Preventing The Next Public Health Crisis Can Define Biden's Legacy

The Biden administration's plan to defeat the coronavirus is underway -- and notably includes intentions to "build better preparedness for future threats." This detailed guidance could not have come at a better time. While we are making progress against the current pandemic, we remain in the midst of a worsening health crisis posed by antibiotic resistance.

Deadly bacteria, commonly known as "superbugs," are evolving to resist even our strongest antibiotics, and we're not even close to developing enough new treatments to keep pace. Fifty years ago, bacteria took approximately 21 years to become antibiotic-resistant. Today, bacteria can become resistant to a previously effective treatment in just one year on average.

Meanwhile, superbugs infect at least 2.8 million people in the U.S. each year -- a new resistant infection every 11 seconds and a death resulting from antibiotic resistance every 15 minutes -- and the death toll is expected to skyrocket in the coming years, especially if superbugs evolve to resist our last remaining treatments. As the December 2020 CDC report on antibiotic resistance spikes in hospital settings during COVID-19 indicates, the pandemic is only exacerbating the problem. I have seen firsthand that secondary resistant infections significantly complicate care for patients seriously ill with COVID-19, and I am deeply concerned that we do not have the antibiotics we need for future public health emergencies.

The Biden administration's new plan rightly notes the threat of antimicrobial resistance, and now is the time for meaningful solutions. Preventing antibiotic resistance from turning into a full-blown catastrophe ought to be one of the Biden administration's top priorities. President Obama launched a critical effort on this issue in 2015, and I urge President Biden to continue that legacy.

Over the past three decades, pharmaceutical companies have developed only one new type of antibiotic. As of spring 2020, only 41 experimental antibiotics were undergoing clinical trials -- compared to more than 1,100 experimental treatments for cancer.

It's no accident that antibiotic development efforts are few and far between.

The current marketplace discourages antimicrobial research. Every time an antibiotic is used, some bacteria survive and can develop resistance. So unlike other drugs, new antibiotics must be used sparingly to prevent bacteria from growing immune to these last-line-of-defense treatments. As a result, use and sales of new antibiotics are slow and small, which makes recovering costs --much less any profit -- difficult, if not impossible.

These conditions create a marketplace with little incentive to produce new antibiotics, despite significant patient and public health need. That's a disaster in the making. Our current antibiotic arsenal will become fully ineffective within decades. Common medical conditions and treatments that weaken patients' immune systems or expose them to potential infection -- including caesarean sections, cancer treatments, and hip replacements -- will become life-threatening without new antibiotics.

Action must be taken to foster a system that can sustain antibiotic innovation. Right now, an important bipartisan bill that can make a difference is under consideration in Congress: the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act.

The PASTEUR Act would implement a subscription payment model to incentivize the development of antibiotics that address high unmet need. The legislation would provide upfront payments to biopharmaceutical companies for highly novel new antibiotics in exchange for access to the medicines in federal health programs. By moving away from a volume-based payment system, PASTEUR would help these companies recoup research and development expenses, supporting the production of new and highly novel antibiotics, even if those drugs are used sparingly. This would protect and prepare us with new antibiotics to keep us steps ahead of the most dangerous superbugs.

As we navigate a path forward from COVID-19, we’d be remiss not to take lessons learned from the current pandemic. Our efforts must include confronting the ongoing antimicrobial resistance crisis. In addition to what we already know about the increasing gaps in sustainable antibiotic treatments, we absolutely must bolster our national pandemic preparedness plan to ensure we are never again caught off-guard.

Helen Boucher, M.D., FIDSA is chief of the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center and director of the Tufts Center for Integrated Management of Antimicrobial Resistance (CIMAR). Dr. Boucher also serves on the Board of Directors at the Infectious Diseases Society of America and the Advisory Board of the Partnership to Fight Infectious Disease.