America's leaders aren't doing enough to confront one of the greatest public health menaces in modern history.
Increasingly, pathogens like bacteria and fungi are evolving into "superbugs" that are immune to existing treatments. This phenomenon, known as antimicrobial resistance (AMR), is one of the top ten public health threats currently facing humanity, according to the World Health Organization. In 2019, antibiotic resistance was associated with more than 170,000 deaths in the United States and nearly 5 million deaths worldwide. Many of these infections were acquired in hospitals and other healthcare settings.
The U.S. government has a long and mostly successful history of responding to national health crises, from funding Operation Warp Speed to accelerate the development and delivery of COVID-19 vaccines, to establishing the Office of Public Health Emergency Preparedness in response to the anthrax attacks of 2001.
But our leaders also often focus on preparing for the sorts of threats we encountered in the recent past, rather than the threats that are gaining momentum right before our eyes.
Consider how many governments around the world are currently dedicating public resources into preparing for the next pandemic -- which, to be sure, is an important task. Yet superbugs pose an equally grave danger today. They're here already, yet they're receiving comparatively little attention.
The solution isn't as complicated as one might expect -- but it is unique to this segment of medicine. In the short-term, we can be better stewards of our current arsenal of antimicrobial drugs. Existing antimicrobial medicines should be administered carefully and taken appropriately to help delay the evolution of pathogens into drug-resistant superbugs.
But better stewardship alone won't combat the superbug threat. We also need to develop new, innovative antimicrobials.
That brings us to the broken antimicrobial marketplace, due to the unique way that these products are used. Many antimicrobials do their work quickly and are often only prescribed for a short duration, like several days or weeks. The judicious use of antimicrobial medicines is also critical for public health because it reduces the opportunity for more resistance. Consequently, low sales make it hard for drug inventors to recoup the major investments required to develop any new medicine.
As a result, many companies developing new antimicrobials -- most of which are small biotech companies -- have been unable to develop and successfully commercialize new products in recent years. The financials simply don't line up. The few companies that do attempt to enter the market with new antimicrobials face long odds. In fact, eight antibiotics developed by small companies have received FDA approval in the last decade. Since their approvals, every one of these companies have either filed for bankruptcy, been acquired, or left the antibiotics space entirely.
In short, the antimicrobials market is fundamentally broken, and we need to repair it. One fix would be to replace the volume-based sales model with something more like a subscription, in which drug developers are compensated for developing new treatments based on the value of the treatment to public health, regardless of the number of doses patients eventually need.
Legislation that would do this is actively under consideration in Congress. In April, a bipartisan group of lawmakers introduced the PASTEUR Act. Under the bill, the government would contract with a company for a set amount of funds for reliable access to an effective new antibiotic, essentially stabilizing a return on investment in highly risky antimicrobial development.
Passing PASTEUR should be one of Congress' top priorities. AMR is a national security threat we know how to prepare for. It's time our political leaders take advantage of that opportunity.
Phyllis Arthur is Senior Vice President for Infectious Disease and Emerging Science Policy at the Biotechnology Innovation Organization (BIO).
