Bacteriophage therapy
were infected by antibiotic-resistant bacteria. Different international versions of this survey (with the same content) were also distributed in China and the United States. Similar patterns were observed.
(c)
With the new drive for phage-related technological commercialization, the foreseeable future of phage therapy is likely to be optimistic. We can also expect the establishment of a more comprehensive training model for phage specialists, particularly in medical schools, as uncertified individuals are unlikely to be permitted to apply phage therapy for themselves or others. Phage treatment centres in which doctors who specialize in phage therapy carry out phage therapy on patients will become more and more common worldwide. In cases that both antibiotics and phages could be used, phage
therapy could be recommended as they do not affect other non-pathogenic bacteria in the body (e.g., an option, not necessarily the last resort). However, phages are unlikely to replace antibiotics, since antibiotics are currently much more convenient, widely accessible, and generally more accepted by the public. However, apart from the regulatory conundrum that may take years to resolve, other potential hurdles and possible solutions have also been identified. Firstly, the cost of phage therapy is likely to be very high, and its sustainability is highly dependent upon its economic viability and the availability of financial reimbursement of phage studies and phage therapy from official authorities or public research organizations. Due to the expectation that phage therapy is unlikely to be massively profitable, Big Pharma are less in favour of such treatment compared with more profitable drugs to treat patients with chronic diseases. 69 Therefore, the focus on phage therapy is mainly shared by start-ups and small and medium-sized enterprises, whose financial basis is, in fact, much weaker with questionable long- term sustainability. Currently, most phage therapy centres are either funded by governmental entities or public research organizations (e.g., universities). For example, the Center for Innovative Phage Therapy and Therapeutics (IPATH) in California, USA, is financially reliant upon and affiliated with the University of California, San Diego School of Medicine. 70 The magistral model of phage therapy in Belgium is primarily funded by the Belgian government, and the supporting phage bank behind it is managed by the military hospital QAMH in Brussels. 71 It is expected that official funding from the government or major research organizations will be essential for the long-term success of phage banks, and official authorities (branches of regulatory agencies) should also be established and financed to support the phage banks by realistic means. 72 In countries with a state-owned healthcare system, the flow of state funding may be considered to be maintained at a stable level.
69 Greene 2008. 70 Schmidt 2019b. 71 Pirnay et al. 2018. 72 Häusler 2021.
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