A plan for meeting the superbug crisis

Another silent killer is lurking in our community, and it’s not COVID-19. 

The threat is antimicrobial resistance — better known as an onslaught of “superbugs.” These are bacteria and fungi that can no longer be treated with existing drugs. 

Between 2017 and 2019, Washington State authorities uncovered 77 infections from the drug-resistant bacteria CRAB inside its health care facilities. In Spokane County in 2020, there were nearly 58 drug-resistant staph infections per 100,000 hospitalized people. That's higher than the state average of 45 per 100,000. Both are considerably higher than the most recent national data (less than 3 per 100,000 in 2016).

This is not just a local problem. Superbug infections could kill up to 10 million people annually by 2050 if we fail to take action, according to the World Health Organization.

As an infectious disease specialist at the University of Washington, I’ve lost patients because of a lack of effective antibiotics. Antimicrobials are not keeping up with resistance. We urgently need solutions.

One step is better antimicrobial stewardship. Medical professionals should be cautious in how we use antimicrobials to treat infections. 

But better management of existing drugs can only take us so far. We also need new medicines, and we’re not getting them quickly enough.

Part of the challenge is that antimicrobials are used differently than other drugs. Prescribing a medicine to one patient usually has no impact on whether it will work on others. But because any use of an antimicrobial can help the bug improve its defenses and make it more difficult to treat, antimicrobials must be used sparingly.

This limited use clashes with the model for developing new medicines. Drug discovery relies heavily on private investment. It costs around $1.58 billion to develop a single new antibiotic. To keep investment going, companies expect a decent-sized market for their product. When a drug needs to be used sparingly, that market isn't big enough.  

Many of the biggest drug makers have left the antimicrobial business, and several smaller biotech companies that took a shot have gone out of business.

Consider Achaogen. It worked for more than 15 years to develop a new antibiotic, plazomicin, which made it all the way through FDA approval. But in the end, the company was unable to stay viable due to the broken marketplace. It went bankrupt in 2019.

One solution would be a payment model that aligns the business of developing novel antimicrobials with the needs of public health.

If you get Netflix, the company makes the same amount of money no matter how much or how little you watch. Likewise, the government could provide drug developers a set payment for access to new antimicrobials, regardless of how many doses are eventually used. This guaranteed return on investment would incentivize companies to invent without fear of going out of business. 

U.S. lawmakers are working on legislation called the PASTEUR Act that would launch such a program, while also providing hospitals funds to support antimicrobial stewardship. 

Reform is urgently needed. Failing to meet the superbug threat will only cost more each year, both in financial terms and in lives lost.

Paul S. Pottinger, MD, is a professor of infectious diseases at the University of Washington School of Medicine and co-director of the University of Washington Medical Center Montlake’s Antimicrobial Stewardship Program. This piece originally ran in The Spokesman-Review.