare access
  • Poor animal management
  • Inadequate use of preventive measures (e.g. vaccination, infection control, biosecurity)
  • Inadequate development and use of alternatives to antimicrobial drugs
  • Inequitable access and distribution of antimicrobials (leading to poor or ineffective use)
  • Defensive medicine

And the list goes on.

Yes, we absolutely need to better fund antimicrobial research and development. But, we can’t rely on that alone to solve the problem. We need to fix (or at least minimize) all the holes in the pipeline at the same time, to reduce the need for new drugs, to reduce the emergence of resistance to new drugs, and to maximize the effective use of new drugs (including for how long they remain effective). If we don’t fix the holes, our efforts to feed more R&D into the pipeline will simply be a waste. In the end we’d only slightly delay the bigger crisis, rather than fixing the problem long term.