Antibiotics and a crisis for capitalism

Last March 2013, England’s Chief Medical Officer, Dame Sally Davies gave the stark warning that antimicrobial resistance poses “a catastrophic threat“. Unless we act now, she argued, “any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.”

Between 1929 and the 1970s pharmaceutical companies developed more than twenty new classes of antimicrobials. Since the 1970s only two new categories of antimicrobials have arrived. Gregory Daniel has written about antibiotic development and market failure. This is an issue as when used appropriately a single £100 course of antibiotics will save someone’s life. However, that clinical effectiveness and short-term use has the unfortunate consequence of making antimicrobials significantly less profitable than the pharmaceuticals used in cancer therapy, which can cost £20,000 per year.

In September 2013 the Department of Health published its UK Five Year Antimicrobial Resistance Strategy. The document called for “work to reform and harmonise regulatory regimes relating to the licencing and approval of antibiotics”, better collaboration “encouraging greater public-private investment in the discovery and development of a sustainable supply of effective new antimicrobials” and states that “Industry has a corporate and social responsibility to contribute to work to tackle antimicrobial resistance.”

I think we should have three major objections to these statements. One, the managers in the pharmaceutical industry do not have any responsibility to contribute to work to tackle antimicrobial resistance. They have a responsibility to make profit for shareholders or be replaced. It is the state that has the responsibility for the protection and wellbeing of its citizens.

Secondly, following last years’ horsemeat scandal we should object to companies cutting corners in attempt to increase profits. This leads on to the final objection, that by promoting public-private collaboration all the state is doing, is subsidising share holder profits by reducing the shareholder’s financial risk.

Mariana Mazzucato in her 2013 book, The Entrepreneurial State, discusses how the state can lead innovation and criticises the risk and reward relationships in current public-private partnerships.

This potential of the state seems to be supported by the public as following announcements of energy price rises, in October 2013, a YouGov poll found that 12 to 1 people were against the NHS being run by the private sector; 67% in favour of Royal Mail being run in the public sector; 66% want railway companies to be nationalised and 68% are in favour of nationalised energy companies.

We should support state funded professors, post-doctoral researchers and PhD students as scientists working within the public sector. They could study the mechanisms of drug entry into bacterial cells or screen natural antibiotic compounds.

Andrew Witty’s recent review of higher education and regional growth asked universities to become more involved in their local economies. The state could choose to build laboratories in geographical areas neglected by private sector investment and help promote regional recovery.

Even more radically, if novel antibiotics are produced for their social good rather than the financial return from the volume sold, they can be reserved indefinitely until a time of crisis.

With regard to democracy, patients and the general public could have a greater say in what is researched and to help shift us away from our reliance on the market to provide what society needs.  As we all know the market responds, not to what society needs, but to what will create the most profit.

This is an abridged version of an article which appeared at New Left Project

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