Thirty years ago, when the world faced the terrifying prospect of an untreatable disease known as Aids, drugmakers scented an opportunity and raced to develop new medicines.

Seen as cheap, routine treatments, antibiotics are overprescribed and taken haphazardly, creating superbugs they can no longer fight

Today, as the world confronts another crisis, this time one of antibiotic resistance, the industry is doing the opposite. It is cutting research in a field that offers little scope for making money.

Antibiotics have become victims of their own success. Seen as cheap, routine treatments, they are overprescribed and taken haphazardly, creating superbugs they can no longer fight.

These superbugs are growing, but are not yet widespread, so the costly research needed to combat them is not worthwhile. Medical experts say this dilemma could return medicine to an era before Alexander Fleming discovered penicillin in 1928.

Fixing the problem will need both faster approval of last-resort drugs and new ways to guarantee rewards for companies, according to both industry leaders and public health officials who have been sounding the alarm.

Paul Stoffels, pharmaceuticals head at Johnson & Johnson , is better placed than many to understand the problems.His company offered a rare glimmer of hope in December, when it won regulatory approval for a new treatment for drug-resistant tuberculosis – a growing issue in many countries.

Unfortunately for the world, it was a one-off and J&J is not currently developing any more antibiotics.

“The market for a new antibiotic is very small, the rewards are not there and so the capital is not flowing,” he said in an interview in London.

“It’s about the sheer amount of money people are prepared to pay for a drug. In cancer, people pay $30,000, $50,000 or $80,000 (per patient) for a drug, but for an antibiotic it is likely to be only a few hundred dollars.”

Last week, AstraZeneca, facing tough decisions about where to invest, said it would put less money in developing anti-infectives. “We have to make choices and we have to focus our investments where we think we can make a substantial difference,” CEO Pascal Soriot said.

The regulatory bar for drug approval is a key consideration for any company weighing R&D investment. For antibiotics is very high, partly due to a scandal over the approval of Sanofi’s drug Ketek in 2004, which US officials said later should be reserved for serious diseases due to the risk of side effects.

The head US Food and Drug Administration’s (FDA) drugs wing, Janet Woodcock, last year pledged a complete “reboot” of the approval process, aware of the stifling effect recent official caution has had on the development of new drugs.

The rapid approval of J&J’s tuberculosis drug in December, based only on mid-stage Phase II data, may be a sign of a new flexibility at the FDA, which matters because the US is the world’s biggest drugs market.

The European Medicines Agency is also working on new rules to encourage antibiotic development, while the EU last year launched a novel public-private partnership to get governments and companies to share information and funding.

Such public-private alliances across countries could start to change the conventional market model, according to Andrew Witty, CEO of GlaxoSmithKline, another of the few Big Pharma companies still actively researching antibiotics.

He favours greater sharing of research and has made an offer to England’s chief medical officer Sally Davies to create new laboratories for developing research ideas brought in by others.

New market approaches could include doing away with a price and instead having the healthcare system paying the inventor a fee per year as a reward for delivering a medicine, he said.

In some years, society would end up paying more in fees than it would in drug bills; in other years less. But at least companies would have an assured revenue stream.

Healthcare officials on both sides of the Atlantic are showing a willingness to do things differently after drawing attention to the antibiotic crisis this month.

Davies said the steady rise in resistance in the last five years represented a “ticking time bomb” that ranks alongside terrorism as a threat to the nation. Tom Frieden, director of the US Centres for Disease Control and Prevention, called for an urgent fight-back against “nightmare bacteria”.

The rush for the exit on antibiotic research has been dramatic.

Pfizer, once the leader in the field, closed its antibiotic R&D centre in Connecticut in 2011, to the dismay of many scientists. It now focuses anti-bacterial work on vaccines.

Since the 1980s, the number of new systemic antibiotics approved by the FDA has plunged from 16 in 1983-87 to just two in the last five years, according to the IDSA.

Meanwhile, the ‘superbugs’ are on the increase. One of the best known is methicillin-resistant Staphylococcus aureus, or MRSA, which alone is estimated to kill some 20,000 people every year in the US – far more than Aids – and a similar number in Europe.

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