Breakthroughs Blog: Antimicrobial resistance

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Duke University researchers have developed a synthetic antibiotic, LPC-233, that could be effective against drug-resistant superbugs and bacteria. LPC-233 was found to be effective in protecting mice from fatal doses of multidrug-resistant bacteria by disrupting the synthesis of the outer membrane of the bacteria. LPC-233, which is a synthetic compound of the LpxC inhibitor, was developed after the first human trial of LpxC inhibitors failed because of cardiovascular toxicity. Hopefully, future studies will confirm the new antibiotic as a potential tool to address drug-resistant superbugs.Last week, the Project to Accelerate New Treatments for Tuberculosis (PAN-TB) collaboration announced the start of a phase 2b/c clinical trial to evaluate novel treatment regimens for drug-sensitive tuberculosis (TB). The trial, which is sponsored by the Bill & Melinda Gates Foundation, will evaluate two novel drug regimens made up of different combinations of five antibacterial agents—including the TB Alliance-developed pretomanid and the Janssen-developed bedaquiline— and will take place in high-burden countries starting with South Africa. The results will hopefully lead to a new, shorter pan-TB treatment regimen for patients.The Coalition for Epidemic Preparedness Innovations (CEPI) and Gennova Biopharmaceuticals last week announced a new agreement to advance the development of Gennova’s self-amplifying mRNA platform to create vaccine candidates against unknown pathogenic threats with pandemic potential. The funding will support the optimization and production of the platform technology and then the production of a vaccine candidate for preclinical studies against a known virus, rabies, to assess the new technology. This will hopefully lead to the development of novel RNA vaccines, which could offer significant advantages over existing mRNA vaccine platform technologies.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Last week, the Global Antibiotic Research and Development Partnership (GARDP) and Bugworks announced an agreement to accelerate the development of a broad-spectrum antibiotic compound, BWC0977, which has shown potential in treating patients with serious infections caused by pathogens that have become increasingly hard to treat due to growing antibiotic resistance to multiple classes of drugs. GARDP has agreed to invest up to $20 million for further clinical and pharmaceutical development. If the antibiotic is ultimately approved, Bugworks plans to launch it in the United States, the European Union, Japan, and China, while GARDP will manufacture and commercialize the compound in 148 countries, including nearly all low- and middle-income countries, with both partners emphasizing their hope to ensure rapid access and appropriate use in high-burden countries like India and South Africa, where access to novel antibiotics is often limited. Promising results from a phase 2a trial of a broad-spectrum influenza vaccine candidate were published in The Lancet Infectious Diseases last week. The trial, which tested the biopharmaceutical company Osivax’s candidate vaccine OVX836 at various doses in 137 healthy adult subjects, found that it was safe and immunogenic at all dose levels tested, warranting further testing in larger phase 2b and 3 trials. The vaccine, which fits the universal influenza target product profile set by the US National Institutes of Health, could be a promising new tool to address influenza if further tests continue to confirm its potential.New research found that a novel mRNA-based malaria vaccine, which takes a unique approach by using an ingredient developed to boost the immune response to cancer, was effective in mouse models. The novel vaccine generated an immune response in mouse models, prevented infection with one form of the Plasmodium parasite, and unlike many other malaria vaccines, proved effective in animals that had already been exposed to malaria, underscoring the potential of this tool in malaria-endemic regions. While this research is still in very early stages, scientists plan to next test the vaccine in humanized mouse models and hope to be able to advance to clinical trials in the coming years.

Congressional negotiations are moving fast and furious as policymakers seek to reach an agreement to reauthorize must-pass legislation, known as the Pandemic and All-Hazards Preparedness Act (PAHPA), governing how the United States prepares for health threats. The latest 2019 reauthorization of the original 2006 law will expire on September 30, leaving legislators with a rapidly closing window to determine how national preparedness infrastructure should be reformed in the wake of the COVID-19 pandemic.Though this legislation has far-reaching implications for America’s entire preparedness architecture, most notably for global health research advocates, it authorizes the work of the Biomedical Advanced Research and Development Authority (BARDA), an agency charged with advancing the research and development (R&D) of medical countermeasures (MCMs) against health threats. BARDA was created via PAHPA in response to the 2001 anthrax attacks in the United States and in recognition of the need for the government to play a role in spurring R&D of tools for chemical, biological, radiological, and nuclear threats for which there is no commercial market. While historically, the agency has focused foremost on man-made bioterror threats, in the past decade, it has increasingly played a role in advancing vaccines, drugs, diagnostics, and other tools against naturally occurring global threats like Ebola, Zika, antimicrobial resistance (AMR), and COVID-19—for the latter, as one of the leaders of the US government’s Operation Warp Speed.While the COVID-19 pandemic underscored the unique value of BARDA’s R&D capabilities, it also brought the United States to a point of intense partisanship on issues of pandemic preparation and public health. These splits have plunged PAHPA—which has historically enjoyed an uncontroversial and bipartisan policymaking process—into a tense 2023 reauthorization cycle.Below we look at where negotiations stand in each chamber and where things could go from here.A bipartisan SenateOn the Senate side, the deliberations for a mostly clean reauthorization have gone relatively smoothly in the Health, Education, Labor, and Pensions (HELP) Committee. While an initial discussion draft released on July 3 reflected areas of disagreement between Chairman Bernie Sanders (I-VT)—who wanted to see the bill tackle drug pricing and supply chain challenges—and Ranking Member Bill Cassidy (R-LA) —who proposed changes to the priority review voucher (PRV) for MCMs—by the July 20 markup, the senators had worked out a bipartisan deal in the form of a managers amendment.The bill, which last week was approved to be reported out of committee, includes a comprise that would require drugmakers to alert the government of disruptions in the supply of drugs and pharmaceutical ingredients and a new government-directed study on policy solutions to delink drug prices from R&D costs in exchange for a straight five-year extension of the MCM PRV program. Importantly for global health research advocates, the bill also includes more expansive and explicit language directing BARDA to conduct R&D for known and as-yet-unknown pathogens with pandemic potential, as well as an amendment introduced by Sen. Hickenlooper (D-CO) to authorize the creation of a new US Food and Drug Administration (FDA) team tasked with reviewing MCMs for emerging pathogens—as was requested by FDA in their fiscal year 2024 priority letter. It is worth noting that the compromise forged between Sens. Sanders and Cassidy included new authorities for FDA that have been the cause of derision across the chamber on the House side.A partisan HouseIn the House, leading up to the Energy and Commerce (E&C) Committee’s July 19 markups, tensions remained heightened as Democrats and Republicans were still unable to reach bipartisan consensus on the two PAHPA bills introduced by Representative Richard Hudson (R-NC): H.R. 4421, the Preparing for All Hazards and Pathogens Reauthorization Act, which covers BARDA and its parent agency the Administration for Strategic Preparedness and Response (ASPR), and H.R. 4420, the Preparedness and Response Reauthorization Act, which proposes changes to the US Centers for Disease Control and Prevention (CDC). Rep. Hudson reportedly decided to split the House version of PAHPA into two bills to disentangle the more politicized portions of the bill, housed in H.R. 4420, from the ones with more consensus, housed in H.R. 4421.Both bills were approved last week to go to the floor of the House.Since the House’s preliminary June hearing on PAHPA at which Rep. Anna Eshoo (D-CA) announced that she had pulled her name from the legislation, Rep. Hudson’s PAHPA bills have advanced through the chamber on a purely partisan basis. Other vocal representatives, like E&C Committee Ranking Member Frank Pallone, Jr. (D-NJ), hammered Republicans for not including FDA authorities to address drug shortages in the scope of PAHPA. Unsatisfied with the Republicans’ response to their demands, House Democrats on the committee released their own version of PAHPA immediately before the July 19 markups. The Democrats’ draft bill includes provisions to strengthen CDC, increase funding for programs like the Strategic National Stockpile (SNS), and give FDA new authorities to mitigate drug shortages.This tension culminated in almost exclusively party-line votes approving 15 health policy-related bills that, among other provisions, would hamper CDC’s powers and, according to experts, underfund CDC, BARDA, SNS, and ASPR. In one small glimmer of good news, the Republican-led H.R. 4421 PAHPA bill, like its Senate counterpart, also included more expansive language directing BARDA’s research on emerging infectious diseases (EIDs).What now?For the first time, the House E&C Committee has sent PAHPA to the House floor on a partisan basis in striking contrast to the Senate HELP Committee’s mostly bipartisan process. Notably, House E&C Committee Chair Cathy McMorris Rodgers (R-WA) alluded to considering the Senate’s “more tailored approach to more FDA authorities” as a workable compromise, but only time will tell as the bills advance to the next stage in the process. If the current House and Senate versions of the bill receive the requisite votes to pass in each chamber, they will then be sent to the Conference Committee, where the differences must be reconciled, and the resulting bill will be sent back to the House and Senate floors for final votes.But with the partisan nature of the PAHPA bills in the House, the slim majority Republicans hold, and the difficult procedural hurdles in the Senate that have been used to hold up anything COVID-related, it could prove challenging for policymakers to reconcile around a bill capable of being passed in both chambers. The only sure thing is that this reauthorization process is unpredictable and at the whim of the current political climate.What is GHTC’s take?Earlier this year, GHTC put out a set of policy recommendations for the House and Senate to consider as they reauthorized PAHPA. Even though the process is not over, there are indications that some of our coalition’s priorities are represented in the draft bills from both the House and the Senate. As discussed, both bills contain explicit language highlighting the need for “advanced development and manufacturing of MCMs for viral families which have significant potential to cause a pandemic” and call out “emerging infectious diseases.” It is welcome news to see the bills specifically highlight the need for R&D for both known and as-yet-known, or Disease X, infectious disease threats.Additionally, the Hickenlooper amendment is also supported by GHTC since it would bolster FDA “activities to advance scientific research related to the development of tools, standards, and approaches to assess the safety, efficacy, quality, and performance of countermeasures.” The inclusion of both EID callouts and FDA’s fiscal year 2024 priorities are notable wins in a year marked by proposed funding cuts to global health programs.Of course, there are still areas of much-needed attention not fully addressed by the bills. The lack of boldness of either chambers’ bills can be attributed to the difficult fiscal environment Congress finds itself in—exemplified by the far more contentious appropriations bills that many believe are sending the United States on the path to a potential government shutdown. GHTC’s recommendations for Congress to create a dedicated EID funding line and authorize more money for AMR research at BARDA are not included in the bills—nor is there discussion on advancing the low-resource settings utility of BARDA products, inclusion of the Pioneering Antimicrobial Subscriptions To End Up surging Resistance (PASTEUR) Act to incentivize AMR research, or provisions to give BARDA loan authorities.However, through our staff-level conversations on the Hill, the dial seems to be turning in a positive direction for these priorities. Especially in discussions on EID funding and AMR priorities (including PASTEUR), there is growing bipartisan agreement that these issues are important enough for standalone funding—just not in this specific PAHPA during this particularly difficult fiscal year. Whether or not PAHPA is the vehicle, we see tremendous strides in the Hill’s recognition of the issues central to GHTC and our future advocacy.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Last week, the World Health Organization (WHO) published its first global research agenda outlining key priorities in the fight against antimicrobial resistance. The intent of the agenda is to provide researchers, policymakers, funders, and other stakeholders with priority research topics for which greater action and evidence is needed. It covers issues including preserving current antimicrobials, advancing point-of-care diagnostic tests, and developing novel drugs to treat drug-resistant infections. The 40 priorities that relate to prevention, diagnosis, treatment and care, and cross-cutting topics were developed after a review of more than 3,000 documents published over the past decade looking at antimicrobial resistance.A recent study found promising results for a new, point-of-care genomic test for human papillomavirus (HPV) that could be a cheaper and more accessible option for cervical cancer screening in low-resource areas like sub-Saharan Africa, which has the highest rate of deaths from cervical cancer globally. Unlike currently available screening options, the HPV DNA test can be performed by a health care professional with minimal training using a mini centrifuge in the lab, cutting out the need for robust laboratory infrastructure and highly skilled professionals. The research team behind the test is now trying to make the test even more effective and efficient in low-resource settings by making it faster, inclusive of more HPV genotypes, and more sensitive.Researchers from the University of Montreal recently published a study showing for the first time the crucial role of a protein, adyl hydrocarbon receptor, or AhR, in allowing HIV to remain latent in the body, thus requiring antiretroviral therapy to be maintained in order to keep the virus from replicating. The researchers used CRISPR technology and drugs to neutralize the activity of AhR and observed that viral growth occurred in people living with HIV and on antiretroviral therapy. The study proposes a “shock and kill” strategy that would use drugs to inhibit and then reactivate AhR in the presence of AhR inhibitors to expose the HIV-infected cells for the immune system to then target and kill. Investigators hope further research can validate this method of fighting HIV.