The Biden Administration Must Wage Battle Towards Antimicrobial Resistance Beginning on Day One
Billions of microscopic bacteria, viruses and fungi live on our skin, in our mouth, in our intestines and in our bodies. Most of them are harmless and some are useful, but a handful of them are pathogenic, which means that they cause disease or infection.
The discovery of antimicrobial drugs, a group of drugs that includes antibiotics and antifungal drugs, was one of the crowning achievements of the last century as it enabled the medical community to treat diseases and infections that had previously killed countless people. For example, penicillin, one of the first antibiotics to be developed, has been estimated to have saved at least 200 million lives since it was first used as a drug during World War II.
Today, most of us take for granted the idea that antibiotics fight many common bacterial infections. But imagine taking penicillin for a sore throat only to find it stopped working – and then prescribing a range of other antibiotics only to find none of them work. Unfortunately, this is exactly what we face as we enter an era when many life-saving drugs are no longer able to fight certain pathogens.
A year ago, the Centers for Disease Control and Prevention (CDC) published a corresponding report on the existential threat of antibiotic resistance (AR) or antibiotic resistance (AMR) that occurs when pathogens develop defenses and defend themselves against the intended antibiotics kill you. The inability to destroy such germs makes certain infections difficult, if not impossible, to treat.
The Infectious Disease Society of America views antibiotic resistance as a public crisis. The CDC goes one step further and cites it as one of the greatest public health challenges of our time. The World Health Organization (WHO) ranks AMR as “one of the ten greatest global threats to human public health”.
Unfortunately, the COVID-19 era brings new AR and AMR challenges. While last year’s CDC report should have triggered a warning shot around the world, the pandemic has diverted attention, energy and resources away from the subject.
Why do antimicrobial drugs become resistant?
In the United States, at least 2.8 million people develop an antibiotic-resistant infection every year – and another 35,000 people die.
The crisis was caused by a number of factors, including the increased use – and abuse – of antibiotics. The CDC believes that at least 30% of antibiotics prescribed in the United States are unnecessary. In large part, this is due to the fact that many healthcare providers are overly liberal in distributing prescriptions. For example, a whopping 41% of antibiotic prescriptions are prescribed for treating respiratory disease, although many respiratory infections – colds, bronchitis, and the like – are caused by viruses that antibiotics cannot destroy.
In addition, many patients simply do not follow the treatment regimens prescribed by their health care providers or ask for antibiotics when they are not in need. To further exacerbate the crisis, many people prescribe themselves and take leftover prescriptions or antibiotics that were prescribed to family or friends. By taking antibiotics inappropriately, or when they don’t need them, they increase the risk of potentially dangerous side effects, including developing AR or AMR.
How the pandemic created new challenges
The pandemic may have increased the AR and AMR threat. Many hospitalized patients with COVID-19 symptoms are given antibiotics to reduce the chance of bacterial infection. For example, in Michigan in March and April, more than half of patients hospitalized with suspected COVID-19 were given antibiotics as a precaution against bacterial infections. Later tests would show that 96.5% of them did not have a bacterial infection, but rather had COVID-19, a virus that cannot be destroyed by antibiotics.
Administering unnecessary antibiotics in a hospital not only increases the risk of developing drug-resistant pathogens, it also speeds up the rate of spread of some of these resistant pathogens. This is a big problem because even before the pandemic, one of the greatest risks for an AR or AMR-associated disease such as MRSA, sepsis, or C. diff was in a hospital or other healthcare facility.
The medical and health communities simply are not equipped to face the AR and AMR challenge. The United States has withdrawn its support for WHO, which believes we must act immediately to protect the future from AR and AMR. It doesn’t help that the public is poorly informed about the extreme danger of drug-resistant pathogens.
How can we fight the problem?
Fortunately, there is a way forward. The National Action Plan to Combat Antibiotic Resistant Bacteria (CARB), 2020-2025, contains a number of specific actions the US government will take over the next five years to reduce AR and AMR. The plan, based on previous CARB action plans and national strategies, has focused on studying and collecting data on antibiotic resistance and preventing and slowing the spread of drug-resistant infections. These actions are observed through the lens of One Health, a collaborative approach that works at local, regional, national and global levels to achieve healthy outcomes for people, plants and animals.
To prevent a post-antibiotic era from becoming our dystopian future, we must act now. In September, Sens. Michael Bennet, D-Colo., And Todd Young, R-Ind., Introduced the bipartisan PASTEUR bill to help address this crisis. For the first time, this bipartisan legislation proposes the establishment of an antibiotic subscription program, which means the federal government could provide funding to companies developing new, much-needed antimicrobial drugs.
It is vital that the government is able to do this. Antibiotics take years to develop and we just don’t have time to wait as current drugs are losing their effectiveness against drug-resistant superbugs. In addition, there is little incentive for companies without a subscription program to look for new antibiotics as it is a huge investment with the risk of amortization. There is simply no big market for new antibiotics that are only used when older drugs fail.
A new presidential administration will enter the White House in January and many new lawmakers at all levels of government will be sworn in. Both new and incumbent legislators must prioritize antibiotic resistance as the cornerstone of their political initiatives – starting with the passage of the PASTEUR law. But the government cannot do it alone. We need coordinated efforts between government, industry and consumers to find solutions to this existential threat.
There is no time to waste.