Q & A: How To Respond To The WHO’s Top 12 Superbugs List

Editor’s note: In February, The World Health Organization (WHO) published its first list of a dozen families of antibiotic-resistant “priority pathogens” that pose the greatest threat to humanity.
“This list is a new tool to ensure R&D responds to urgent public health needs,” said Marie-Paule Kieny, WHO’s assistant director-general for health systems and innovation, in a press release. “Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.”
The pathogens on the list were chosen based on:
•    How long a hospital stay they require
•    How frequently they’re resistant to existing antibiotics
•    How contagious they are
•    Whether they can be prevented through things like good hygiene and vaccination
•    The number of treatment options available
•    Whether there are new antibiotics to treat them in the research and development (R&D) pipeline
The following is an edited Q&A about the WHO’s list with Jennifer Pisano, MD, medical director of the antimicrobial stewardship program (ASP) at the University of Chicago Medicine and Biological Sciences, and Trevor Van Schooneveld, MD, FACP, medical director of the University of Nebraska Medical Center’s ASP, program director of its infectious disease fellowship, and associate professor in its Division of Infectious Disease. The interviews were conducted separately.
PSMJ: Why is it so hard to develop new antibiotics? Are there any reports or signs of new antibiotic(s) coming out in the next five years?
Pisano: It is very expensive to develop any drug, and antibiotics are particularly difficult. A lot of times it’s likely not worth a pharmaceutical company investing the money into creating a drug that will only be used for a short period of time (around seven to 14 days) when drugs that people take for lifestyle diseases like HTN [hypertension] and DM [dermatomyositis] are taken for much longer periods—often a lifetime.
Additionally, since there’s a bigger emphasis on stewardship programs and saving drugs for when you really need them, any new antibiotic likely will be restricted to “save” it and hinder the development of resistance. It has been frustrating that even with the new antibiotics that have come out to treat resistant Gram-negative infections, they’ve offered new beta-lactamase inhibitors but not necessarily new mechanisms of action.
Van Schooneveld: The process of developing and obtaining regulatory approval for a new antibiotic takes roughly 10 years and many hundreds of millions of dollars. There are new antibiotics in the pipeline, but there are not very many, and there are very few truly new antibiotics. Additionally, there are very few new antibiotics which will have activity against some of these highly resistant pathogens.

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