If Scientists Don't Develop New Antibiotics Soon, 'We'll All Be in a Lot of Trouble'

A chemist by training, Erin Duffy has worked in drug discovery for more than 20 years and has experienced firsthand the growing challenges of finding and developing novel antibiotics.

Before joining the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X), Duffy served as executive vice president and chief scientific officer at Melinta Therapeutics, a developer of new antibiotics. Despite recently bringing a new antibiotic to market, the company filed for bankruptcy in 2019. It had become one of the increasing number of companies unable to sustain business operations because of the high costs of development coupled with limited revenue potential.

Today, Duffy is chief of research and development at CARB-X, a nonprofit led by Boston University that partners with companies, governments, and major foundations to provide funding and expert support to accelerate early-stage innovative antibacterial products.

Duffy oversees a global, multidisciplinary team that supports promising and innovative science to help combat the growing and urgent threat of resistant bacteria. She spoke recently about the work of CARB-X, what lies ahead for the organization, and what needs to be done to bring critically needed antibiotics to market. This interview has been edited for clarity and length.

Q: Can you talk a little bit about what drew you to working with CARB-X?

A. One of the research programs I ran at Melinta received a CARB-X award, so I was very familiar with the organization, and it seemed like a good fit. I appreciate CARB-X’s laser focus on early-stage products and efforts to ensure that promising candidates don’t get abandoned before their potential is fully explored. So often at drug companies—especially those with limited resources—you focus on late-stage assets and products already on the market that will bring in revenue. This is often at the expense of more nascent programs, which means we too often lose out on potential products that could help patients.

Q: CARB-X launched nearly five years ago. What have been some of the major successes and challenges?

A. CARB-X quickly established itself as an efficient and effective organization for identifying and accelerating promising innovations for combating antibiotic resistance. Before CARB-X, I’m not sure anyone realized just how much innovation was going on out there—but without the support needed to advance. To date, we have had more than 1,000 expressions of interest, supported more than 70 programs that aim to treat, prevent, and diagnose infections caused by antimicrobial resistance, and helped seven products progress to late-stage development.

We’ve learned a lot and adapted accordingly. We have expanded the team to make sure we have the best expertise to offer our developers, streamlined our processes, and reduced the cost-sharing required, given the ongoing challenges of the antibiotic market.

Q: Looking ahead, what are the priorities for CARB-X over the next five years?

A. Earlier this year we launched a strategic review asking this very question, and we’ll be publishing the results in the coming months. What we found is that there’s a real need for us to keep doing what we’re doing. The world still urgently needs new types of antibiotics that can treat the most dangerous pathogens identified by the Centers for Disease Control and Prevention and the World Health Organization. That process underscored some common themes that plague our product developers and encouraged us to initiate a number of cross-project initiatives within CARB-X to support the entire research ecosystem.

Q: What other changes would help ensure that promising antibiotics aren’t lost because of company bankruptcies and consolidations?

A. First and foremost, we need economic incentives to help slow the exodus of companies from antibiotic development and stimulate development of urgently needed drugs. It does no good to go through years of research and development to bring a new antibiotic to market, only for it to not be available to patients because the company incurs massive losses and goes bankrupt. We don’t want to build a bridge to nowhere. But there seems to be some good momentum for these types of policies—for example, a new subscription payment model piloted in the U.K. and the proposed PASTEUR Act here in the U.S.—and we need to keep that going. These new payment models are intended to provide revenue to companies for antibiotics based on the value they provide to society, rather than on volume sales.

Initiatives like the AMR Action Fund, an industry-funded group launched earlier this year, also play an important role and could help to ensure that products coming out of CARB-X have the support they need. What I specifically like about this initiative is that, like CARB-X, it offers more than just funding but also industry expertise. That’s important because most of the little companies driving antibiotic development today do not have the resources for transitioning to late-stage clinical trials, navigating the FDA approval process, and bringing a product to market. If AMR Action Fund and others can support late-stage products in the way that CARB-X does for early-stage products, that would be extremely helpful.

Q: What lessons can be learned from the COVID-19 pandemic as everyone works to prevent another public health crisis with antibiotic resistance?

A. In terms of lessons applicable to the fight against superbugs, I hope that people recognize the extreme importance of preparedness. You can’t just flip a switch when a public health crisis hits. Developing new treatments takes time, and that’s why it’s essential to put in the work now to find the new antibiotics we need.

Q: What do you wish more people understood about the threat posed by superbugs?

A. We’ve gotten so used to living our lives fueled by effective antibiotics. What young woman thinks she’ll die from an infection during childbirth? What person getting a hip replacement thinks a hospital-acquired infection will kill him or her? What cancer patient considers foregoing treatment because of the infection risk?

The promise of safe and effective antibiotics is not just taken for granted. It’s not even something we think about. But by the time that perception changes, it may be too late.

Part of the challenge is that there are few people alive today who remember the perils of the pre-antibiotic era. For the rest of us, the concept of it is so foreign and seemingly impossible to fathom. It’s like my kids trying to imagine a world without cellphones. They can’t.

People also need to understand that antibiotics aren’t like a bottle of aspirin. They won’t always work the same way, and we know that bacteria will eventually become resistant to every antibiotic available today. If we don’t find new ones soon, we’ll all be in a lot of trouble.