The market for new antibiotics has collapsed and that’s a problem because our current ones are failing.
Almost every antibiotic you or I take is an older generic drug that was discovered decades ago. Society relies on older, generic medicines because they are affordable, easy to manufacture, and widely available around the world. But unlike most generic drugs, which maintain their effectiveness over time, our antibiotic arsenal has weakened thanks to a phenomenon known as resistance.
Antibiotic resistance occurs when bacteria are exposed to antibiotics and then evolve to become impermeable to those drugs. It can go so far that bacterial infections, so-called superbugs, no longer respond to individual or even all antibiotics. Soon, the generic antibiotics we rely on after scratching our hikes or breaking our arms at the playground will no longer work.
When antibiotics fail, people pay the price with their lives.
We are now at a tipping point where antibiotic-resistant infections are so common that the World Health Organization has listed antibiotic resistance as one of the top ten global health threats.
The COVID-19 pandemic has accelerated this problem, but it’s a problem I’ve known all my life. I live with cystic fibrosis, a rare genetic condition that causes a buildup of thick, sticky mucus in my airways. This thick, sticky mucus is the perfect environment for harmful bacteria to thrive, and several species of bacteria have called my lungs home since childhood. Decades of exposure to antibiotics have caused the bacteria that live in my lungs to become resistant to all but a limited number of last-choice options.
My health is stable because drug companies have historically been stimulated to target rare diseases like cystic fibrosis, so I have drugs that alleviate the protein dysfunction at the heart of my disease. But I still depend on antibiotics to keep up the fight against infectious diseases in my lungs.
One of my best friends with cystic fibrosis died suddenly in 2018 when all antibiotics failed her. It was scary how fast it went.
Their end is one that is already happening to people around the world without cystic fibrosis. Millions of Americans already suffer from antibiotic-resistant infections each year, and tens of thousands die each year because of a barrier to the development of new antibiotics.
In the absence of new drugs, the only way to limit the spread of resistance is to limit the use of antibiotics. This basic policy governing the prescription of antibiotics is called stewardship and minimizes the evolutionary growth of superbugs as it results in less antibiotic exposure.
However, the result is a negative feedback loop. With fewer antibiotics being prescribed, a whole host of drugmakers are running out of cash, and because so many ventures have failed, investors are reallocating their resources to other therapeutic areas. Now only a handful of drugmakers are working to develop much-needed antibiotics.
Without capital, many small life science companies do not have the resources necessary to invest in research, development, clinical trials and more to bring new antibiotics to market.
Unless this market failure is addressed, more people living with bacterial infections will pay the ultimate price.
Congress needs to incentivize the industry.
Our legislators can act with the non-partisan Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) law. The law encourages the development of novel antibiotics with upfront payments after regulatory approval. In fact, the law proposes a subscription, allowing antibiotic stewards to keep new drugs on the shelf until a medical need beckons, while allowing drugmakers to keep the lights on. The UK recently introduced a similar payment.
For investors who have put their capital into other indications, the law will provide certainty about sales forecasts and hopefully boost future funding for antibiotics manufacturers.
For society, PASTEUR significantly reduces the risk of an economic catastrophe. New antibiotics will reduce the inflated costs of antibiotic resistance, already worth $55 billion a year in the US.
And most importantly for patients, the law will give us much-needed options to treat our stubborn infections. The PASTEUR law is a factual, bipartisan proposal that needs to be signed into law.
Gunnar Esiason is a patient advocate living with cystic fibrosis. His family’s non-profit organization, the Boomer Esiason Foundation, has raised more than $160 million in the fight against CF. He guides the patient-centric strategy Florence healthcare. Follow him on Twitter @G17Esiason.
