So where are antibiotics supposed to come from?

Last month I wrote about the unexpected bankruptcy of the small biotech firm Achaogen, which declared Chapter 11 despite having brought out a needed new antibiotic. It’s remarkable that, in the five weeks since the company put itself up for sale, the alarm provoked by its crash hasn’t died away. If anything, the concern has gotten more intense. It sounds like this: If a company that had everything going for it can’t profitably produce an antibiotic, who can?

Maryn McKenna (@marynmck) is an Ideas contributor for WIRED, a senior fellow at the Schuster Institute for Investigative Journalism at Brandeis University, and the author of Big Chicken.

The answer may be that no one can—that the traditional structure of the pharma business, which works so well to bring forth cancer and cardiovascular and lifestyle drugs, can’t profitably produce the antibiotics that society needs. Which means it may be time to stop asking pharma to make them, and create some other entity—a government institute, an international nonprofit, a utility—to perform the task instead.

This sounds unthinkably radical, but a surprising number of leading thinkers about antibiotics are starting to advance the concept, out loud.

At the end of March, Lord Jim O’Neill—the former chief economist of Goldman Sachs, who ran the British government’s two-year Review on Antimicrobial Resistance—startled the audience at a London summit on resistance by recommending that antibiotic R&D be excised from companies and nationalized. “Just take it away from them and start over,” he said, excoriating pharma companies for being “endless talk but no progress.”

That same week, three British researchers proposed that governments band together to create an international nonprofit that would assume responsibility for discovering new compounds and conducting trials to prove their worth. One of the authors, Adam P. Roberts—who is a microbiologist and antibiotic discoverer at the Liverpool School of Tropical Medicine—said by email that if the institute found new antibiotics, they would be considered joint intellectual property, held as open science on behalf of the world and turned over to generic drug firms to be manufactured as cheaply as possible.

And two weeks ago, Rick Bright, director of Barda—a division of the US Department of Health and Human Services that functions as the government’s own biotech investment firm—wrote in Forbes that new antibiotics can only be achieved through “novel business models” and “real change.”

That may seem like a lot at once, but the medical community’s frustration with achieving new antibiotics has been boiling up for a while. One after another, the large pharma companies that once made antibiotics—including AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Abbvie, Sanofi, and Novartis—departed the specialty, claiming they couldn’t make a profit on drugs that are only taken for short periods of time and that lose effectiveness to resistance every day they are on the market. That left the field to small biotechs such as Achaogen, which found the profitability crunch even harder to endure than the big companies did, because they didn’t have other drug categories bringing in revenue to even out the balance sheet.

The proposals to remake antibiotic R&D into a government possession or a nonprofit concern are a response to those departures. They say, in effect: If profitability is an insoluble problem for antibiotics companies, we can solve that problem by making profit irrelevant.

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Creating a whole new entity feels like it might be throwing good money after bad—but Roberts says this effort could be funded by redirecting money that governments are investing and wasting. To date, he said, governments and philanthropies such as the Wellcome Trust have put more than $600 million into boosting antibiotic research, contributions that produced no results because companies shelved their proprietary findings when they abandoned their research programs or went broke.

And there’s a historic precedent for government ownership of antibiotic production, dating back to the first antibiotic, penicillin. It was identified in a London laboratory in 1928, but it was only turned into a mass-produced drug in the 1940s, after the US government—which needed it for the war effort—gave grants to multiple companies to make it, coupled with massive military contracts to later buy it.

Organizations already exist that might serve as models for creating an international antibiotics initiative, or for doing some of the tasks an international initiative might perform. Gavi, a global vaccine alliance, guarantees that low-income countries can afford childhood vaccines by placing bulk orders on behalf of several countries at once, negotiating prices with manufacturers, and funding the purchases through a mix of government contributions and philanthropic funds. The Global Antibiotic Research and Development Partnership, meanwhile, supports research into new and abandoned antibiotics for neonatal and childhood infections and sexually transmitted diseases. Laura Piddock, its scientific director and a microbiologist at the University of Birmingham, calls the nonprofit “not a replacement for pharma companies, but an alternative approach.” She adds: “We want to fill the gaps that no company is addressing.”