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The emergence of anti-microbial resistance in the bugs that cause infectious diseases has been called the biggest threat to modern medicine. For example:

England’s chief medical officer has warned of a “post-antibiotic apocalypse” as she issued a call to action urging global leaders to address the growing threat of antibiotic resistance.

Professor Dame Sally Davies said that if antibiotics lose their effectiveness it will spell “the end of modern medicine”.

That sounds pretty serious. So I was surprised to read the following claim in PharmaForum:

There are now less [sic] than 500 scientists studying antimicrobial resistance (AMR) worldwide

This seems incredibly small. The pharmaceutical industry in the UK alone, for example, employs about 25,000 people in R&D according to the ABPI and the UK is nothing like the top country for drug R&D.

Such a potentially serious problem might be expected to attract significant resources. Is the estimate of fewer than 500 people in R&D worldwide on the topic of antibiotic resistance credible?

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matt_black
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    My gut feeling is that it's on the low end of the believable range, but consider that there's not much money in it, and many powers in the industry do not want to draw attention to the problem. – Daniel R Hicks Dec 05 '17 at 20:31
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    Research is sometimes about hype, not pragmatism. Things like cancer, ms, and heart disease attract more funding because they are more popular to talk about. –  Dec 05 '17 at 21:02
  • [This](https://academic.oup.com/cid/article/46/2/155/452327) doesn't state any numbers on researchers, but it does back Daniel's assertions with facts. A nicer presenation is the 2nd graph in http://phenomena.nationalgeographic.com/2015/05/23/oneill-amr-3/ It takes 23 years to break even on antibiotic research. – Fizz Dec 06 '17 at 06:44
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    It is not clear what do they mean by studying. Are these full time researchers dedicating every day of their life to it or anyone who tried to read something about it in a last year? Also R&D does not work this way, you can't just grab any person in R&D and tell - go and study this stuff. Some of them are specialists who dedicated most of their carrier to one narrow field. You can't just suddenly move it to another field because professor Dame thinks it is important. – Salvador Dali Dec 06 '17 at 18:33
  • You don't need to study antibiotic resistance to be engaged in developing new antibiotics. I'm not even sure that it makes sense to spend any money researching either. That money might be much better spent on developing an alternative approach to deal with the problem of bacterial infections like customized phage therapy. – Christian Dec 11 '17 at 11:38

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This is from a researcher in the field, and while it doesn't give any hard numbers, it does support the general idea of few US researchers having been involved, at least for quite some time:

The Veterans Administration has a wonderful research support system that allowed me to get started and funded me virtually constantly for the 16 years I worked there. I will always be grateful to the VA for their constant support. Their approach should be contrasted to that at the National Institutes of Health (NIH) where there was, for many years, a bias against funding antibiotic resistance research. They felt that antibiotic resistance was not important or at least that it was somehow not good science. If it was important, the pharmaceutical industry and not the NIH should fund it. The pharmaceutical industry was not so interested in resistance in those days either since it usually did not do any good for marketing their products. I submitted grant requests to the NIH – but they were mostly not successful. It wasn’t just me. There were only a very few of us in the United States working on antibiotic resistance and we all knew each other. One reason there were so few of us was that it was so difficult to obtain support for our research. When we got together we realized that we all had the same problem. In 1986 we met and began to investigate the NIH and their funding practices as far as antibiotic resistance was concerned. We confirmed that they did not fund much research in the area and requested a meeting with them.We found that one major reason they did not fund resistance research was that they had very few people working on reviewing grant proposals who were even familiar with antibiotic resistance. Since the NIH relied entirely on the grant reviews provided by their reviewers, resistance researchers were left out. We actually held several small workshops with the NIH over the next 5 or 6 years. One of our main recommendations to the NIH was to establish a special peer group to review grant requests in the area of antibiotic resistance. As a result of our efforts, we were the subjects of an article in the prestigious journal Science that referred to us as disgruntled scientists. Finally, 20 years after our group first met, the NIH established the very peer review group we recommended. Any discrimination against resistance research in the NIH seems to be gone, but grant money is still very hard to come by.

From David M. Shlaes, Antibiotics: The Perfect Storm (2010), p. 2. And from p. 67:

In 2008, the Pharmaceutical Research and Manufacturers of America (PhRMA) reported that their industry was sponsoring almost 22,000 clinical trials with drugs for cancer being the most common (almost 7,000 trials). PhRMA listed no trials for antibiotics (even though there are a few going on). This should give you an idea as to the priority industry is giving to antibiotics these days.

Data on lack of new antibiotics development is much easier to corroborate, but I think it probably says something about researchers too. From a 2017 review:

Most pharmaceutical companies have stopped or have severely limited investments to discover and develop new antibiotics to treat the increasing prevalence of infections caused by multi-drug resistant bacteria, because the return on investment has been mostly negative for antibiotics that received marketing approved in the last few decades. In contrast, a few small companies have taken on this challenge and are developing new antibiotics.

There is one recent review of funding in this area. Unfortunately it doesn't report any totals. Using its supplementary data I've quickly calculated the US funding to be about $900M and the EU funding to 1.4B+3.2B, but the latter 3.2B is for clinical trials support, so I'll leave it out... in estimating the number of grants. I'll use the US average grant value of about $400k/grant. That would give us 2,250 US grants and 3,500 EU grants. So, these would definitely support more than 500 researchers (even if we just count the PIs).

As the review notes however, most of the projects funded are preclinical research... and the quick-and-dirty total figures (I came up with) aren't all that impresive considering the ~$700M bill for pushing a single new antibiotic to market.

Fizz
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