The widespread use of antibiotics, antivirals and antifungals has driven the evolution of antimicrobial resistance, set to kill 10 million people a year by 2050. Besides antimicrobial resistance, other challenges to combating infectious diseases include, for example, that of tuberculosis, with immune tolerance which makes it extremely hard to target with a single strategy,²³ and the chronic fungal infections immunosuppressed patients often develop.²⁴ But new drugs are hard to discover and develop, as they do not make much money competing against cheap generics, such as current antibiotics on the market.

Future Horizons:

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5-yearhorizon

Diagnostic technologies improve

Development and implementation of diagnostic technologies that can rapidly identify infecting pathogens and which antibiotics work against a particular strain allow healthcare professionals to make informed decisions about which antibiotics to use. Machine-learning models predict “dual function” treatments — ways to kill pathogens while simultaneously boosting immune properties. Phage therapy begins to be adopted in agriculture instead of antibiotics to keep livestock infections in check.

10-yearhorizon

Increasing convergence and transparency

How bacteria build resistance to phages starts to be understood and can be modelled using AI. Gene therapy begins to be deployed against pathogenic bacteria to target their survival strategies (including propensity to form biofilms and transition into “persister” states). Autologous prophylactic faecal transplants become a routine precursor to taking antibiotics. Phage therapies move into the clinic.

25-yearhorizon

Research develops a cure for HIV

Purging the viral reservoir of HIV totally eliminates the disease in a one-shot cure. Sustainable chemical-synthesis strategies are employed in small molecule synthesis, dramatically reducing time and cost of delivery of new medicines.

One such recent candidate, zosurabalpin, overcomes existing antibiotic-resistance mechanisms in a major hospital-acquired pathogen, carbapenem-resistant Acinetobacter baumannii (CRAB), and is now in human trials. Although AI holds the promise to speed up drug-screening processes, a major challenge in developing new antibiotic medicines remains the progression of new chemotypes that kill bacteria effectively in vitro into human medicines that carry well-balanced drug-like properties, including safety profiles.

It will be necessary to embrace entirely new ideas. First, existing antibiotics may be made more effective by using them in combination with non-antibiotic drugs. The use of bacteria-infecting viruses known as phages can treat bacterial infections and reduce resistance to antibiotics by removing physiological barriers — biofilms — which contribute to resistance. However, infrastructure is underdeveloped for clinical trials and research is still needed to answer important questions about the specific actions of phages against bacteria and how bacteria develop resistance against phages.²⁵Regulatory infrastructure also needs to be updated for the research into phages to advance.²⁶ Research is also under way to develop microbiome strategies to cultivate gut flora to outcompete pathogenic strains. In addition to faecal transplants, more sophisticated RNA-based sculpting of the microbiome can selectively kill certain bacteria.²⁷ Immunotherapy is also being investigated for deployment against bacterial infections²⁸ and fungus.²⁹ The more alternatives to defeating antimicrobial resistance the better, to minimise the chance of pathogens evolving mechanisms to evade the treatment — that is, resistance.

Anti-infectives - Anticipation Scores

The Anticipation Potential of a research field is determined by the capacity for impactful action in the present, considering possible future transformative breakthroughs in a field over a 25-year outlook. A field with a high Anticipation Potential, therefore, combines the potential range of future transformative possibilities engendered by a research area with a wide field of opportunities for action in the present. We asked researchers in the field to anticipate:

The uncertainty related to future science breakthroughs in the field
The transformative effect anticipated breakthroughs may have on research and society
The scope for action in the present in relation to anticipated breakthroughs.

This chart represents a summary of their responses to each of these elements, which when combined, provide the Anticipation Potential for the topic. See methodology for more information.