By Dr. Anurag Malani
A highly contagious and often deadly fungal infection recently broke out in a Detroit-area health care facility, forcing the medical center to temporarily turn away all new patients. The outbreak of Candida auris was extremely dangerous because of its ability to spread easily and its resistance to antifungal medications.
C. auris had evolved into a “superbug” – one of an increasing number of strains of bacteria and fungi causing infections that are resistant to currently available treatments. Superbugs were linked to nearly 5 million deaths worldwide in 2019 alone.
As an infectious diseases specialist and a consultant to the Michigan Department of Health and Human Services regarding antimicrobial resistance, I have seen firsthand that we are in a race against the clock. The only way out is a speedy and robust response from our nation’s lawmakers to fight resistant infections with a sufficient arsenal of antimicrobials.
The discovery of antibiotics was one of the greatest triumphs in the history of medicine. Yet even as these treatments are saving millions of lives, dangerous pathogens evolve to find ways around them.
Fifty years ago, bacteria took an average of 21 years to become resistant to treatments. Now, it can take just one year.
We have the technology to stay one step ahead of superbugs. But we don’t have the viable economic ecosystem to guarantee new antimicrobials make it to patients. That’s what we need to fix.
With most medical treatments, companies can expect to recoup their research funding if the drug is approved by the FDA and the company successfully commercializes the product.
In the case of antibiotics, however, widespread use that is associated with high-volume sales is what we’re trying to avoid. Doctors must use antibiotics judiciously and keep the newest ones in reserve for infections that don’t respond to current treatments. We need to be careful about prescribing them widely to slow down the time it takes for pathogens to develop resistance.
That makes it hard for antimicrobial researchers to stay in business. The FDA has approved 13 new antibiotics in the past decade, but the companies behind nearly half of those drugs have since gone bankrupt or were sold at a near-zero valuation.
A new model for antimicrobials is necessary. The PASTEUR Act, a bipartisan bill, would create just that. Right now, the federal government reimburses antimicrobial makers based on the quantity of antimicrobials sold. PASTEUR would change this model to a subscription-style mechanism, so that the federal government could pay upfront for access to a new, FDA-approved antimicrobial. This model would help meet a critical public health need.
With the support of this contract from Washington, the antimicrobial maker would manufacture and supply as much of the new treatment as necessary for patients.
PASTEUR would help reinvigorate the antimicrobial pipeline to ensure a steady supply. PASTEUR would increase resources for hospitals to guide appropriate antimicrobial use and prevent resistance. Such a public-private partnership would help us fight superbugs here in Michigan and elsewhere.
Anurag Malani, MD, is the medical director of antimicrobial stewardship, hospital epidemiology and special pathogens at Trinity Health St. Joseph Mercy Ann Arbor.