By Dr. Rachael Lee
More than 80 Americans across 18 states have been struck with a serious bacterial infection thanks to contaminated eye drops. Several have suffered permanent vision loss. Four have died.
The contaminated drops housed a strain of the bacterium Pseudomonas aeruginosa, which, due to a rare gene, is immune to almost all antibiotics.
Though the drops are now off the shelves, the larger crisis of drug resistance is far from over. Antibacterial-resistant pathogens claimed more than 1.2 million lives in 2019. That number will continue to increase if we don’t act now.
Antimicrobials are a miraculous tool in the fight against infections. Human life expectancy increased by eight years between 1944 and 1972, largely attributable to the development of antibiotics. Even so, bacterial infections are still the second-leading cause of death worldwide, responsible for one in eight deaths.
Antimicrobial resistance, or AMR, occurs when pathogens — like fungi or bacteria — become immune to our existing medicines. We’ve been using antimicrobials to fight infections since 1937. After nearly 90 years under antimicrobial attack, it’s no surprise that pathogens have developed the ability to defeat the drugs designed to kill them.
By 2050, it’s estimated that AMR will cause 10 million deaths per year. It’s more important now than ever to course-correct. Antimicrobial stewardship, or improving how antimicrobials are prescribed, is a key part of the solution. When antimicrobials are prescribed only when needed and for the shortest durations possible, it ensures patients receive the best treatment and also slows a pathogen’s ability to develop resistance. But stewardship alone won’t solve the problem when infections are becoming increasingly difficult, and sometimes impossible, to treat.
New antimicrobials are another piece of the solution. The next generation of antimicrobials needs to attack and kill germs better, and in new ways, than current ones.
Unfortunately, the current drug business model does not work for antimicrobials due to the unique way they are used. Prescribing antimicrobials only when appropriate is critical for public health because it slows resistance, but it also keeps sales volume low. Investing in drug research and development is a significant risk as few products receive FDA approval, so the potential financial outlook needs to be stable enough to attract investors. Antimicrobials aren’t a lucrative enough proposition to pique such investor interest.
Legislation under consideration in Congress could revitalize antimicrobial innovation, giving us a major leg up in the fight against AMR. The PASTEUR Act would establish a system in which the government enters into contracts with antimicrobial developers via a subscription model rather than paying by unit sales. This would help guarantee companies some stability for their investment in new treatments, even if the sales volume is low.
Infectious disease specialists like me see the devastation of antimicrobial resistance too often. In the race against superbugs, our innovation is up against their evolution. We must regain the lead.
Rachael Lee, MD, is an associate professor and the chief healthcare epidemiologist at the University of Alabama at Birmingham. This piece originally ran in the Houston Chronicle.
