Countries need to incentivise drugmakers to make it worth their while investing in the development of new antibiotics.

That is the key point in a report published by the Office of Health Economics (and funded by GlaxoSmithKline) which specifically calls for a "shake-up in the way future antibiotics are to be rewarded in Europe so that biopharmaceutical companies can spend more to fight superbugs".

Bacteria have developed resistance to almost every single antibiotic developed in the past 50 years, the analysis notes, and the rate of resistance to new antibiotics is increasing rapidly, with new superbugs emerging all the time. Very few new classes have been discovered in the past decades and the two main reasons for this, according to the OHE, are the "low returns on R&D investment in this area and a restricted use of newer antibiotics to manage resistance".

The report makes a couple of alternative recommendations at European level on how future antibiotics should be rewarded. First up, it suggests "a hybrid approach whereby EU regulatory authorities need to provide an accelerated review for new antibiotics and member states should ensure that prices reflect the growing cost of antibiotic resistance. This should be accompanied by restrictions on the use of new antibiotics to delay the build-up of resistance".

Upfront fee on registration

A second approach would see companies receive "an upfront payment for registration, rather than for volume of use". If correctly designed, the OHE says this second recommendation is "better able to balance the tension between public health goals of policy makers - to slow the growth and spread of resistance and encourage the development of new antibiotics - and the need for pharmaceutical companies to earn a return on their R&D investments".

The report also calls for more research to better quantify the value of the expected health benefits of investing in antibiotic R&D, and for more dialogue, "not only between the EU and the USA but, given the global nature of the problem, other institutions as well".

OHE director Adrian Towse notes that the European Commission has been tasked to come up with a comprehensive action plan with proposals for incentives to develop new antibiotics by the end of this year. "It is essential that this happens," he says, and that "new incentives are introduced to make sure that we get new antibiotics and that their use is managed to prevent superbugs building up resistance”.