by Dr. Latania K. Logan
Chicago is one of a handful of American cities where a deadly fungal infection, Candida auris, has been spreading rapidly.
It was first detected five years ago. By 2019, researchers were noting the emergence of a strain of the infection that is resistant to antifungal medications.
C. auris is a “superbug” — an antimicrobial-resistant (AMR) infection that does not respond to existing medications such as antifungals. It kills 30% to 60% of patients who contract it, mostly in nursing homes and hospitals. And it is not alone.
As chief of pediatric infectious diseases at Rush University Children’s Hospital in Chicago and an expert in antimicrobial resistance, I have witnessed this crisis with my own eyes. But I need you to see it too.
Millions of people around the world contract drug-resistant infections every year, and almost 2,000 die every day. Our global health care system is on a collision course with a superbug pandemic. As a 2019 report by the Centers for Disease Control and Prevention found, America “must stop referring to a coming post-antibiotic era — it’s already here.”
The good news is that combating superbugs is not a question of the science. While developing better antibiotics and antifungals will be challenging, we can do it. The bad news is that distorted market forces are discouraging their development.
The problem we face is baked into the DNA of infectious bugs. It’s in their nature to evolve and adapt. That’s why, especially in recent years, doctors have become increasingly judicious in prescribing antibiotics. Every dose encourages the microbes to adapt, strengthen and grow more resistant to treatment.
Under such circumstances, the prudent course is a two-pronged strategy. First, we must conserve our current arsenal of antibiotics to slow superbugs’ evolution. Second, we must elevate the development of new and stronger antimicrobials as a public health priority — to be ready as more AMR infections inevitably emerge.
The medical and scientific communities are working hard on our end. The federal government can help by enacting antimicrobial policies that address the problem.
Making new antimicrobials today is not economically viable. New antimicrobial products are not designed to be widely prescribed, but instead used sparingly, against infections resistant to current treatments. That means the market for them isn’t large enough to support the cost of research and development.
Thus, the incentives of the health care system — which needs antimicrobials to support most modern medical care, from cancer chemotherapy to C-sections — are out of alignment with those of drug manufacturers, which cannot earn returns on their investments under current policy.
Changes to federal law could help microbiologists develop what I would argue are some of the most important medicines of the 21st century — medicines we need right now and know we will need more of.
A promising reform now under consideration in Congress is called the PASTEUR Act. It’s a bipartisan bill that would change the nation’s purchasing system for new antimicrobials. In its current arrangement, the government buys antimicrobials based on the volume of doses. The PASTEUR Act would change this system to a long-term subscription model, in which the government would pay a set fee upfront for access to novel antimicrobials that address the most pressing public health needs.
Whereas the current system of sustaining research and development investments on per-dose sales does not fit the science or economics of the market for antimicrobials, the system proposed in the PASTEUR Act would provide the financing needed to spur the innovation of new antimicrobials and encourage their judicious use to protect the longevity of these treatments.
With Illinois as an epicenter of C. auris, our senators and representatives should be leading on this urgent challenge. It’s a bipartisan policy issue with life-or-death consequences.
We cannot sit back and wait for AMR infections to overrun our health care system in another pandemic. Superbug preparedness is a choice — and one we cannot afford to ignore.
