The Problem with Pathogen-Selective Antibiotics
34 Pages Posted: 23 Oct 2018 Last revised: 14 Oct 2019
Date Written: March 16, 2019
In the battle with bacteria, humanity is outnumbered and outgunned. The ability of bacteria to quickly evolve and share antibiotic resistance strategies, combined with humanity’s indiscriminate use of broad-spectrum antibiotics, has created a terrifying antibiotic resistance crisis: soon, even a simple scrape or a routine medical procedure may become life-threatening. Hope may lie in pathogen-selective antibiotics. That is, if we design “magic bullet” drugs that each target only one bacterial species, we can avoid the problems of cross-resistance and antibiotic overuse that have led to the current crisis. But that’s difficult, both scientifically and economically. Current antibiotic incentives focus on antibiotics as a broad monolith and are generally inadequate for incentivizing the development of one-bug-per-drug therapies.
Here I identify two important respects in which pathogen-selective, “one-bug-per-drug” antibiotics differ from traditional, broad-spectrum drugs: conditional spillover benefits and network-dependent social utility. These characteristics must be considered if we are to incentivize development of a pathogen-selective arsenal. Accordingly, I suggest that a comprehensive prize or bounty framework, targeted research grants, coupled or tolled exclusivity, or revised clinical trial standards may be useful tailored solutions. Last, I suggest that it might be more generally useful, in innovation scholarship, to think generally about incentive frameworks not in terms of disease or symptom but rather in terms of the contextual relationship be-tween the drug, the doctor, the disease, and society.
Keywords: antibiotics, antibiotic resistance, FDA, exclusivity, spillover, innovation incentives, grants, prizes
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