How to Stop the Superbugs

“Superbugs are not a unique problem to COVID-19, of course; they already kill 35,000 Americans every year. If bacteria continue evolving to outwit antibiotics, however, the World Health Organization estimates they will become the leading global cause of death by 2050.

[..] The ability of biotech upstarts to earn revenue clashes with the basics of evolutionary biology. Superbugs develop as bacteria accumulate mutations over time, forming strains that elegantly evade our existing antibiotic arsenal. The more consistently a bug goes up against one of our trusted antibiotics, the more likely it is to evolve to escape it. Accordingly, to prevent the spread of progressively resistant and dangerous superbugs, we doctors prescribe the newest, most powerful antibiotics as sparingly as possible, only in situations where no other treatments would work. This antibiotic stewardship is prescient for public health, but devastating for drug sales. There is, essentially, an inverse relationship between an antibiotic drug’s sales volume and its medical value. This makes it difficult, if not quixotic, for biotech companies developing novel treatments to recoup their investment.

[..] What might really help is a redesign of the antibiotics market altogether. A recent congressional bill sponsored by Sens. Michael Bennet and Todd Young aims to help. Known as the PASTEUR Act—an homage to the father of microbiology, Louis Pasteur—the bill would offer multiyear contracts paid annually by the U.S. government to drug developers with new antibiotics. The money would pay for the developer’s antibiotics to be used by anyone who is on a public insurance program, including Medicaid, Medicare, and TRICARE, as needed. This model, which is already in use in the United Kingdom and Sweden, treats access to novel antibiotic medicines like a Netflix subscription: For a fixed price paid out to a biotechnology company each year, the government could use as many antibiotic doses as it needs. If you wind up using Netflix just to watch a new release here and there, the company gets your money all the same. Similarly, if doctors use an antibiotic sparingly, the drug company still profits and has an incentive to develop new medicines.

Importantly, this model breaks the link between antibiotic sales volume and the total number of patients who receive the drug. This would be a boon for patient care, public health, and pharmaceutical innovation. Patients receive only the antibiotics they need, because drug manufacturers won’t be compelled to oversell drugs to meet revenue targets. The biotechnology industry will benefit from the predictability of financial rewards in exchange for developing much-needed novel treatments. Finally, hospitals and physicians will benefit from a new repertoire of valuable antibiotics to quell emergent superbugs. The global toll of COVID-19 has been a dangerous reminder of how much damage an infectious disease can do and our pressing need for novel antimicrobials. Unless we proactively design a functioning market to attract the talent and investment required to build a new generation of antimicrobial therapies, our next pandemic risks being one of superbugs.”

Full article, Jin J and Patel NA. Slate 2020.9.18