The perverse economics of the antibiotics industry means the human race could be in trouble.
Right now, humanity is engaged in an epic battle against fast-adapting and merciless predators. No, zombies are not beating down doors to tear chunks of flesh out of the living. Rather, humanity is being hunted by deadly pathogenic bacteria that have gained resistance to antibiotics.
And thanks to the peculiar incentives that drive the pharmaceutical industry, it looks like the cavalry may be a long time in coming.
To understand the current state of the antibiotics market, we have to go back millennia. Humans have co-existed with bacteria throughout our history. They live in our bodies from birth to death. It’s estimated that up to three percent of a typical human's body mass is made up of symbiotic bacteria, which assist us with bodily functions like digesting food.
Most bacteria in the human body are kept in check by the body’s immune system. But bacteria are constantly evolving to survive and reproduce. Either the immune system successfully adapts to new threats, or the body risks being overrun. Sometimes the immune system will fail to respond to a novel bacterial threat, allowing the bacteria to kill the host.
Before antibiotics were widely available, any accident, injury, or medical procedure that allowed pathogenic bacteria into the body was potentially deadly. One in nine skin infections was fatal. One in three cases of pneumonia led to death. Invasive surgeries including caesarean sections left the patient open to killer infections. Insect bites, burns, and blood transfusions frequently became a source of infection.
So the discovery of the first antibiotic, penicillin, by Alexander Fleming in 1928 remains one of the high points in medical history. Antibiotics kill bacteria, which meant wounds were no longer death sentences. Yet when Fleming won the Nobel Prize for medicine in 1945, he warned of the dangers of antibiotic resistance:
It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them… There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.
Fleming’s prediction was right. Penicillin-resistant bacteria arrived while the drug was still being given to only a few patients. Each new class of antibiotics since then has soon been greeted by resistant bacteria.
Unfortunately for the human race, research into antibiotics remains costly. One estimate suggests that the cost of bringing a new antibiotic to market is over $1 billion, and that new antibiotics lose $50 million on average. There are far more profitable drugs for pharmaceutical companies to throw money at, since antibiotics are usually single-serve drugs for humans, not long-term treatments.
Drugs for chronic conditions tend to be more profitable. And with drug resistance quickly evolving, rendering older antibiotics ineffective, pharmaceutical companies have even less incentive to invest in the drugs.
The economics are perverse. Taking preventative action today would not be very profitable because there are fewer potential customers.
The incentives to produce more and better antibiotics only kick in under the worst circumstances, when millions of people are dying from antibiotic-resistant infections.