Zachary Zimmerman, co-founder and director of the tiny antibiotic company Forge Therapeutics, which has two novel antibiotics in development, claims that “the market is flawed.” Therefore, we must eliminate the market from consideration.
The Pasteur Act would accomplish this. It pledges $6 billion over several years to create a sort of subscription scheme for creating new antibiotics in their current form. When the plan was first submitted in 2020, it called for $11 billion, so this number is the result of several negotiations, and it wouldn’t entirely go toward purchasing pharmaceuticals. A panel of experts would be assembled as part of the mechanism it would establish within HHS to assess whether any novel proposed antibiotic fulfils an unmet need. They would then calculate a societal value.
The Pasteur Act won’t get very far when you contrast the $6 billion in funding with the more than $1 billion cost of bringing out a single medicine. Before needing to be renewed, it could support a few new medications. However, specialists who have been pushing for such a programme claim that it won’t just ensure the success of certain medications but will also convey to the general public and private capital that investing in antibiotic development might be a safe bet.
“We hear loud and clear from smaller drug companies that they regard this funding mechanism as highly valuable to the sustainability of not only the specific antibiotics that they will bring up as candidates, but to the viability of their entire industry.
Numerous obstacles stand in the road. The first is that there isn’t much time left for the returning Congress. The second is that, in order for the Pasteur Act to be successful, it will need to be included in a bigger piece of legislation at a time when many sponsors are vying to pass their favourite measures. An omnibus budget bill that reauthorizes health programmes that are about to expire could be one method. Another option is the yearly National Defense Authorization Act, which is nonpartisan and typically unpolitical. Pasteur appears to be a natural fit with 66 cosponsors from both parties.
Yet last week, a coalition of six academics and 11 organizations—including the liberal-leaning groups Public Citizen and Doctors for America—asked the legislators who oversee military authorization to keep the measure out of that end-of-year act. In a letter to Senators Jack Reed of Rhode Island and James Imhofe of Oklahoma—the Democratic chair and Republican ranking member of the Senate Armed Services Committee—the group called the Pasteur Act “a blank check to pharmaceutical manufacturers.”
That objection offers a glimpse of what might spoil the Pasteur Act while it’s on the brink of success: its cost. So many large companies have been excoriated for extortionate pricing that the prospect of giving any money to any drugmaker is risky. Yet while the small biotechs holding up the field may be in pharma, they’re not Big Pharma: many have just a few employees, are working on their first-ever product, and aren’t earning anything yet, let alone extortionate returns. “We’re hearing: It’s just too much. We’re not prepared to spend this much,” says Mary Dwight, the chief policy and advocacy officer at the Cystic Fibrosis Foundation, which has taken on the Pasteur Act as a cause. “We would really like to flip that narrative, because it’s pretty clear to us that combating antimicrobial resistance is cost effective.”
According to research supported by the CDC, the US already spends $4.6 billion each year to respond to antibiotic-resistant infections. If that spending could be obviated, it would save in one year most of what the Pasteur Act would spend over several.
“If Pasteur passes, it would help not just CF patients, but the whole population,” Brown says. “We got through Covid, but if there are not more antibiotics to help treat bacterial infections, then Covid is going to look like the least of our worries. If a superbug gets out and nobody has anything to work with, then we’re all going to be in trouble.”
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