Biotechnology, Health, Medical, Pharmaceutical industry, Science

Big pharma failing to address our greatest medical threat

GLOBAL HEALTH SECURITY

Intro: Drug-resistant infections now kill more people every year than HIV or malaria, yet only six companies remain active in antibiotic research

Writing in the last few days, Professor Lord Darzi, FRS, said that big pharma is failing to tackle our greatest medical threat.

The world-renowned and eminent surgeon says that every caesarean section, joint replacement, and round of chemotherapy depends on antibiotics. In medicine as in war, a successful attack needs a solid defence. Antibiotics are not medicine’s glamourous front line – they are its foundations. And those foundations are crumbling.

Citing that drug-resistant infections now kill 1.27 million people every year, by 2050 the toll could reach eight million. The current mortality rate is more than HIV or malaria. The World Health Organisation (WHO) has warned that one in six bacterial infections is already resistant to standard treatment.

Yet this growing threat has been neglected by the very industry that has the capacity and resources to confront it. The major pharmaceutical companies walked away from antibiotics when they stopped generating lucrative returns. In the 1980s there were 18 companies involved in antibiotic research. By 2020 the number had fallen to six. The rest have pivoted to focus on expensive but highly remunerative medicines to beat cancer and long-term conditions such as obesity.

The ways in which these new medicines attack disease is indeed transformative, but they do not save lives all by themselves. Patients undergoing treatment are at higher risk of infection, but without effective antibiotics, the surgeon cannot operate safely, the oncologist cannot deliver chemotherapy, and the transplant physician cannot suppress rejection.

It is strategically incoherent to innovate relentlessly in attack while underinvesting in defence. The defensive arsenal is not optional infrastructure. It is foundational.

Between 2011 and 2020, US venture capital invested just $1.6bn in antimicrobials, compared with $26.5bn in oncology. The antimicrobial pipeline has declined by 35 per cent since 2021, from 92 to 60 projects, according to the 2026 AMR Benchmark report by the Access to Medicine Foundation, last month. Half are led by GlaxoSmithKline (GSK), which is carrying a disproportionate share of the large-company burden.

There are now only 3,000 active antimicrobial resistance (AMR) researchers worldwide, against 46,000 in oncology. When antibiotic programmes close, 90 per cent of researchers leave the field entirely. The talent and expertise needed for these medicines is collapsing alongside the drug pipeline.

This weakness puts at risk the pharmaceutical industry’s own growth. In 2024, global oncology revenues exceeded $200bn and R&D investment surpassed $40bn. Yet one-third of cancer patients develop bacterial infections during treatment, and up to half of these are now resistant – causing delays, dose changes, and poorer outcomes.

Developing new antibiotics is especially challenging. Most drugs succeed commercially by reaching as many eligible patients as possible. But for antibiotics, good stewardship means reserving novel agents for resistant infections – precisely the behaviour that collapses commercial returns.

In 2020, a consortium of more than 20 major pharmaceutical companies committed around $1bn to bridge the “valley of death” between discovery and profitability by creating the AMR Action Fund. The fund’s ambition was to deliver two to four new antibiotics by 2030. To date, it has delivered one – pivmecillinam, for urinary tract infections.

Bold initiatives such as this $1bn scheme look impressive. But there is a danger of their becoming “guilt capital” – spending that looks responsible but does not change the underlying economics. Without genuine pull incentives, and without adequate investment in diagnostics, stewardship, and surveillance alongside drugs, the spending risks being perceived as reputational insurance rather than strategic investment.

Most tellingly, the fund itself acknowledges it “struggled to find investment opportunities in clinical development exactly because the pipeline is insufficient”. When a $1bn fund cannot find enough assets worth backing, the problem is not capital. It is upstream failure to generate candidates and downstream failure to create a market that rewards success.

The conclusion is quite simple. We need a new approach.

First, build a sustainable pipeline through modern discovery – including AI-enabled research that must prove itself with real-world data – and implement payment models that reward access rather than volume. The UK’s subscription-style scheme is now being expanded. Similar approaches in other countries could create a viable global market.

Second, reduce misuse through transformative diagnostics. Rapid pathogen identification and resistance profiling at point-of-care would cut inappropriate prescribing – the single largest driver of resistance – and protect new drugs from the fate of their predecessors. A deadline should be called: no antibiotic prescription without a diagnosis by 2030.

Third, strengthen stewardship, surveillance, and access so that new antibiotics are protected, monitored, and reach patients appropriately anywhere in the world – particularly in low-income and middle-income countries where the burden of resistance is heaviest.

In 2028, we will mark the centenary of Alexander Fleming’s discovery of penicillin at St Mary’s Hospital in London – a moment that launched the antibiotic era and transformed human health. The centenary should be a moment of celebration. It risks becoming a memorial if action is not taken.

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Britain, Defence, Economic, European Union, Government, Military, Politics

Labour’s defence spending. A ruse

UK DEFENCE SPENDING

Intro: Ministers are resorting to desperate measures to boost Britain’s military budget

“We cannot defend Britain with an ever-expanding welfare budget … We are under prepared. We are under insured. We are under attack. We are not safe … Britain’s national security and safety is in peril.”

If these words had been said by James Cartlidge, Britain’s almost invisible shadow defence secretary, no one would have batted an eyelid. This sort of rhetoric is what Opposition politicians are supposed to say, whether justified or not.

But when it’s said by no less a Labour stalwart than Lord George Robertson – a former secretary general of NATO and the principal author of the Government’s recent Strategic Defence Review – it really is time for everyone to sit up and take notice.

Robertson is blunt and direct in his language when he says policy was being determined by the “corrosive complacency” of non-military experts in the Treasury. This has led to repeated delays to the 10-year investment plan caused by arguments over how to fund it.

It is of course a core part of the Treasury’s function to say no to the constant stream of departmental demands for more money. Someone has to keep the lid on burgeoning government spending and it falls to the Treasury to perform that role.

It should be said that this would be an understandable, even an admirable, characteristic if it were applied across the board to all forms of public spending.

What so infuriates military chiefs, however, is the double standards the Treasury seems to apply, not to mention the vast gap that separates the political dogma from reality. There could scarcely be a more vital government function than defence of the realm, for everything depends upon it from national to an individual person’s basic security; yet ministers pay lip service to its importance.

At the same time, too, they’ve squeezed defence spending to virtual oblivion. The proportion of national income devoted to welfare and public sector pay, coincidentally, has run out of control.

This didn’t happen by accident. It was done deliberately from the end of the cold war onwards. The resources once thought necessary for defence were instead diverted into social and health spending – a so-called peace dividend that allowed for a massive expansion of the welfare state.

Defence spending has meanwhile shrunk from about 5pc of GDP at the time of the Falklands war in the early 1980s to just 2.3pc last year.

Only belatedly have ministers realised their peril. Russia’s invasion of Ukraine was warning enough. US threats to withdraw from NATO provided another wake-up call. Then came the national humiliation of being unable to field a single frigate to defend British interests in the latest outbreak of hostilities in the Middle East.

There seems to be plenty of money that can be found when it comes to inflation-busting increases in public sector pay, yet ministers struggle to find the resources needed to sustain an operational navy. Somewhere along the line, the Government lost its sense of priority.

While welfare spending, taxes, and borrowing mushroom, there are still no answers as to how to deliver even the relatively unambitious targets the Government has set for defence – 3pc of GDP by the end of the parliament and 3.5pc by 2035.

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In acts of desperation, ministers are reaching for what they amusingly call “creative solutions”, apparently unaware of the unfortunate connotations the expression carries in accountancy circles – as in “creative accounting”.

If increased defence spending can somehow be kept off the public balance sheet, then miraculously it immediately becomes perfectly “affordable”.

In pursuit of such sleight of hand, the UK is exploring setting up a new mechanism for collectively funding defence spending with the Netherlands and Finland. There is also the possibility of Poland and other NATO allies joining in.

The attraction of the scheme is that under international accountancy conventions, the additional spending moves “off balance sheet” if the entity pursuing it is multinational. Typically, a minimum of three countries is required to satisfy these requirements.

It’s cajolery and a swindle, because whichever way you cut it, and however the entity is funded, ultimately it’s the customer that pays, and the customers here are the three countries involved. Eventually, the costs will bounce back on to the British taxpayer.

Still, if it helps support the additional spending the military so desperately needs, it would perhaps be perverse to knock it. But it is also just an accounting ruse that allows the Government to spend money that it doesn’t have. Markets are sensing hidden deception and that something is wrong, and rightly so.

As is apparent from International Monetary Fund (IMF) analysis just published, Britain is in a dire fiscal hole, with fast rising taxes and borrowing struggling to keep up with increased welfare and other forms of government spending.

The peace dividend is gone, so the Government is desperately searching for ways of cooking the books in the hope that nobody notices. In practice, few are going to be fooled by this kind of window dressing.

Already, there are hundreds of billions of pounds worth of government liabilities conveniently shunted into the shadows of off-balance sheet finance, including the costs associated with previous wars in Iraq and Afghanistan. This would further add to them.

How Britain is going to pay for increased defence spending is anyone’s guess. Even the Prime Minister, Sir Keir Starmer, said that the Government was still trying to figure out how to do it in conjunction with European partners. Many will be sensing what he meant is the charade of international defence procurement and financing.

Seeking solutions in Europe is becoming a bit of a thing with this Government. Getting closer to the EU is also proposed as a solution for the country’s lack of growth, even if it is hard to see how a little “dynamic alignment” in standards is going to make much of a difference. But this halfway house doesn’t get the Prime Minister or the country anywhere. It is certainly not going to get the UK out of the fiscal hole it has dug for itself.

In terms of the public finances, Britain is on the ropes. It is also widely considered to be acutely vulnerable to the current energy price shock. The IMF expects UK growth this year to be slower and inflation higher than any other major advanced economy.

Worse still, the tax burden is projected to rise by more than anywhere else in the world during the remainder of this parliament, and that’s on the basis of what we already know about the Government’s plans. It is eminently possible to imagine further shock announcements to come. And yet public debt is still expected to swell to more than 100pc of GDP by 2029.

A rational person would have thought that somewhere in this developing financial Armageddon, the money might have been found to at least keep the military operational.

But no, social spending priorities continue to eclipse all else.

Resorting to accounting tricks only makes matters worse.

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History, Military, Politics, Second World War

Chamberlain had courage. Does Starmer?

POLITICAL HISTORY

Intro: Trump’s comparison between the pair misses the point. Despite what the critics say, whilst Chamberlain did make some grave errors he did have courage. What will Starmer’s legacy leave on the pages of history?  

Just a few days ago Donald Trump delighted in comparing our Prime Minister, Sir Keir Starmer, to Neville Chamberlain. Winston Churchill’s predecessor is blamed for the failed policy of trying to appease Hitler rather than confront German expansionism across Europe in the years before the Second World War.

Chamberlain is the most vilified of British prime ministers, “the guilty man” who, it is argued, failed to deter Hitler and left us almost defenceless when he resigned in May 1940.

Had Donald Trump studied history a little more carefully, he would not have made the comparison, however. Far from failing in his duties, Chamberlain was the author of the rearmament policy from the mid-1930s that made it possible for Britain to stand firm in 1940.

To compare our current prime minister to him does a grave disservice to Chamberlain, while some might say it greatly inflates Starmer’s political courage and grasp of strategy, neither of which is in evidence in his policies or speeches. Despite frequent public denigration today, Chamberlain’s reputation among historians is higher than might be expected.

As Chancellor from 1931-1937, and then as Prime Minister, he stuck to a double strategy: try to ease tensions with Germany through diplomacy, while at the same time rearming. Rearmament would not only prepare Britain for any future conflict, but would also deter German aggression by showing that we had the means and commitment to fight.

No one looking at Britain today, with its naval ships and fleet under constant repair, its tanks numbering at only a few dozen, and its Army unable to field anything larger than a brigade – about 5,000 men – for about a month of fighting, would be deterred by the readiness of our Armed Forces.

Chamberlain was the principal author of defence plans from 1936 that committed £1.5bn – then a vast sum – over five years to rearmament. He recognised that Britain’s defence would depend on airpower and set a target of nearly 2,000 front-line planes for the RAF. Were it not for this far-sightedness we would not have had the Spitfire and Hurricane and would likely have been invaded in 1940. New warships were commissioned for the Navy; older ships were modernised.

After Hitler’s invasion of the Czech provinces of Moravia and Bohemia in March 1939, this programme was rapidly accelerated. The Ministry of Supply was established to oversee the production of military equipment, and peacetime conscription began. The Territorial Army was doubled in size. Just as war began in September 1939, the famous chain of radar stations around Britain’s coastline became operational.

Revealingly, Chamberlain had been attacked during the 1935 election campaign by the deputy leader of the Labour Party, Arthur Greenwood, for the “disgraceful” suggestion “that more millions of money needed to be spent on armaments”.

Chamberlain understood something else about war readiness: the need for strong finances. Any war would likely be a long one, and a strong economy with reserves to spend would play a vital part in any struggle. He planned for what is now called headroom, fiscal surpluses that could be used in time of national emergency. In 1937, he put up income tax to 5s in the pound.

Today, our peacetime taxes are at the highest levels since the end of the Second World War and yet we have no headroom at all. Everything points to cuts in expenditure, above all to pay for a ballooning welfare bill. Starmer, though, does not have the courage or political capital to tell his backbenchers, as the former Labour prime minister, Jim Callaghan, told the Labour Party conference during the 1976 International Monetary Fund (IMF) crisis, “the party’s over”: the spending on benefits has to stop.

Chamberlain is rightly blamed and held accountable for giving Germany the Sudetenland, then part of Czechoslovakia, at the 1938 Munich Conference, and for taking Hitler at his word by believing his protestations of peace. These were crucial failures of judgment. Then, when war came and Britain’s position looked increasingly hopeless, Chamberlain lacked the resolve to fight.

It was in this context, in May 1940, that the Conservative MP Leo Amery, speaking in the House of Commons, and using words attributed to Oliver Cromwell, demanded of Chamberlain: “In the name of God, go!”. If the upcoming local elections in May don’t finish off Starmer, it is quite likely that someone will say these words to our current prime minister.

For military campaigners and those on the political right will surely argue it would be excellent if Starmer could behave with Churchillian resilience and bravery by living up to our responsibilities to NATO and the free world. Failing that, it would be enough if he could follow Chamberlain’s example and at least lay a basis for having a stronger military and economy that we now require.

If Starmer really did behave like Chamberlain he would leave a better legacy, and also do something that would save his future reputation among historians. Time is short and running out for Starmer politically, but he still has time to act.

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