Hospitals across the globe are overwhelmed with coronavirus patients. Many of those patients ultimately develop viral pneumonia, one of the most common symptoms. But a subset of patients must fight another—and more terrifying—enemy. Doctors are increasingly watching in horror as drug-resistant bacteria, or "superbugs," invade patients' weakened bodies and send them into fatal septic shock. These secondary bacterial infections are largely immune to our current antibiotics arsenal. And as a result, patients who might have survived if we had more effective treatments are dying instead. If lawmakers don't learn from this quickly—and jumpstart antibiotics development—we'll be woefully unprepared when the next pandemic strikes. The outbreak of COVID-19 has brought the threat of antibiotic resistance front and center. But it's far from a new public health challenge.
Every time a patient takes any antibiotics to treat an infection, some bacteria survive. And these surviving strains can multiply and evolve into deadly, treatment-resistant superbugs. Last year, superbugs infected one American every 11 seconds and killed one every 15 minutes. Today, amid the COVID-19 crisis, superbugs pose an exponentially greater threat. In one Lancet study of 41 hospitalized coronavirus patients, 10% developed secondary infections. A different Lancet study of 99 COVID-19 patients with secondary infections identified five types of bacteria in their systems, one of which—A baumannii—was antibiotic-resistant. This particular superbug can cause septic shock, resulting in severe organ damage and, in some cases, death. Unfortunately, the widespread use of antibiotics has an unintended effect: It inevitably fuels the evolution of superbugs. Every patient in the first Lancet study, even those without secondary infections, received antibiotics. Solving the challenge of antibiotic resistance requires a two-part solution. First, we need to make sure patients are receiving the right antibiotics for their particular infections—but only when appropriate. Otherwise, we give bacteria more chances to mutate and grow immune. Second, we need to develop new, more potent antibiotics. Unfortunately, that's not happening right now. In fact, research funding for new antibiotics is running dry. The last novel class of antibiotics hit the market in the 1980s. Five major biopharmaceutical companies that tried to revive this line of research closed their antibiotic development projects in 2017 and 2018. Two antibiotic start-ups went belly-up in 2019, and just this month, the pharmaceutical company AcelRx shut down another antibiotic maker, Tetraphase, after acquisition. The reason so many companies are abandoning antibiotic research projects is simple: the market is broken. Drug development is a challenging, expensive venture. On average, innovators can expect to spend 10 to 15 years and up to $2.6 billion to create just one new medicine. Companies accept these risks because if they succeed, there's a good chance they'll be able to sell enough of their treatments to recoup their research dollars.
This sales model works for most types of drugs, but not for antibiotics. Unlike treatments for many chronic diseases, antibiotics are intended for extremely selective use. The newest ones are kept as drugs of last resort, hidden away and only used when older antibiotics fail. Such restrictions make sense, medically speaking. But they make it difficult for antibiotics developers to earn back their investments. It's time lawmakers fixed the broken antibiotic market and catalyzed the creation—and responsible use—of new treatments to save lives. Lawmakers could consider policies that increase reimbursements for hospitals that appropriately administer novel antibiotics. In turn, demand would likely increase and it would become viable for firms to develop antibiotics. Governments could also offer "market-entry rewards" to companies working to produce novel antibiotics. This would provide companies the opportunity to recoup research and development capital. In turn, this would incentivize more investment in antibiotic research projects. Other experts suggest providing "transferable exclusivity vouchers" to firms that successfully develop antibiotics. Upon receiving FDA approval for a new antibiotic, this voucher would allow firms to extend the period of market exclusivity for another drug in their arsenal. This method even allows firms to sell that voucher to other drug companies, increasing their opportunity to make up research and development spending. COVID-19 offers a stark warning to every lawmaker and health policymaker. Unless we get serious about fighting antimicrobial resistance, we'll remain woefully unprepared in future pandemics. Kenneth E. Thorpe is a professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease.