The antimicrobial resistance crisis needs action now
I could rant on all day about this.<p>AMR is actually a SOLVED problem at this point. If we threw money at it like we threw them at Patriot missiles, we wouldn&#x27;t run out. But... here we are.<p>Rant on why things are why they are:<p>1. Making antibiotics is hard and expensive. The &quot;low-hanging fruit&quot; are all gone, and in the last few decades we&#x27;ve just been rehashing different variations of the same classes of antibiotics. We&#x27;re seeing bacteria become resistant to entire variations within classes so quickly that, it doesn&#x27;t make sense to develop those variations anymore.<p>2. Making antibiotics is harder, and more expensive than it needs to be. This is because of regulations, and mostly it&#x27;s a good thing. It protects us from getting sick(er), and from scams and grifts. Clinical trials are expensive: <a href="https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=33545209" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=33545209</a><p>3. We expect antibiotics to be cheap to buy. We expect them to be cheap, and if the price gets jacked up, people (doctors, patients, ppl on social media) complain. Because it&#x27;s a pill we think it should be free (and it should; gov&#x27;t should subsidize) but it&#x27;s not free to make. If we required iPhones to sell for $5 each by law, they wouldn&#x27;t be around either.<p>4. New antibiotics are &quot;not allowed&quot; to be sold. This is because we&#x27;re afraid of resistance developing against them, which makes sense! But this means no company is allowed to recuperate the hundreds of millions of dollars of up-front development costs it takes to new versions of these things.<p>5. No one expects to make profit. Few expect to recuperate costs in antibiotics, at this point. It&#x27;s not profitable (or cost-recoverable). If we treated bacteria like the Russian invasion of Ukraine, and we called antibiotics &quot;Patriot&quot; then we&#x27;d get more funding. Yes there&#x27;s GARD-P and CARB-X etc. but look... the total amount of money raised in antibiotics funding is like less than half what Bird scooters raised before getting acquired by their Canadian subsidy.<p>6. Gov&#x27;t has &quot;more important things to do&quot;: new funding for AMR didn&#x27;t pass congress, and Pasteur Act in general has been in a holding pattern. Basically it introduces more funding and allows for new ways to sell antibiotics. (Higher ups call it a &quot;Netflix model&quot; but it really is a &quot;Doordash model&quot; because Netflix has near-zero distribution costs. But it didn&#x27;t matter bc it didn&#x27;t pass)<p>7. It&#x27;s not a real crisis yet. It&#x27;s not really anyone&#x27;s problem. Since we&#x27;re not staring down the barrel of a real crisis. It&#x27;s like going to the gym or eating healthy — yes we should probably do it, but let&#x27;s put it off til next year, and make a resolution for it. Kick the ball down the road.<p>Ending on a slightly happier note:<p>1. Old school antibiotics development take many years to develop. Hopefully with AI, ML, genome sequencing, we might be able to find new classes!<p>2. Phages definitely work. We work with them! We&#x27;ve been treating some very hard-to-treat patients at Phage Australia, as a five person team, out of Westmead Institute.<p>3. Does phage therapy work at scale? We&#x27;re shifting our answer from &quot;is this crazy? Will it even work?&quot; to &quot;will this be sustainable?&quot; It costs around $70k+ AUD per patient (time, labor, equipment, for labs and paperwork) but we have no systems in place. Lots of room to bring it down.<p>4. Does it work at scale, with good unit economics (and to Western standards)? We TGA to figure out regulations, and we&#x27;re figuring out how to get them reimbursed for the long run. Ideas include using them as compounding pharmacy ingredients (like &quot;Magistral Phage&quot; out of Belgium)<p>5. There&#x27;s no money in phages - even with our success, it&#x27;s hard, and we&#x27;re always scrambling for money to keep the lights on. But hopefully the Aussie gov&#x27;t will keep the project running for long enough that we can get a better understanding of running this with &quot;lifestyle business&quot; unit economics (it&#x27;s probably not venture scale).<p>6. Going to market is very tricky. Phages are a service, not a drug. Each person&#x27;s phage treatment is different than the other, so this doesn&#x27;t fit the clinical trial pathways currently available. It&#x27;s also different in each country, and we&#x27;re open to ideas.<p>Final note:<p>What we REALLY want is to provide a &quot;concierge service&quot; to wealthy clients and hospital systems that always want &quot;insurance&quot; to treat some of the worst pathogens lurking around the hospital or their region. AMR infections can strike quickly, but usually it&#x27;s strains that we&#x27;ve seen before — especially in hospitals. It&#x27;s always the &quot;most wanted&quot; strains that have previously caused problems. We&#x27;re able to create &quot;countermeasures&quot; for any bacterial threats using phages. Pretty much like Patriot missiles (and with similar costs). This would also follow the Tesla playbook for (&quot;a rich people toy&quot; before releasing a cheaper version).<p>This would really help us fund us to find ways to lower our production and get it into more hands.<p>We need help on that front!
If you&#x27;re able to help, or have ideas, please find me on my twitter (same as my handle here) or on the Phage Australia website)<p>Thanks everyone and merry xmas!