There’s also pharma world wide. Seems the system is broken if only massive economic upside in the US is what leads to drug discovery and successful clinical trials.

Testing requirements are as high in other rich countries. And existing antibiotics work fine atm. Nobody’s gonna pay to use new ones unless there’s no alternative, both for cost and resistance reasons. So why bother? Might as well postpone development until there’s a real market, right?

I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics.

Yes and no. Many strategies for delaying antibiotic resistance require having multiple different effective antibiotics at the same time. Thus, getting down to the point where only a few work rapidly speeds up antibiotic resistance.

Unfortunately, antibiotics are the tragedy of the commons writ large, and we’ve been wasting them for minimal gain because even minor private benefit generally outweighs long term consequences.

The reason not to postpone development is because it isn't a particularly quick solution. It would be one thing to develop and test them, and then postpone deployment of them. It's another thing to not have a backup plan and hope that one of the antibiotic candidates work out, and quickly.

Modern cities are a huge disease vector. That kind of population density lets sickness run rampant. Untreated TB has something like a 25% mortality rate, and we've already seen drug-resistant (DR) and extreme drug-resistant (XDR) strains of TB. An outbreak of TB that we have no antibiotics for would be devastating.

Edit: Apparently broad spectrum antibiotics can actually lead to antimicrobial resistance [1][2]

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> I actually think this is good since it means we postpone usage of, and thereby resistance to, any new antibiotics.

This is true if you use them in isolation but I thought broad spectrum antibiotics, aka many at once, is what is typical now to slow down development of resistance? In this case you’d want to develop a few new ones and deploy them in batch.

1: https://en.m.wikipedia.org/wiki/Broad-spectrum_antibiotic

2: https://www.science.org/content/article/combining-antibiotic...

Seems likely there’s a fairly small number of possible classes of broad spectrum antibiotics that can be developed. Bacteria don’t just evolve resistance to a single molecule but instead to a vector of attack, and anything you’re giving to people needs to avoid harming human cells.