The outlook isn’t entirely grim. In its report on potential innovative therapies, the W.H.O. identified 252 agents in development that target 12 pathogens the health agency has declared grave threats to humanity. They include multidrug-resistant E. coli, salmonella and the bacteria that cause gonorrhea.
Nearly 80 percent of these products are being developed by drug companies, the vast majority of them in Europe and North America, and they include a number of novel therapies like phages and antimicrobial peptides that offer the possibility of treating infections without a reliance on traditional antibiotics.
“It is very encouraging to see a wide variety of new innovative approaches in the preclinical pipeline,” the study said. “Nonetheless, many scientific challenges are yet to be overcome.”
The report on drugs in the later stages of development was less sanguine. Only eight new antibiotics have been approved since 2017, it said, and most are derivatives of existing drugs. The majority of them do not treat pathogens on the W.H.O.’s list of urgent threats.
Of the 50 new antibiotics being tested in clinical trials, only two are active against the most worrisome class of bugs, called gram negative bacteria, that can prove deadly for newborns, cancer patients and those undergoing elective procedures like hip and knee replacements.
It can take ten years and cost more than $2 billion to develop a new antibiotic and bring it to market, and much of that expense is for the failures along the way. Congress has been considering a bill that would shore up the market for antibiotics but it has yet to advance, despite bipartisan support.
In the meantime, many experts worry that the few remaining start-ups in the field may not survive.
“We can’t have more companies going bankrupt,” said Dr. Helen Boucher, an infectious disease specialist at Tufts Medical Center and a member of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. “If the pipeline remains this anemic, that’s going to have real implications for our patients.”