Most Americans could probably guess that heart disease, diabetes and cancer are among the world’s fastest-growing causes of death. Yet one rapidly accelerating health threat now lurks under the radar, despite its devastating consequences.
The threat comes from antimicrobial resistance, or AMR, the evolved immunity of dangerous microbes to lifesaving drugs. In 2019 AMR killed 1.27 million people—more than malaria and HIV combined—according to the most recent comprehensive global analysis. A groundbreaking study published in the Lancet last September estimates that, without action, AMR will kill more than 39 million people in the next quarter of a century. Average annual deaths are forecast to rise by nearly 70 percent between 2022 and 2050.
We don’t have to stay on this trajectory. But changing direction will require decisive moves from the U.S. government. As the leader in pharmaceutical development, the U.S. has a moral obligation to lead the way on solving this global problem. We need to jump-start research and development on new antimicrobial drugs and shore up the patent system that enables our country to bring so many new medicines to market.
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Without action and investment soon to support the development of new antibiotics, we could be thrown back to the pre-penicillin era, when a simple cut could turn deadly.
AMR occurs when disease-causing microbes—most often bacteria—evolve to evade the drugs created to kill them, turning them into so-called superbugs. Some better-known ones include methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Mycobacterium tuberculosis, and Streptococcus pneumoniae, a bacterium that causes pneumonia and can be resistant to penicillin. In 1993 U.S. hospitals recorded fewer than 2,000 MRSA infections. In 2017 that number had jumped to 323,000, according to the latest data available from the Centers for Disease Control and Prevention. Preliminary data show that cases of another superbug, Candida auris, jumped fivefold between 2019 and 2022.
Overuse and misuse of antibiotics are major causes of AMR. The more a bacterium is exposed to a particular antibiotic, the more opportunities it has to acquire mutations and become resistant. The danger is that as these essential medicines stop working, even minor infections will become hard to treat. That will make even routine surgeries and common illnesses much more dangerous—and make it much harder for those who are battling cancer and whose immune systems are compromised to fight off infections. Without action and investment soon to support the development of new antibiotics, we could be thrown back to the pre-penicillin era, when a simple cut could turn deadly.
Yet despite the urgent need for new antibiotics, the pipeline for developing them is drying up. As of today, only four major pharmaceutical companies still work on antibiotics, down from dozens just a few decades ago. The reason is simple: the economics of modern antibiotic development don’t work. Creating a single new drug takes an average of 10 to 15 years and costs more than $2 billion. But because antibiotics are typically used for short periods ranging from seven to 14 days and must be used sparingly to limit AMR, their profitability is necessarily low. This built-in roadblock means companies have a hard time justifying the expense and risk.
The Lancet study recommends several ways to fight back. One of them, unsurprisingly, is to develop new antibiotics—an area in which the U.S. has an opportunity to show global leadership, expand its influence and make an enormous difference.
Colored scanning electron micrograph (SEM) of bacteria cultured from a mobile phone.
Steve Gschmeissner/Science Source
America has the world’s best system of intellectual-property protection, which has made us the frontrunner in biopharmaceuticals as well as dozens of other high-tech industries. IP protections—in particular patents—provide a window of market exclusivity that allows companies to recoup their enormous investments in research and development. Without reliable patents, few businesses would take the risk of developing new antimicrobial drugs.
Unfortunately, over the past several years some U.S. lawmakers have advocated for reducing patent protections as a way to reduce drug prices. But these efforts, though well intentioned, would just make the situation worse. Attacking patents isn’t the right strategy, because it would only create another disincentive to invest in novel antibiotic development. This would likely make it harder to combat outbreaks of infectious diseases and superbugs, which are evolving and growing deadlier every year.
There’s no single panacea for the brewing AMR crisis. It will require action from all stakeholders and segments of society. Everyday Americans, for their part, need to do a better job of letting respiratory viruses like the common cold run their course rather than asking their provider for antibiotics. Not only are antibiotics ineffective against viruses, but attempting to use them to treat viral infections contributes to resistance. Doctors need to take more responsibility, too. As a physician, I know many of my colleagues could be more judicious in prescribing antibiotics.
Finally, Americans need Congress to be more proactive. One solution to the antibiotic conundrum would be a subscription-type model to incentivize new research and development. Under this kind of system, which is already being tested in the U.K., the government would contract with companies to provide antibiotics for a fixed fee, regardless of how many doses are needed. This would give drug developers a more predictable revenue stream, allowing them to invest in high-risk, high-impact antimicrobial research that extends lives when we need it.
Former secretary of state Madeleine Albright called the U.S. the “indispensable nation,” essential to global progress and peace. Some dispute this characterization, and it’s true that the U.S. can’t solve every problem. But drug R&D is one area where we already lead. Smart policies to tackle AMR can help ensure we maintain this leadership while saving potentially millions of lives worldwide.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.