On the evening of Saturday 31 August 1901, the celebrated French novelist Marcel Proust wrote to his mother with characteristic intimacy, recounting his struggle to quell a severe attack of asthma the previous day. Having suffered from periodic attacks of asthma since the age of nine, Proust was familiar with the range of contemporary treatments for the condition: over the years, he had been prescribed opium, caffeine, iodine, and morphine (which had once been injected by his father, Dr Adrien Proust), his nose had been cauterized numerous times, he had adopted a milk diet, and he had occasionally attempted to relieve both his asthma and his hay fever by visiting health resorts, such as Evian-les-Bains, on the shores of Lake Geneva. However, as his note to his mother suggests, Proust's favoured remedy involved the inhalation of smoke from anti-asthma cigarettes or powders:

This paper analyses how research on antibiotic resistance has been a driving force in the development of new antibiotics. Drug resistance, while being a problem for physicians and patients, offers attractive perspectives for those who research and develop new medicines. It imposes limits on the usability of older medicines and simultaneously modifies pathologies in a way that opens markets for new treatments. Studying resistance can thus be an important part of developing and marketing antibiotics.

The chosen example is that of the German pharmaceutical company Bayer. Before World War Two, Bayer had pioneered the development of anti-infective chemotherapy, sulpha drugs in particular, but had missed the boat when it came to fungal antibiotics. Exacerbated by the effects of war, Bayer’s world market presence, which had been considerable prior to the war, had plummeted. In this critical situation, the company opted for a development strategy that tried to capitalise on the problems created by the use of first-generation antibiotics. Part and parcel of this strategy was monitoring what can be called the structural change of infectious disease. In practice, this meant to focus on pathologies resulting from resistance and hospital infections. In addition, Bayer also focused on lifestyle pathologies such as athlete’s foot. This paper will follow drug development and marketing at Bayer from 1945 to about 1980. In this period, Bayer managed to regain some of its previous standing in markets but could not escape from the overall crisis of anti-infective drug development from the 1970s on.

“An effective AIDS vaccine could be found as early as 2012, saving 6 million lives if the world is willing to put £10 bn a year into a new programme, the chancellor, Gordon Brown, said in a speech last night in Tanzania”. Faith in biomedical science; the conviction that new vaccines will be translated into lives saved; belief in the necessity of globally concerted action: the British minister's statement reflects views of vaccine innovation that are widely held today. New and improved vaccines seem our best hope of coping with the scourge of AIDS, of arming ourselves against the unknown threats of emergent diseases and potential bioterrorism, and of tackling the resurgence of old diseases arising once more in Europe. Global coordination, pooling our resources, seems self-evidently necessary, given the international nature of a modern epidemic. Much current discussion of vaccine development and use thus has a global character. That is to say, it is conducted under the banner of global slogans or it seeks to establish globally integrated approaches to vaccine research and development (R&D). Over the past two decades the development and rapid introduction of new vaccines have come to dominate the vaccine agenda worldwide. Social scientists and health policy analysts have been set to work, examining barriers to the implementation of international priorities at the national level. Why, for example, are national responses to the availability of new vaccines often so lethargic? A recent study of the adoption of Hemophilus influenza b (Hib) conjugate vaccine is a good example. It shows policy makers in four countries rationally weighing the burden to public health of the diseases against which the vaccine offers protection (bacterial meningitis and pneumonia), against the high cost of the vaccine. Health policy analysts tend to explain the decision to introduce a new vaccine, or to replace an existing vaccine by a new alternative, in terms of the epidemiology and seriousness of the disease, and of scientific consensus regarding the efficacy and potential risks of the vaccine and (perhaps) their costs. The studies of vaccine diffusion and adoption that they conduct have little or nothing to say about political disagreements, or the influence of commercial interests, national traditions, international relations, or global agendas. Where any attention is paid to vaccine history, it is generally in the attempt to illustrate factors (such as resistance to vaccination) that might cause deviations from the rational deployment of vaccines.