The antimicrobial resistance crisis needs action now

I'm not sure. Not only do you need to kill bacteria, you need to not kill or harm humans at the same time. That is a high bar.

If this ends up being the approach, I really hope it will be led by a country with a few decades experience in successfully being socialist. The US really has no business doing this, the government departments and oversight boards that exist today are much too compromised by the pharmaceutical industry to pull this off.

Another factor to consider is it’s much better for social good to wait until you have 2-3 working new antibiotics to mix together to reduce the survival rate exponentially. But that would require delaying the short term profits of selling the single-cocktail twice.

Is that a third world countries issue? I’ve heard of it in the UK, there are a lot of comments on this page about it in the US. Your point about livestock is good, but that is definitely happening in the UK and US.

I could rant on all day about this.

AMR is actually a SOLVED problem at this point. If we threw money at it like we threw them at Patriot missiles, we wouldn't run out. But... here we are.

Rant on why things are why they are:

1. Making antibiotics is hard and expensive. The "low-hanging fruit" are all gone, and in the last few decades we've just been rehashing different variations of the same classes of antibiotics. We're seeing bacteria become resistant to entire variations within classes so quickly that, it doesn't make sense to develop those variations anymore.

2. Making antibiotics is harder, and more expensive than it needs to be. This is because of regulations, and mostly it's a good thing. It protects us from getting sick(er), and from scams and grifts. Clinical trials are expensive: https://news.ycombinator.com/item?id=33545209

3. We expect antibiotics to be cheap to buy. We expect them to be cheap, and if the price gets jacked up, people (doctors, patients, ppl on social media) complain. Because it's a pill we think it should be free (and it should; gov't should subsidize) but it's not free to make. If we required iPhones to sell for $5 each by law, they wouldn't be around either.

4. New antibiotics are "not allowed" to be sold. This is because we're afraid of resistance developing against them, which makes sense! But this means no company is allowed to recuperate the hundreds of millions of dollars of up-front development costs it takes to new versions of these things.

5. No one expects to make profit. Few expect to recuperate costs in antibiotics, at this point. It's not profitable (or cost-recoverable). If we treated bacteria like the Russian invasion of Ukraine, and we called antibiotics "Patriot" then we'd get more funding. Yes there's GARD-P and CARB-X etc. but look... the total amount of money raised in antibiotics funding is like less than half what Bird scooters raised before getting acquired by their Canadian subsidy.

6. Gov't has "more important things to do": new funding for AMR didn't pass congress, and Pasteur Act in general has been in a holding pattern. Basically it introduces more funding and allows for new ways to sell antibiotics. (Higher ups call it a "Netflix model" but it really is a "Doordash model" because Netflix has near-zero distribution costs. But it didn't matter bc it didn't pass)

7. It's not a real crisis yet. It's not really anyone's problem. Since we're not staring down the barrel of a real crisis. It's like going to the gym or eating healthy — yes we should probably do it, but let's put it off til next year, and make a resolution for it. Kick the ball down the road.

Ending on a slightly happier note:

1. Old school antibiotics development take many years to develop. Hopefully with AI, ML, genome sequencing, we might be able to find new classes!

2. Phages definitely work. We work with them! We've been treating some very hard-to-treat patients at Phage Australia, as a five person team, out of Westmead Institute.

3. Does phage therapy work at scale? We're shifting our answer from "is this crazy? Will it even work?" to "will this be sustainable?" It costs around $70k+ AUD per patient (time, labor, equipment, for labs and paperwork) but we have no systems in place. Lots of room to bring it down.

4. Does it work at scale, with good unit economics (and to Western standards)? We TGA to figure out regulations, and we're figuring out how to get them reimbursed for the long run. Ideas include using them as compounding pharmacy ingredients (like "Magistral Phage" out of Belgium)

5. There's no money in phages - even with our success, it's hard, and we're always scrambling for money to keep the lights on. But hopefully the Aussie gov't will keep the project running for long enough that we can get a better understanding of running this with "lifestyle business" unit economics (it's probably not venture scale).

6. Going to market is very tricky. Phages are a service, not a drug. Each person's phage treatment is different than the other, so this doesn't fit the clinical trial pathways currently available. It's also different in each country, and we're open to ideas.

Final note:

What we REALLY want is to provide a "concierge service" to wealthy clients and hospital systems that always want "insurance" to treat some of the worst pathogens lurking around the hospital or their region. AMR infections can strike quickly, but usually it's strains that we've seen before — especially in hospitals. It's always the "most wanted" strains that have previously caused problems. We're able to create "countermeasures" for any bacterial threats using phages. Pretty much like Patriot missiles (and with similar costs). This would also follow the Tesla playbook for ("a rich people toy" before releasing a cheaper version).

This would really help us fund us to find ways to lower our production and get it into more hands.

We need help on that front! If you're able to help, or have ideas, please find me on my twitter (same as my handle here) or on the Phage Australia website)

Thanks everyone and merry xmas!