Imagine surviving a tough fight with COVID-19 only to find your weakened body attacked by a “superbug” contracted in the hospital. It’s a terrifying thought, but these days more and more patients face this situation.
A superbug is a microbe, such as a bacterium or fungus, that has evolved to resist drug treatments, causing incurable, sometimes deadly, infections. As a physician who specializes in infectious diseases and antimicrobial resistance, I’ve seen too many superbug infections firsthand.
A new paper in Wednesday’s Lancet estimates that antibacterial resistance killed 1.27 million people worldwide in 2019. By 2050 it could be as high as 10 million, according to research by the U.K. government and Wellcome Trust. Although the highest burdens occur in low-resource countries, antimicrobial resistance is all too common in North Carolina and the U.S.
Alarmingly, we’re not doing enough to stop it. But with policy changes, we could slow this approaching pandemic before it engulfs us.
It’s hard to overstate the potential impact of unchecked antimicrobial resistance. Consider the role antibiotics play in our lives. When first introduced in the early 20th century, they transformed medicine. Without antimicrobials to ward off infection, minor injuries and routine surgeries could be deadly. Even small cuts and scrapes could be disastrous.
In North Carolina, nearly 30% of women give birth via cesarean section. Nationwide, surgeons carry out about 600,000 knee replacements annually. On average, Americans undergo seven surgeries over a lifetime.
All these procedures, as well as most other surgeries, organ transplants and chemotherapy, rely on effective antimicrobials. We shouldn’t have to go into these medical treatments fearing killer infections, yet that’s what will happen if we don’t take action.
I’ve seen a hint of our possible future during the current COVID-19 pandemic. We’ve had nearly 2 million cases here in North Carolina, with tens of thousands of patients hospitalized. Ventilators and intubation sustained the lives of many, and yet left patients highly vulnerable to life-threatening secondary bacterial and fungal infections.
And when a COVID patient is battling an additional infection, every single drug matters. With so many strains of bacteria and fungi resistant to treatment, it could be the fourth, fifth, or sixth one we try that works — if any work at all.
To combat the crisis of resistance, we need a more robust pipeline of new antimicrobial medicines. To make that happen, it’s important to understand that novel antimicrobials are used differently from many other drugs — infrequently and for short periods.
Because antimicrobials need to be used so judiciously, traditional commercial models haven’t been able to sustain ongoing research and development. Developing a novel product is costly, and there isn’t enough demand for companies to sustain investment.
In fact, the unique marketplace dynamics for antimicrobial products are so challenging that most larger pharmaceutical manufacturers — unable to generate a reasonable return on R&D investment — have left the field entirely. Much of the innovative development has fallen to small biotech firms, but most don’t have the resources to keep going if their novel products don’t have an opportunity to earn a return on investment.
One promising policy solution is the PASTEUR Act, a bipartisan bill advancing through Congress. It would establish a unique model, under which the government pays developers a set dollar amount for access to cutting-edge antimicrobials, regardless of how many are used. Like a subscription, the company would make the same amount whether a little or a lot is used. This would help strengthen the pipeline of novel antimicrobial products to ensure that we’re prepared for future public health crises, rather than scrambling to catch up once they’ve hit.
We face converging challenges: a dwindling supply of new antimicrobials, a broken market, and a growing superbug threat. Covid-19 has pushed our health care systems beyond their limits. But by looking ahead and planning wisely, we can make necessary strides in the fight against antimicrobial resistance.
Fowler is a professor of medicine and infectious disease specialist at Duke University School of Medicine.