Secretary Azar can’t wait to address antibiotic resistance

Late last month, Health and Human Services Secretary Alex Azar extended COVID-19’s status as a public health emergency.

But a less publicized health crisis also requires his attention – “superbugs.”

These drug-resistant bacteria and fungi already kill over 35,000 Americans each year, according to the Centers for Disease Control and Prevention. And that’s a conservative estimate. Researchers at Washington University in St. Louis estimate the true annual U.S. death toll may exceed 162,000. While resistant infections can strike anyone, many of those victims are hospital patients whose weakened immune systems can’t fight off these infections.

In the coming years, deaths could skyrocket as superbugs evolve to resist our last remaining treatments. If and when that happens, these untreatable infections could threaten millions of Americans and make common medical procedures, from C-sections to knee replacements, too risky.

Secretary Azar is well aware of the enormous threat superbugs pose. But many others in the federal government aren’t. It’s up to the long-time public servant to educate his colleagues and help catalyze the development of new, more effective treatments.

Superbugs pose an urgent, dire threat to public health. Every year, more than 2.8 million Americans contract an antibiotic-resistant infection. Many never recover. Worldwide, superbugs claim 700,000 lives annually.

Paradoxically, the more we use antibiotics, the more resistant these infections become.

Every time a patient takes antibiotics, say for strep throat or an ear infection, some bacteria can survive. These survivors then evolve and multiply into stronger, more resistant strains, rendering future antibiotic treatments useless.

That’s especially concerning during a pandemic, which makes patients more susceptible to secondary bacterial infections. Consider that secondary bacterial pneumonia accounted for 29 to 55 percent of deaths during the 2009 H1N1 influenza pandemic. During the current pandemic, 21 percent of hospitalized U.S. COVID-19 patients sustained a secondary bacterial infection. As these life-threatening superbugs develop more and more resistance and threaten the lives of COVID-19 patients, we need every top medical mind in the country working on new antibiotics.

But that’s not happening. In fact, biotech firms are struggling to develop any new antibiotics.

From a financial standpoint, it’s practically impossible for biotech firms to successfully invest in antibiotics. Normally, the biotech business model involves spending huge sums of money upfront on research, and then — hopefully — recouping that investment and earning a return by selling large volumes of any resulting drug.

But doctors reserve the strongest antibiotics for dire emergencies, since using them more frequently would contribute to drug resistance. In fact, the stronger and more novel the antibiotic, the less it should be used. The conventional business model simply doesn’t work for these types of drugs.

That’s why fewer and fewer large companies are investing in antibiotics. Small biotech firms account for 80 percent of antibiotic research and development — and they’re struggling to keep their doors open. Last year, antibiotic startups Melinta and Achaogen filed for bankruptcy despite having viable products.

Fortunately, 20 drug developers, including large biopharmaceutical companies like Merck, Pfizer, and Eli Lilly, just announced a $1 billion joint fund aimed at developing two to four new antibiotics by 2030. This “AMR Action Fund” plans to invest in early stage antibiotics research.

This is a welcome development in the fight against superbugs. But $1 billion won’t win the war. As Secretary Azar himself admitted at the congressional hearing, the federal government must do far more to spur antibiotics research and development.

His own department could lead the way. The Centers for Medicare and Medicaid Services, which falls under HHS, could offer higher reimbursement to hospitals that use novel antibiotics appropriately. If biotech firms know hospitals will buy their novel antibiotics, they’ll be much more likely to pour resources into antibiotics development.

Azar could also support market-entry rewards for antibiotic developers. These one-time financial incentives from the government would help cover R&D costs for the next lifesaving antibiotic.

With the right incentives, we could spur the development of 16 to 20 desperately needed antibiotics over the next 30 years. According to one study, a reward between $800 million and $1.5 billion would pave the way for these life saving drugs.

During a recent hearing, Azar admitted, “We want drug companies to invest in an antibiotic that won’t get used. That is an economic problem.”

Clearly, he understands the issue at hand. Let’s hope he starts working on the solution. Unlike our coronavirus experience, we know the superbug pandemic is coming and can start to develop needed medicines now.

But if we delay any longer, untreatable superbugs could make the coronavirus look like a walk in the park.

Greg Frank is senior director of Infectious Disease Policy at the Biotechnology Innovation Organization (BIO) and executive director of Working to Fight AMR.