The global fight against antibiotic-resistant infections has seen a rare glimmer of hope with the approval of two new drugs. However, health experts warn that humanity is still losing the broader battle, with a dire shortage of new medicines in development and existing treatments becoming increasingly ineffective.
A New Model for a Stagnant Pipeline
This month, the US Food and Drug Administration (FDA) approved two new antibiotics specifically targeting gonorrhoea, a sexually transmitted infection with strains resistant to every known class of drug. Crucially, one of these drugs, Zoliflodacin, is the product of an innovative partnership designed to tackle the systemic failure of antibiotic development.
The non-profit Global Antibiotic Research and Development Partnership (GARDP) collaborated with the pharmaceutical firm Innoviva, providing funding and managing clinical trials to reduce costs and navigate regulatory barriers. This approach directly addresses a core problem: since 2017, only 16 new antibiotics have gained widespread approval, most of which are closely related to existing drugs and thus vulnerable to quick resistance.
This model echoes the UK government's pioneering 'subscription model', launched in 2022, which guarantees pharmaceutical companies a fixed annual fee for access to certain antibiotics, decoupling profit from volume sold. These initiatives represent the best hope of sustaining a trickle of new drugs from a broken economic system where curative, short-course antibiotics are far less lucrative than medicines for chronic conditions.
The Inevitability of Resistance and the Rationing Dilemma
While the arrival of Zoliflodacin is a significant relief for doctors, its long-term utility is already under question. The drug is sometimes described as a new class of antibiotic, meaning it attacks bacteria in a novel way, theoretically forcing pathogens to start from scratch to develop resistance. However, scientists caution that resistance to Zoliflodacin is inevitable.
This reality sparks a difficult debate: should such a valuable new tool be held in reserve, rationed only for the most resistant infections? This rational approach is complicated in practice, especially in the global south where access to high-end laboratory testing needed to identify such cases can be limited. Careful, internationally coordinated use is the only way to preserve the advantage of new drugs, but achieving this globally remains a monumental challenge.
Running Fast to Stand Still
The broader outlook for antibiotic discovery is bleak. As former World Health Organization director-general Dr Margaret Chan observed, the 'easy' antibiotics found in nature, like penicillin, have all been discovered. The search for new ones has diminishing returns.
Hope has been placed in artificial intelligence to accelerate discovery, though early candidates like the much-hyped halicin (identified in 2020) have yet to progress beyond animal trials. The development of fully synthetic drugs in labs constantly runs up against the unyielding laws of chemistry; imagining a perfect molecule does not mean it can be easily or cheaply made.
The prevailing scientific view is stark: in the arena of antibiotics, we must run very fast indeed just to stay in the same place. The scale of future breakthroughs is likely to seem paltry compared to the curative bonanza of the 20th century. The approval of two new drugs is welcome news, but it underscores a much larger and more dangerous race that the world is currently losing.
