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Policy leaders and public health experts may be overlooking effective ways to stimulate innovative antibiotic research and development. I analyzed archival resources concerning the US government's efforts to produce penicillin during World War II, which demonstrate how much science policy can differ from present approaches. By contrast to current attempts to invigorate commercial participation in antibiotic development, the effort to develop the first commercially produced antibiotic did not rely on economic enticements or the further privatization of scientific resources. Rather, this extremely successful scientific and, ultimately, commercial endeavor was rooted in government stewardship, intraindustry cooperation, and the open exchange of scientific information. For policymakers facing the problem of stimulating antibiotic research and development, the origins of the antibiotic era offer a template for effective policy solutions that concentrate primarily on scientific rather than commercial goals. (Am J Public Health. 2013;103:426-434. doi:10.2105/AJPH.2012.300693)
DURING THE LAST QUARTER of the 20th century, the antibiotic research and development pipeline was unable to address the increasing impact of antibiotic resistance. Instead of producing an array of novel compounds, the pipeline became less innovative and delivered fewer new drugs over time. For more than 30 years, the pharmaceutical industry failed to introduce a new class of antibiotics. Between the introduction of trimethoprim in 1968 and linezolid in 2000, all new antibiotics worked in ways similar to previous drugs, a factor in promoting drug resistance. In addition, the discovery rate for next-generation compounds declined 56% in the two decades leading up to 2003.1
As the need for novel antibiotics has continued to increase, the pharmaceutical industry has withdrawn from this area of development. Half of all pharmaceutical firms in the United States and Japan ceased their antibiotic activities in the late 1980s.2 This was most likely attributable to a market saturated by antibiotics with similar indications. Years later, when the biotechnology revolution failed to readily deliver new antibiotics, many pharmaceutical executives began to feel that antibiotic research and development was no longer "the best opportunity for success." 3 Between 1999 and 2003 pharmaceutical giants such as Aventis, Eli Lilly, Bristol-Myers Squibb, GlaxoSmithKline, Procter and Gamble, Wyeth, Abbott, and Roche discontinued, downsized, or spun offefforts to produce novel antibiotics.4 By this time, antibacterials accounted for less than 1.6% of the industry's overall...