Despite growing awareness of the urgent threat of antibiotic resistance, the world is still failing to develop needed antibacterial treats, according to a new report by the World Health Organization (WHO). 

Of the 43 antibiotics and 27 non-traditional antibacterial agents in the current clinical antibacterial pipeline, none is sufficient to tackle the challenge of increasing emergence and spread of antimicrobial resistance (AMR). 

The persistent failure to develop, manufacture, and distribute effective new antibiotics is further fueling the impact of antimicrobial resistance and threatens our ability to successfully treat bacterial infections,” said Dr Hanan Balkhy, WHO Assistant Director General on AMR.

WHO’s annual Antibacterial Pipeline Report reviews antibiotics that are in the clinical stages of testing as well as those in early product development. The aim is to assess and identify gaps in relation to urgent threats of drug resistance, and encourage action to fill those gaps.

The report evaluates the potential of the candidates to address the most threatening drug-resistance bacteria, as outlined in the WHO Bacterial Priority Pathogens list, which includes 13 priority drug-resistant bacteria, including Mycobacterium tuberculosis and Clostridioides.

Static Antibiotic Pipeline 

The 2020 Report reveals a near static development pipeline, with only a few antibiotics approved by regulatory agencies in recent years. 

Of the 43 antibiotics, 26 are active against WHO priority pathogens, 12 against M. tuberculosis and five against C.difficile.

Eleven new antibiotics have either been approved by the US Food and Drug Administration (FDA) or the European Medicines Agency (EMA), since 1 July 2017. However, the newly approved antibiotics have limited clinical benefit over existing treatment, as over 80% of them are from pre-existing classes where resistance is well-known 

Of the traditional antibacterials, only three new products entered the clinical pipeline while seven were discontinued or do not have any recent information.  

For the preclinical antibacterial pipeline, there are currently 292 diverse antibacterial agents in progress with commercial and non-commercial entities. 

Novel Solutions and Global Initiatives Needed 

The lack of progress on antibiotic development highlights the need to explore more innovative approaches to treat bacterial infections. 

While the COVID-19 crisis accentuated the gaps in sustainable funding to address the health and economic implications of an uncontrolled pandemic, it also revealed the opportunity that exists when there is both political will and enterprise. 

“Opportunities emerging from the COVID 19 pandemic must be seized to bring to the forefront the needs for sustainable investments in R&D o f new and effective antibiotics, said Haileyesus Getahun, Director of AMR Global Coordination at WHO.

“Antibiotics present the Achilles heel for universal health coverage and our global health security. We need a global sustained effort including mechanisms for pooled funding and new and additional investments to meet the magnitude of the AMR threat.”

Several global initiatives have been created to address gaps in funding in antibiotics development. WHO and its partner Drugs for Neglected Diseases Initiative (DNDi) have set up the Global Antibiotic R&D Partnership (GARDP). In addition, WHO is working closely with non-profits such as the United States-based Combating Antibiotic-Resistant Bacteria (CARB-X) to accelerate antibacterial research.

There is also the AMR Action Fund, a partnership set up by pharmaceutical companies, philanthropies, the European Investment Bank, with the support of the WHO, that aims to strengthen and accelerate antibiotic development through global pooled funding. 

Image Credits: Interpol, Shutterstock.