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Hi Alyssa! Thank you so much for your detailed question! The repurposing of nonantibiotic pharmaceuticals, AI advancements, and combination therapy all have promise in developing new ways to combat antimicrobial resistance. However, I think the point you raised about a non-profit approach is the most important and relevant to Dr. Bai’s talk. It has been well established through our learning and through the knowledge Dr. Bai imparted on us, that the current entrepreneurial development model for antibiotics is broken and needs to be fundamentally transformed. Dr. Bai mentioned that the most relevant factor which is impeding the development of new antimicrobials is the lack of incentive for large pharmaceutical companies. Nonprofit organizations have substantial advantages over for-profit companies as nonprofit companies can choose to not enter markets in favor of addressing unmet needs, as they face no pressure to continually generate revenue growth and drive-up shareholder value. As nonprofits lack shareholders, they face less pressure to increase drug prices and are better positioned to control post-approval antibiotic use. A drug with tens of millions of dollars in annual sales is considered a failure for large for-profit companies but could be very impactful for nonprofits, who can reinvest this revenue to sustain research and development efforts in the future. An improved system would encourage discovery and development of truly needed antibiotics that improve patient outcomes, rather than continued development of “me too” drugs for profits. This would make the development of antibiotics with low peak sales economically feasible and would permit more effective control over the post-approval use of antibiotics to prolong their effectiveness. To specifically answer your question, based on my research I believe that this non-profit approach which I have outlined would be more successful than the other new potential avenues which you mentioned as in my opinion they would most likely fall prey to the same issues we see in large pharmacological companies today with antimicrobials. I do not know if these new therapies would be susceptible to the ”me too” drug movement we see in antimicrobials however the directly profit-oriented agenda of these companies would undoubtedly have an effect on which new therapies are pursued which I believe could be lessened through a non-profit system.

Pierce Colpman

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