John
As a parent, there is nothing worse than your kid being sick. When the illness is cancer, the emotional impact is monumental. That is the situation my wife Barbara and I found ourselves in with our youngest, who was diagnosed at age 13 with acute lymphoblastic leukemia (ALL).
When we started down that long, frightening path, we expected to be frequent visitors at the hospital and doctors’ offices for appointments and treatments. We didn't anticipate the incessant infections that exploited my daughter’s weakened immune system.
The worst was a one-month stay when her blood cell count couldn't get above the number required for discharge until late on 24 December, thus avoiding her spending Christmas in the ICU. We were fortunate that this particular infection was not a drug-resistant superbug. After she recovered, I remember thinking about how other families aren't so lucky.
Medicine has made huge advancements in cancer treatment over the last two decades. Meanwhile, we seem to be going backwards in treating life-threatening infections. The rise of drug-resistant superbugs, which contributed to the deaths of nearly five million people globally in 2019, is rendering antimicrobial tools ineffective and threatening people around the world.
People with cancer are prone to infections; their immune systems are compromised, and they spend a lot of time in medical settings – a significant source of drug-resistant infections. One study estimated that the mortality rate of fatal infections for cancer patients in the US was nearly three times that of the general population. The situation is more pronounced in low- and middle-income countries, which tend to have less resilient health care systems. It’s a double whammy: people have difficulty accessing and affording oncological care while cancer rates are on the rise. Estimates suggest that by 2030, 75% of cancer deaths will occur in LMICs.
Physicians are all too aware that, as much as they need new cancer therapies, they also need new ways to treat infections. A recent survey of oncologists in the UK showed that nearly 50% of them are worried drug-resistant infections will soon render chemotherapy unviable.
Why are we making such great strides in one critical area of patient need and coming up short in another? It comes down to risk versus reward. The market does not reward antibiotic innovation the same way it does for most other therapeutic areas, where safe and effective treatments can sell well, and are worth the time and resources in research and development. But new antibiotics must be used sparingly to conserve their effectiveness, which limits their volume of sales and the likelihood the company will ever recoup its investment—let alone make any profit.
Many large pharmaceutical companies have scaled back or shelved their antibiotic programmes, leaving most research and development in the hands of small companies reliant on private equity. This trend does not bode well for antimicrobial advancements. Consider that, between 2011 and 2020, venture capital firms’ investments in oncology drugs grew by billions of dollars while investments into antibacterial research remained flat.
To help bring private investment back into this cornerstone of medicine, a group of pharmaceutical companies, along with the European Investment Bank and the Wellcome Trust, established the AMR Action Fund.[Ed. note: AMR, antimicrobial resistance] With nearly USD 1 billion under management, the Fund is investing in a range of small and mid-size biotech companies, which are developing antimicrobials for priority drug-resistant pathogens identified by the World Health Organization and the Centers for Disease Control and Prevention in the US.
While the funding is proving to be a vital lifeline for these small companies, the harsh reality is that they will still have to navigate the fundamentally flawed market and face the possibility of bankruptcy. To remedy this situation, it is imperative that governments enact policies that reward the successful development of new antibiotics irrespective of how many units are sold. Sometimes called “pull incentives,” these types of policies are critical to ensuring that patients can access new antibiotics and that investors continue to support innovative research and development to replenish the ailing pipeline of antimicrobials.
Cancer touches so many lives. Cancer Moonshot in the US, which aims to cut the death rate from cancer by at least 50% in the next 25 years, will benefit millions of people. At the same time, LMICs are facing an even more daunting task: survival rates for cancer are much lower than in high-income countries, largely owing to the quality of health care available, including access to effective antimicrobials. To reduce the cancer burden globally, we need effective, enduring treatments for drug-resistant infections.
With smart policies and continued investment, we can break the life-threatening synergies between cancer and AMR to the benefit of patients everywhere.