Antimicrobial Resistance: The Authors Reply

Antimicrobial Resistance: The Authors Reply We are grateful to see industry support for adding our “guardrails” (May 2016) to any proposal for antibiotic vouchers with transferable exclusivity, as expressed by Patrick Holmes and JonMauer of Pfizer. However, we stand by our original calculations of the inefficiencies of the older proposals. We used the best available data on the cost of antibiotic drug research and development. If Holmes and Mauer are right when they say that the research and development is even more expensive, then certainly that would argue for proportionally higher incentives and therefore the same inefficiencies we describe. One difficulty with all voucher proposals is the potentially large mismatch between the value of the innovation and the value of the voucher. If the mismatch is too large in one direction, companies lack an incentive to innovate. If it is too large in the other direction, governments vastly overpay for new products. Our guardrails— most importantly, the dollar cap on total protected sales—much more closely align the incentives, which benefits both innovators and the public. Kevin Outterson Boston University BOSTON, MASSACHUSETTS