Areas of Concern in ID

Segment Description: Jason Gallagher, PharmD, FCCP, FIDSA, BCPS, clinical professor at Temple University College of Pharmacy and editor-in-chief of Contagion®, discusses areas of unmet need and challenges ahead in the ID development economic landscape.

Interview Transcript (modified slightly for readability):

Gallagher: CDC [US Centers for Disease Control and Prevention] and other entities have done a good job of refocusing the public's attention on antimicrobial resistance. The report that came out in 2013 outlining the threats that antimicrobial resistance poses in the United States really was seminal.

If nothing else, it gave us nice graphics to put into our slides and numbers, conservative numbers, for the number of resistant infections and death due to resistance that were at least agreed upon, even if they were conservative.

That focus got lost a little bit after that due to viral outbreaks and other things that occurred in the following years. And then they just updated it again this year.

There’s been a good focus on the issue of resistance.

After many years of a real deficit in antimicrobial drug development, all of a sudden there's this big boom in the past 10 years, in response to a couple of things. IDSA (Infectious Disease Society of America) deserves credit for their 10 by 20 initiative, which I have to say to my absolute amazement has been successful.

However, it's been successful in developing drugs that in many cases aren't doing well. Some of these drugs, we could debate the necessity for them in the first place. Other ones, there really is a true medical need and yet those companies are struggling.

While these push incentives that were developed in order to get these drugs developed were successful in doing so, through government grants and other forms of stimulating drug development, it led to drugs being approved that then are failing on the market, as we first saw with a Achaogen becoming bankrupt this year.

Whether that was the beginning of a trend or just a blip —I’m concerned it's the beginning of a trend.

That was a drug that costs hundreds of millions of dollars to develop, and then the company goes bankrupt. Some of those dollars are tax dollars, so we have a vested interest in the success of these as well, when there's a true medical need.

We’ve done pretty well at focusing the need for these drugs to be developed, we have not done well at developing pull incentives for them to be used. And I don't mean used for everyone, I mean, used in the in the correct settings.

The patient with a resistant infection should be the most obvious place that you're going to use a drug for a resistant infection, even if that drug is expensive, as they typically are, because they will never be inexpensive as long as it costs all this money for them to be developed.

But not just that, there’s the patient who's at risk for a highly resistant infection. Right now, there's a huge economic disincentive to use any of these expensive agents in that patient. And that's something that we'll have to figure out.