The original QIDP definition was fiercely contested. (For the record, I was among those who favored an "unmet need" standard and opposed including antifungals.) But even now, there are others who would broaden it further - for example to include biologics.
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But quibbles about defining QIDP point to a bigger underlying question: what is the best way to ensure a robust pipeline of antibiotics that will meet future needs?
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Most (but not all) observers of the space agree that the current market is inadequate & policy change is needed to increase/supplement revenue from sales. But how much, and to which products? Some say smaller awards to more companies; some say big awards for only the best drugs.
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Pros of small/many: possibly saving existing companies and creating a viable business model for biotechs, thereby retaining R&D expertise. Also it is hard to predict how resistance will emerge (ie which drugs may be useful in future). And it is just hard to find truly novel
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Cons of small/many: small awards likely won't be sufficient to get big pharma back in the space, they require the taxpayer to pay for products that have no clear advantage over what exists, and they don't incentivize trials against harder indications.
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Pros of big/few: public pays only for actual clinical advances/chemical or structural novely, incentivizes harder indications, larger award may attract capital that wouldn't go after small awards.
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Cons of big/few: many current companies won't qualify and therefore may not survive, it is hard to define and predict what drugs would qualify (since most clinical development programs do not support an FDA label for superiority or activity against resistant bugs).
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Some, including John Rex, have proposed a hybrid: a baseline award with tiered additional sums for added value. Challenges of that include total cost of the program and the aforementioned arguments against rewarding undifferentiated drugs. /end
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