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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Biotechnology, Government, Health, Medical, Science, Society

Genomic medicine is being blocked by the NHS

NHS: GENOMIC MEDICINE

THIS MONTH the NHS will become the first health service in the world to offer whole genome sequencing to patients where clinically appropriate. Heralded by NHS leaders as “a new era of genomic health”, the goal is to use these data and new technologies to decode and treat previously intractable diseases, to move away from symptomatic treatments to cures and prevention.

The Prime Minister has said she wants the UK to lead the world in this new area of science – to continue a tradition of innovation in this country that will “extend horizons and transform lives”.

Theresa May’s ambition to lead the world in genomics and precision medicines is one that we should all want to support. Scientists and doctors know that pioneering precision medicines and their advances change lives, but they will also be aware of the challenges that must be overcome to realise its potential. This is not necessarily because the science is lacking, but because a fundamental shift in thinking is still needed by governments, regulators and policymakers in how they assess the value of this innovation.

Cystic fibrosis (CF) is an excellent example of this challenge. In 1989, when the cystic fibrosis gene was first identified, scientists did not know how mutations in the gene caused the condition. There was nothing to treat the underlying cause of the disease and people could only seek treatment for their symptoms.

After nearly 20 years of research and development by hundreds of scientists, and the design, synthesis and testing of more than 400,000 unique molecules, they have now done what was once thought impossible – discovered and brought to nearly half of all CF patients the first medicines to treat the underlying cause of this devastating disease. Today, multiple medicines approved by the EU and U.S. now exist, and there are more coming down the line. The ultimate goal is to cure CF once and for all.

For this remarkable cycle of innovation to be completed, Governments must now play their part, by providing patients with access to these medicines. Three years after approval of these medicines, this has still not happened because scientific innovation is outpacing the UK medicines evaluation system.

The evaluation criteria and processes used by the NHS and the National Institute for Health and Care Excellence (NICE) are currently preventing them from being made available to patients. Despite universal acceptance of the benefits that these medicines will bring, people in the UK have been waiting for access for more than 1,000 days, while thousands of people with CF in other countries in Europe and the US have been benefiting from them for years.

CF patients don’t really have the time to wait. Half of those with this cruel disease will die before they are 31. Science has delivered the breakthroughs, but the system is blocking access. The UK has the second largest number of CF patients in the world.

In 2016, the UK’s own chief medical officer recommended a fundamental shift in how new transformative medicines are developed and appraised for use in healthcare systems. The appraisal system in the UK needs to reflect that the genes and pathways underlying genetic diseases seldom respond to traditional pharmaceutical approaches, and so precision medicine requires risk-taking innovation.

The Life Sciences Industrial Strategy, a report made to the Government just last year, echoes many of these sentiments. It outlines the need for industry to take on bold, far-sighted ambitions in the life sciences with the intention of creating commercial success, underpinned by novel technology and higher-risk science. The strategy singles out a handful of successful biotech companies with highly innovative products. Yet, unlike in many other European countries, the NHS and NICE have not yet followed these recommendations and evolved their evaluation criteria for these types of transformative precision medicines.

The Government must surely need to act, not just for more than 10,000 people currently living with CF in the UK, but also for people suffering from many other kinds of genetic diseases.

Genomic medicine stands on the cusp of becoming an everyday reality. Those institutions at the cutting edge of gene therapy and gene editing need a system that is already thinking about the innovations of tomorrow. Such systems need to incentivise innovators to get medicines into the hands of patients as soon as possible.

Organisations involved in scientific advances will never give up on their ambition to cure serious diseases that today might still seem impossible to tackle. While they continue to deliver on the science, the UK Government must show its commitment to biomedical innovation if the genomic revolution is to be fully realised.

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Biotechnology, Britain, Environment, European Union, Government, Research, Science, Society

Pesticides require to be cut to save bees…

COLONY COLLAPSE DISORDER

Bees are an essential part of our life-cycle. Without them, flowers would not be pollinated and crops would fail. And as the world’s human population continues to grow, bee numbers in recent times have been falling, indicating that there is a big problem looming. Scientists are concerned.

Biologists and environmentalists have been puzzling about the cause for some time. Of particular concern is what has become known as colony collapse disorder, an affliction that has already led to the death of entire hives of bees during the winter months. The collapse of colonies is something which has been happening with frequent occurrence. The finger of suspicion is now pointing ever more firmly at insecticides and aggressive agricultural practices, especially those chemicals containing compounds known as neonicotinoids.

These are recently developed pesticides that have become widely used in agriculture because they are much less toxic to humans and other animals than the chemicals they replaced.

Evidence is mounting, though, that they are highly toxic to bees. A scientific study has found that hives that had similar levels of mite and parasite infestation, also thought to be a factor in colony collapse, were much more likely to die if the bees had also been exposed to neonicotinoid pesticides.

Empirically, several studies have now borne out this effect, with researchers edging closer in identifying the casual mechanism – that neonicotinoids are responsible for disrupting the immune and neurological systems of bees. This makes them less resistant to disease caused by parasites.

European and British regulators have already moved to restrict the use of neonicotinoids, but the case for a much tougher clampdown to reverse the loss of honey bees is gaining traction.

 

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