Superbugs are a major threat

by Nicholos Joseph

We don’t know when the next pandemic will strike. But we have a good idea of where it’ll start — in hospitals.

Bacteria and fungi are constantly evolving and growing more and more resilient to the antibiotics we use to treat them. These “superbugs” will eventually mutate to resist even our last-line-of-defense treatments.

When that happens, these microscopic killers could spread from room to room within hospitals and eventually out into the world. Today, these “superbugs” — resistant to the most potent treatments we have — pose a threat during procedures ranging from organ transplants to routine childbirth. And the problem continues to grow at a pace faster than we can innovate. Even minor scrapes and cuts could ultimately prove fatal if we do not act now.

Today, antibiotic resistance kills more people around the world than HIV or malaria. If left unaddressed, superbugs are on track to kill a staggering 10 million people annually by 2050, unless scientists develop new and improved treatments that keep pace with these ever-evolving microbes.

Thankfully, we can take steps now to avert this catastrophe — and the unfathomable human and financial toll it would cause — by smartly spending money to spur the creation of those new treatments.

As a final-year student at Harvard Medical School, I’ve done my fair share of hospital rotations, and I’ve seen the threat posed by superbugs up-close.

I helped care for a liver transplant recipient, H, who developed a bacterial infection about a week after his surgery. This wasn’t a surprise; transplant recipients are severely immunocompromised after their operations, and about 1 in 2 liver recipients will develop an infection within two weeks of their transplant.

We treated H in a hospital isolation unit, initially with the usual antibiotic regimen. When he didn’t seem to be getting better, we tried more and more potent combinations, eventually reaching the most powerful antibiotics available. Yet, after about 100 days, his body, despite the assistance of our full arsenal of antibiotics, lost the battle.

Antibiotics aren’t as effective as they once were because whenever we administer these treatments, some microbes inevitably survive. These “superbugs,” immune to many of our medicines, then reproduce.

This is basic science. And it’s why doctors, nurses, pharmacists and other health care workers know not to overprescribe antibiotics. Every dose of amoxicillin or doxycycline we administer brings these invaluable therapies one step closer to obsolescence.

The superbug threat has always been frightening. But because of the millions of secondary infections COVID-19 patients developed over the last two years, antimicrobial resistance is also now accelerating.

The greatest obstacle to defeating antimicrobial-resistant infections today is not biological, but rather, economic.

The average cost of developing a new drug is $2.6 billion. Pharmaceutical companies typically make those huge upfront research investments because they know that, if they’re successful, they can recoup their investment dollars and earn a return from selling large volumes of the drug.

Unfortunately, this business model doesn’t work for antibiotics. They are purposefully prescribed as infrequently as possible, and usually for just a few days, rather than for months or years. Ironically, the more effective antibiotics are at curing people, the less profitable they become.

That Catch-22 helps explain why only one new class of antimicrobials has come to market in more than 35 years, and why so many smaller antibiotics companies have gone bankrupt. There just isn’t sufficient economic incentive to innovate in this space, and this must change now.

Ultimately, the war against superbugs won’t be won just in a lab but rather in Washington. Our leaders could spur this much-needed research and development by changing the economics of antibiotics.

One of the most promising current legislative measures in this arena is the PASTEUR Act, a bipartisan bill that would create a new subscription payment structure for antibiotic drugs. Essentially, the government would pay a recurring fee for unlimited access to a company’s advanced antibiotics. Research companies could then focus on science, instead of sales.

Suddenly, creating advanced antimicrobials that’d be held in reserve — to be deployed only in true emergencies — could be just as financially viable as inventing mass-market treatments for chronic diseases such as cancer or high blood pressure.

Of course, the PASTEUR Act isn’t cost-free. We’re going to have to spend money on the fight against superbugs, whether proactively or reactively. The question we must ask is: Do we judiciously spend billions upfront to develop effective new treatments, or do our leaders let this opportunity pass, instead saddling future taxpayers with the costs — trillions of dollars and millions of human lives — brought about by rampant, uncontrolled superbugs bringing our entire medical system to the brink of collapse? To me, the answer is clear: Incentivize innovation now to avoid the massive toll this will take in the future.

As a medical student in the midst of the pandemic, my experiences led me to emergency medicine as my chosen specialty. And bipartisan reforms, like the PASTEUR Act, will help ensure that as an emergency room doctor, I’ll have the tools available to help my future patients ward off avoidable, life-threatening infections.

Nicholos Joseph is a fourth-year student and class president at Harvard Medical School.