Drug companies aren’t making new antibiotics. Is there an economic cure?
JUDY WOODRUFF: Now to our series on the hunt for new antibiotics, as superbugs and bacteria are building more resistance to the current line of drugs.
It is a joint project from our correspondents Paul Solman and Miles O'Brien.
Last night, Paul looked at why the market for developing new drugs is simply no longer working. But, as one expert warned, antibiotics are a class of drugs that could be lost for treatment if there's no new investment.
As part of his series Making Sense, Paul looks at some new options for solving that problem.
PAUL SOLMAN: Northeastern University biologist Slava Epstein has traveled the world on the hunt for hitherto undiscovered microbes. Some trips are shorter than others.
MILES O'BRIEN: We are five minutes from your lab, right in the heart of Boston, and this soil is as good as any?
DR. SLAVA EPSTEIN, Co-founder, Novobiotic Pharmaceuticals: This soil is as good as any.
PAUL SOLMAN: As Professor Epstein told my NewsHour counterpart on the science beat, Miles O'Brien, just about any handful of soil contains tens of thousands of different microbial species, 99 percent of which remain utterly unexamined, in part because they refuse to grow in petri dishes.
Epstein's breakthrough was figuring out how to cultivate them, inventing a gizmo that isolates individual bacteria, then grows them back into teeming colonies.
So, you can kind of see through them there.
AMY SPOERING, Research Director, NovoBiotic Pharmaceuticals: That's right. So, in each one of those individual holes, in theory, there is a single cell. And by capturing single cells and putting them back out into the environment that they came from, you can cultivate microorganisms no one has ever cultured before.
PAUL SOLMAN: Amy Spoering is research director at NovoBiotic, the company Slava Epstein co-founded to study newfound bacteria, now up to 60,000 strains, and counting, as potential sources of new antibiotics. And how does that work?
SLAVA EPSTEIN: Antibiotics are produced by microorganisms to kill their neighbors, so the enemies, the competitors. This is an exercise that the microorganisms have been going through for the past four billion years.
PAUL SOLMAN: And that humans have exploited for the past century or so, with chemicals from microorganisms like penicillium, the mold that makes penicillin.
The trick is finding chemicals that kill infections in people without killing the people too.
So, I don't mind interviewing movers and shakers, but it's actually making me slightly dizzy, so I'm just going to look at you.
AMY SPOERING: Just look at me. That's fine.
PAUL SOLMAN: So, what is this?
AMY SPOERING: So, what this is, is, this is where we grow all of the novel microorganisms that we cultivate. They need a large amount of air in order to grow well, in order to produce the antibiotics.
PAUL SOLMAN: So you're aerating them?
AMY SPOERING: That's right. That's why they're shaking.
PAUL SOLMAN: So far, they have identified 33 novel compounds here, one of which may be a breakthrough: a new antibiotic that kills bacteria in two completely different ways, making resistance much less likely.
AMY SPOERING: So, this is making our lead compound, teixobactin.
PAUL SOLMAN: And the cost, if all goes well, of eventually getting it to market?
AMY SPOERING: That's big money.
PAUL SOLMAN: Big money that investors would be tripping over one another to provide, right, to get in on the ground floor of the next Z-Pak.
AMY SPOERING: The payout will be huge, if we are successful.
PAUL SOLMAN: But it's a long lug, says Spoering, between bug and drug.
AMY SPOERING: This is 30 liters of it growing to produce the compound that we need to do the next set of pre-clinical tests.
PAUL SOLMAN: And then, after you have done those animal trials, the toxicology trials…
AMY SPOERING: Yes.
PAUL SOLMAN: … then, and only then, do you do trials on humans?
AMY SPOERING: First, an initial set of studies that is just for safety, and then you move on to the efficacy studies, which is phase two, and then much larger efficacy studies, which are phase three, clinical trials.
DALLAS HUGHES, President, NovoBiotic Pharmaceuticals: Drug discovery is a very long process.
PAUL SOLMAN: Dallas Hughes is NovoBiotic's president.
DALLAS HUGHES: We are talking with venture capitalists now, but venture capitalists aren't going to become interested until we discover a compound like teixobactin and move it forward a bit farther than it is now. And we're hoping to raise some financing soon.
PAUL SOLMAN: But, for now, they're relying on government and foundation grants.
SLAVA EPSTEIN: Promising something that may or may not happen 10 years from now doesn't make people as excited as if you were promising the results like here.
PAUL SOLMAN: But, hey, every drug costs a fortune to bring to market. That can't be the reason antibiotic firms like this one have such a tough time raising private capital.
So, what's the story? As we explained in a prior report, there just isn't enough profit soon enough. You buy a week's worth of an antibiotic, not three months, say, of Harvoni for hepatitis C.
NARRATOR: That's one pill, once a day, for 12 weeks.
PAUL SOLMAN: And it costs about $30,000 a month.
Moreover, when a company comes up with a new superbug slayer, the medical community wants to keep it off the market as long as possible to delay toxic microorganisms developing resistance to it. Meanwhile, the patent runs out. Small wonder that even big pharma has said no mas.
DR. JOHN REX, Former Pharmaceutical Industry Executive: Most of the companies that were really doing the large-scale development work backed away from the area.
PAUL SOLMAN: Like AstraZeneca, where infectious disease Dr. John Rex used to head antibiotic development. What did he learn from his tenure?
DR. JOHN REX: It's a good way to destroy $50 million to $100 million worth of net present value after 30 years of really hard work.
PAUL SOLMAN: But ever-hopeful startups like this one, Tetraphase, outside Boston, have popped up. And a new public-private partnership called CARB-X has stepped in to help fund their trek from test tube to clinical trials.
KEVIN OUTTERSON, Executive Director, CARB-X: We have, at CARB-X, $455 million over the next five years, but what we need globally across all countries is about $2 billion per year for antibiotic R&D, supported by public and charitable funds.
PAUL SOLMAN: So, says executive director Kevin Outterson.
KEVIN OUTTERSON: This is an infrastructure investment that has to be made in order to keep this drug class alive. I think antibiotics is the most valuable drug class in human history. It's done more to save lives than any other drug class. It's incredibly powerful. But it's the only one that, if you don't keep investing, you lose it.
Every other invention of modern medical science is still going to work in 100 years. Antibiotics, we know they won't.
PAUL SOLMAN: Because bugs resistant to the antibiotic will evolve. But what cure can economics possibly come up with, when the market itself fails?
KEVIN OUTTERSON: The model that people are coalescing around is some sort of a significant prize, a significant billion-dollar payment, that rewards them for the innovation, and then we can still use that antibiotic sparingly for the next 10 or 20 years.
PAUL SOLMAN: Rich prizes, they have motivated everything from discovering a way to determine longitude at sea, to Charles Lindbergh's transatlantic solo flight in 1927, to private space flight today.
DR. PETER DIAMANDIS, XPRIZE Foundation: We have got $50 million of prizes on the table right now, and $200 million of prizes in development at different stages in the pipeline.
DANIEL BERMAN, Longitude Prize: Prizes can be the answer when you're trying to motivate people beyond the normal suspects.
PAUL SOLMAN: Daniel Berman is in charge of today's so-called longitude prize, 10 million British pounds for a quickie test to see if you need antibiotics at all.
NARRATOR: One of the main reasons why drug resistant infections occur is that antibiotics are used inappropriately, such as people taking the wrong ones or not needing them in the first place.
DANIEL BERMAN: We need a rapid diagnostic test because we need to make sure that we don't burn through the few antibiotics that are left. And when new antibiotics come on, we have to make sure that we dramatically use them in a more rational way.
PAUL SOLMAN: Without such a test, doctors are under constant pressure to prescribe.
DR. LINDSEY BADEN, Brigham and Women's Hospital: Often, acute infections are viral, and without the ability to specifically diagnose you at the point that you're in the office, it's very hard to know that an antibiotic won't help.
PAUL SOLMAN: Boston infectious disease expert Lindsey Baden.
But to just distinguish between a virus and a bacterium, that would be a big deal.
DR. LINDSEY BADEN: A virus and bacterium would be very important.
PAUL SOLMAN: And even more so in developing nations.
DANIEL BERMAN: For example, in India, you can still purchase antibiotics without a prescription in a lot of places. And people are dying because, for some pathologies, there are simply no antibiotics that work anymore.
PAUL SOLMAN: But look, says Slava Epstein:
SLAVA EPSTEIN: Can you use antibiotics smarter? Absolutely. But that will not prevent antimicrobial resistance. It will delay it.
PAUL SOLMAN: That's why, he says, we must ramp up the efforts and investments in new ones.
This is economics correspondent Paul Solman, reporting for the PBS NewsHour.
JUDY WOODRUFF: And I'm still dizzy from the shaking.
Join us next week as Paul and Miles continue their series.