Without new antibiotics, the superbugs will keep winning
“It is a very scary moment.”
That’s how former NFL player Brandon Noble recently described his career-ending, antibiotic-resistant infection — and the disclosure from his doctors that the available antibiotics might not be able to save his life.
The same could be said of the moment we find ourselves in now: a nearly 40-year drought of urgently needed new types of antibiotics, leaving us not even close to keeping pace with the increasingly resistant superbugs that continue to emerge and spread.
According to a recent study published in “The Lancet,” the 1.27 million people killed by antibiotic-resistant bacteria in 2019 exceed the annual toll from either HIV or malaria. Alarming new data from the Centers for Disease Control and Prevention, as well as previous research from The Pew Charitable Trusts and others, indicates that the COVID-19 pandemic has accelerated this threat. By 2050, as many as 10 million people could die each year as a result of antibiotic resistance. And without effective antibiotics, common medical procedures that rely on infection control and prevention measures — such as chemotherapy, cesarean sections, dialysis and many others — could become too dangerous. But the danger isn’t limited to serious infections or wounds: Even simple ones can turn deadly when no adequate treatment is available.
Amidst this looming crisis, the World Health Organization’s most recent analysis reveals a grossly insufficient pipeline of antibiotics in clinical development. We’re simply not developing the types and numbers of new drugs needed to tackle the world’s most alarming bacterial threats, which means that medical professionals and health care providers are quickly running out of options to treat their patients.
The superbugs are beating us at a competition we can’t afford to lose. But proposed legislation can make a significant difference by transforming our nation’s approach to antibiotic research and development.
The bipartisan Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act (H.R. 3932, S. 2076), introduced by Reps. Mike Doyle (D-Pa.) and Drew Ferguson (R-Ga.), and Sens. Michael Bennet (D-Colo.) and Todd Young (R-Ind.) would help reinvigorate the antibiotic pipeline by investing U.S. resources more wisely. Specifically, the bill would offer sizable, upfront funding commitments to incentivize the development of innovative, high-priority antibiotics. This approach, which has been called for by experts, commissions and reports, and has been successfully piloted in the United Kingdom, would de-link companies’ revenue from the volume of drugs they sell and instead pay for high-need antibiotics based on their value to public health.
To be clear, the U.S. already spends a lot of money financing antibiotic access for patients insured by federal programs, such as Medicare, TRICARE and the Veterans Administration. But that money isn’t being spent in a way that drives innovation and appropriate antibiotic use.
The approach outlined in the PASTEUR Act is critical to addressing the dysfunctional antibiotic market that has led most large pharmaceutical companies to discontinue antibiotic research and development over the past decade in favor of focusing their efforts on disease areas with a more predictable return on investment. The few small companies that are still working to develop new antibiotics — mostly startups that have never brought a drug to market — face nearly insurmountable financial strain or bankruptcy, which means that many potentially lifesaving antibiotics may never reach patients. This untenable situation requires systemic change.
The PASTEUR Act would also increase support and resources for antibiotic stewardship, which is key to preserving the efficacy of existing and new antibiotics for as long as possible.
Recently, there’s been some encouraging support for the prompt passage of the PASTEUR Act. In March, President Joe Biden included language in his FY2023 budget calling for economic incentives like those proposed in the PASTEUR Act. During a congressional markup in the House Committee on Energy and Commerce, Doyle raised the importance of passing the PASTEUR Act before the end of this Congress, and congressional leaders have acknowledged the importance of the issue as well.
As the authorizing committees look ahead to other health-related legislation, we strongly urge policymakers to act on their commitment to the fight against antibiotic resistance and include the PASTEUR Act in one of the bills expected to pass this Congress. The act’s passage would be a major step forward in mitigating the threat of antibiotic-resistant bacteria.
Brandon Noble narrowly avoided a tragic ending. Although he could no longer play football, antibiotics saved his life. His “scary moment” became an opportunity to highlight the dangers of antibiotic resistance and effect positive change. Now, Congress has a similar opportunity to help confront antibiotic resistance by passing the bipartisan, bicameral and broadly supported PASTEUR Act. We cannot overstate the urgency of seizing this opportunity — or the risk of waiting any longer.
The superbugs are here. Fortunately, so is the PASTEUR Act, which fosters American innovation and leadership — and will save lives. The time to pass it is now.
David Hyun, M.D., directs The Pew Charitable Trusts’ antibiotic resistance project. Daniel P. McQuillen, M.D., FIDSA, is the president of the Infectious Diseases Society of America.