A global health emergency is underway, and we are dangerously unprepared to contain it.
Drug-resistant infections are outpacing our medical defenses, and the gap between rapidly evolving superbugs and dwindling antibiotic pipelines is widening, putting millions of lives at risk.
Currently, approximately one in six bacterial infections is resistant to antibiotics. A major analysis published in The Lancet also estimates that antibiotic resistance will contribute to around 170 million deaths worldwide over the next 25 years.
We know how to reverse this trajectory by developing new antibiotics. But experts warn that there is a significant lack of research and development in this area. Of the 90 antibiotics in development in 2024, only five will be effective against one of the World Health Organization’s “emergency priority” pathogens, which cause some of the most difficult-to-treat infections. The need to accelerate innovation has never been more urgent.
Antibiotic resistance occurs when dangerous microorganisms, such as bacteria and fungi, become unresponsive to the drugs needed to treat them. Antibiotics revolutionized medicine and saved lives by treating infections. Without effective methods, routine procedures such as knee surgery and C-sections pose deadly risks. Drug-resistant bacteria already claim more than 1 million lives worldwide each year.
This growing crisis concerns me not only as a health policy expert, but also as a patient and citizen. This health crisis carries significant national security risks. Antibiotic shortages leave us horribly vulnerable to biological threats. And like any pandemic or natural disaster, it will harm not only civilians but military personnel as well.
I worry that we are not doing enough to address this crisis, but I recognize the challenges that got us here. We are losing out to superbugs in part because of the way antibiotics work and how that affects the economics of drug development.
Every time an antibiotic is used to kill an infection, the surviving microorganisms mutate and adapt, making them more resistant the next time. This means that antibiotics become less effective as they are used. Therefore, antibiotics should be used with caution.
This smart approach reduces resistance. But it also means that the market for antibiotics is small, despite their enormous value in terms of saving lives. Companies trying to develop something new have difficulty achieving break-even points. This is not surprising, considering that the development of just one antibiotic takes more than a decade and costs more than $1 billion. Frankly, by some estimates, the return on investment for antibiotic development is negative $50 million. The situation remains unfavorable for developers.
As a result of these developments, many large biopharmaceutical companies have withdrawn from antibiotic development. Smaller biotech companies are still grappling with this challenge, but most are fighting for survival. Since 2017, several antibiotics from startups have received FDA approval. Since then, nearly every company has gone bankrupt, abandoned antibiotic research, or been forced to sell.
This market collapse is particularly alarming given the enormous value that antibiotics provide. Researchers estimate that by developing new antibiotics and improving access to them, the U.S. health care system could save $97 billion annually by 2050.
This means we need to establish new models for antibiotics that give drug developers the financial security they need to see these treatments through to completion. A bipartisan group of US lawmakers proposed just that in the Pasteur Act, which was recently reintroduced in Congress.
The bill would create a subscription model between the federal government and companies that successfully develop new antibiotics for the most threatening infectious diseases. Medical professionals will have access to these treatments, and companies will be able to earn predictable revenue instead of having to struggle to rely on revenue based on the number of antibiotics they sell. Most importantly, patients will have access to life-saving medicines for their most dangerous infections.
If lawmakers don’t pass the Pasteur Act soon, our economy, national security, and countless lives are at risk.
The introduction of this impending bill gives lawmakers an opportunity to finally prepare the United States for a health crisis caused by antimicrobial resistance before the consequences of inaction become irreversible.
Phyllis Arthur is executive vice president and director of health policy and programs at the Biotechnology Innovation Authority.
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