Antimicrobial resistance threatens our health security — both domestically and globally

Antimicrobial resistance threatens our health security — both domestically and globally
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Following the recent news that the new Ebola outbreak in the Democratic Republic of the Congo (DRC) reached an urban area where its spread can accelerate, congressional attention to reauthorizing the Pandemic and All Hazards Preparedness Act (PAHPA) is timely.

The re-emergence and spread of this disease in the country where it was discovered four decades ago should remind us all that domestic and global health security preparations are only as strong as their weakest links.   

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Signed into law in 2006, PAHPA seeks to strengthen weak links, ensuring that our public health, medical preparedness, and response capacities are equipped to protect Americans from biological emergencies. But in the years since its enactment, the spread of antibiotic-resistant infections, the greatest public health threat facing our country, has only gained momentum, with the diminishing arsenal of effective antibiotic medicines.

 

The spread of antibiotic-resistant bacteria poses a major threat not only to our ability to treat and prevent specific diseases, but to provide medical care across a range of emergency events. The reauthorization of PAHPA gives legislators an opportunity to strengthen our weakest link by providing pharmaceutical companies with a necessary incentive to fill an unmet need.

That the need for new antibiotics is both immediate and growing has been well documented by the United Nations, which in a 2016 declaration recognized resistance to antibiotics as the “greatest and most urgent global risk,” by the World Health Organization (WHO). WHO ranked antibiotic-resistant bacteria on a list of the most dangerous “priority pathogens” requiring new medicines with which to treat them.

The U.S. Centers for Disease Control and Prevention, estimates that of the 2 million Americans who become seriously ill from infections resistant to treatment each year, at least 23,000 die.

Antibiotic resistance puts our health security at risk, both within the U.S. and globally. An outbreak of a serious resistant infection with limited or no treatment options could overwhelm health systems, harm economies, and destabilize communities and nations in the process.

From a national security perspective, the lack of antibiotics to treat resistant pathogens poses additional grave dangers. Studies indicate that a weaponized, resistant pathogen in just a single incident in the Washington, D.C. area could kill 3 million people.

Significant wounds and burns resulting from a mass casualty event can quickly become infected, and we have frighteningly few available treatments for these infections.

But while the need for new antibiotics increases, impetus toward developing and marketing new infection-fighting medicine continues to be stalled. The Biomedical Advanced Research and Development Authority  (BARDA) provides essential support for antibiotic research and development with funding for costly clinic trials.

Still, because courses of antibiotic treatment must be prescribed judiciously, and are typically short, efforts to develop new antibiotics are unlikely to lead to high-volume sales. With little or no opportunities to earn returns on investments, companies have backed away from antibiotic research and development.

The reauthorization of PAHPA provides an opportunity to fill the gap by giving new funding authority to BARDA to provide market entry rewards for the successful development of new antimicrobials, paid over a period of five years.

Such rewards would be reserved for antimicrobials that only address the most urgent unmet needs to treat resistant infections and would require commitments to antimicrobial stewardship and access.

An effective market entry reward program that leads to the development of new antibiotics would save money. Currently the CDC estimates that AMR costs the U.S. health-care system an additional $20 billion in annual excess costs.

It also would save lives. As an infectious diseases physician, I have seen the toll of antimicrobial resistance, most recently during the influenza outbreak of the last season in which secondary bacterial infections claimed many lives.

Much more than Ebola, antimicrobial resistance threatens our health security, both domestically and globally. It is critical that PAHPA reauthorization addresses that threat.

Barbara Murray M.D. is the J. Ralph Meadows Professor of Medicine and director of the Infectious Diseases Division at the University of Texas Health Sciences Center at Houston, Chair of the Infectious Diseases Society of America’s Antimicrobial Resistance Committee and former President of IDSA.