The US must lead the global fight against superbugs

The United States must lead the global fight against superbugs

By Howard Dean

Most Americans could probably guess that heart disease, diabetes and cancer are among the fastest-growing causes of death worldwide. But despite its devastating consequences, a rapidly growing health threat lurks under the radar.

The threat comes from antimicrobial resistance (AMR), the evolved immunity of dangerous microbes to life-saving drugs. AMR killed 1.27 million people in 2019, more than malaria and HIV combined, according to the latest comprehensive global analysis. Now a groundbreaking study has been published in the lancet estimates that without action, AMR will kill more than 39 million people in the next quarter century. The average annual death rate is projected to rise by nearly 70 percent between 2022 and 2050.

We don't have to stay on this path. But a change in direction requires decisive steps from the US government. As the world leader in pharmaceutical development, the United States has a moral obligation to lead the way in solving this global problem. We need to boost research and development of new antimicrobial drugs and strengthen the patent system that allows us to bring so many new drugs to market.

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AMR occurs when disease-causing microbes – most commonly bacteria – evolve to evade the drugs designed to kill them, turning them into so-called “superbugs.” Among the more well-known are methicillin-resistant drugs Staphylococcus aureus (MRSA), multidrug-resistant tuberculosis and Streptococcus pneumoniae, a bacterium that causes pneumonia and may be resistant to penicillin. In 1993, U.S. hospitals recorded fewer than 2,000 MRSA infections. In 2017, that number had risen to 323,000, according to the most recent data available from the Centers for Disease Control and Prevention. Preliminary data shows that cases of another superbug have emerged C. auris increased fivefold between 2019 and 2022.

A major cause of AMR is the overuse and misuse of antibiotics. The more frequently a bacterium is exposed to a particular antibiotic, the more opportunities it has to mutate and become resistant. The danger is that even minor infections become difficult to treat when these vital medications no longer work. This makes even routine operations and common illnesses much more dangerous – and it becomes much more difficult, especially for cancer patients whose immune systems are weakened, to fight off infections. Without urgent action and investment to support the development of new antibiotics, we could be thrown back to the pre-penicillin era, when a simple cut could be fatal.

But despite the urgent need for new antibiotics, the pipeline for their development is drying up. Today, only four major pharmaceutical companies are involved in antibiotics, whereas just a few decades ago there were dozens. The reason is simple: the economics of modern antibiotic development don't work. Developing a single new drug takes an average of 10 to 15 years and costs more than $2 billion. However, because antibiotics are typically used for short periods of seven to 14 days and must be used sparingly to limit AMR, their profitability is inevitably low. Because of this built-in hurdle, companies find it difficult to justify the costs and risks.

The new lancet Study recommends several ways to defend yourself. Not surprisingly, one of these is the development of new antibiotics – an area where the US has an opportunity to lead the world, expand its influence and make a huge difference.

America has the best intellectual property protection system in the world, making us a global leader in biopharmaceuticals and dozens of other high-tech industries. Intellectual property protection – particularly patents – provides a window of market exclusivity that allows companies to recoup their huge investments in research and development. Without reliable patents, few companies would take the risk of developing new antimicrobial drugs.

Unfortunately, in recent years, some U.S. lawmakers have advocated for reducing patent protection in order to lower drug prices. But these efforts, while well-intentioned, would only make the situation worse. Attacking patents is not the right strategy as it would only create further incentive to invest in the development of novel antibiotics. This would likely make it harder to combat outbreaks of infectious diseases and superbugs, which are evolving and becoming deadlier every year.

There is no panacea for the emerging AMR crisis. It will require action from all stakeholders and parts of society. Ordinary citizens, for their part, need to let respiratory viruses like colds run their course instead of asking their doctor for antibiotics. Not only are antibiotics ineffective against viruses, but attempting to use them to treat viral infections still contributes to resistance. Doctors also have to take on more responsibility. As a doctor, I know that many of my colleagues could be more careful when prescribing antibiotics.

Ultimately, Americans need a more proactive Congress. One solution to the antibiotic problem would be a subscription model to incentivize new research and development. Under such a system that is already being tested in the United KingdomThe government would contract with companies to provide antibiotics for a fixed fee, regardless of how many doses are needed. This would give drug developers a more predictable revenue stream and allow them to invest in high-risk, high-impact antimicrobial research that saves lives when we need it.

Former Secretary of State Madeleine Albright called the United States the “indispensable nation.”“,” essential for global progress and peace. Some dispute this characterization, and it is true that the United States cannot solve every problem. But drug discovery and development is an area where we are already a leader. Smart policies to combat antimicrobial resistance can help us maintain this leadership role while potentially saving millions of lives worldwide.

This is an opinion and analysis article and the views expressed by the author(s) do not necessarily reflect those of Scientific American.