Dear Members of the House Budget Committee Health Care Task Force:
Thank you for the opportunity to provide information on key drivers of health care costs and ways to improve outcomes while reducing health care spending. Below please see feedback from the Partnership to Fight Infectious Disease (PFID). PFID is a group of patients, providers, community organizations, academic researchers, business and labor groups, and infectious disease experts working to raise awareness of threats posed by infectious disease and advocate for solutions to reduce those threats.
Address the Rising Threat of Antimicrobial Resistance: Pass the PASTEUR Act
The presence of antimicrobial resistance (AMR) not only increases health care costs and the burden of illness in the United States today, but its continued rise threatens to increase costs and risks associated with even the most basic of medical procedures exponentially. As we saw with the COVID-19 pandemic, infectious pathogens know no borders and the fall-out from the inability to control outbreaks involves costs well beyond the health care system. We also understand that policy solutions to address these may pose a complicated budgetary picture, making your work here all the more important.
Stewardship programs assure that newer antibiotics are preserved and utilized only when others fail to work. These use restrictions are important in the fight against resistance, but both significantly delay and limit any return on investment for the development of new antibiotics. As a result, several have launched novel antibiotics into the market only to declare bankruptcy from the lack of sales and the number of companies investing in the development of new antibiotics and other antimicrobials and the pipeline for novel treatments have dwindled. All the while, resistance continues to rise and was made worse by the pandemic. The spread and resistance of some sexually transmitted illnesses have become so problematic that the CDC recently proposed using a common, reliable antibiotic as a post-exposure prophylaxis against bacterial sexually transmitted infections.1
The rise of AMR carries significant costs that will grow exponentially without decisive policy action. In 2020 alone, there was a 15% increase in AMR infections and deaths.2 For 2022, treating people who acquired AMR infections in healthcare settings cost an estimated $5.8 billion in direct medical care and another $7.2 billion in economic losses relating to premature deaths.3
To demonstrate the importance of policy changes to improve the pipeline and viability of novel antibiotics and other antimicrobials, PFID developed national4 and state-specific fact sheets5 that detail the added costs associated with infections acquired in hospital settings and then projected what those costs would be in 2035. The fact sheets present scenarios that assume no, modest, and aggressive rises in resistance by 2035. Even though the estimates are just for the added costs from an infection being resistant and assume prevention activities work to keep infection levels low, the numbers are staggering. Costs increases involve extended lengths of hospital stays associated with resistant infections, additional medical costs associated with those infections, and the excess loss of life.
Though 2035 may seem a lifetime away, with the realities of drug discovery and development timelines and the need for bold policy changes, the time to act is now. For these reasons, we strongly support the bipartisan, bicameral PASTEUR Act (HR 2940/S 1355) helps to address the problems associated with antibiotic and antifungal development by delinking the reimbursement of these novel antimicrobials from the volume of their use.
Given the PASTEUR Act reliance on a subscription-like model for to guaranty the availability of novel antibiotics and antifungals for federally funded health programs and the savings associated with being able to treat otherwise resistant infections, scoring the savings from the upfront investments may present challenges. For example, given the lead time required to discover and develop new drugs and stewardship in their usage, much of the savings from the ability to treat resistant infections may fall outside the CBO’s traditional 10-year budget window. There will also be value – both human and economic – derived from extending life, reducing disability, and improving health outcomes that derive from the ability to reduce infection risks that may require more dynamic scoring than currently used by CBO. Passing the bipartisan, bicameral Preventive Health Savings Act (HR 766/S 144) could help in terms of the CBO’s providing Congress a more complete picture of the benefits of investments like the PASTEUR Act that accrue outside the 10-year budget window.
Increase the Rates of Vaccination Across All Ages and Communities
Vaccination is one of the safest, most cost-effectiveness medical interventions we have available. Despite the availability of vaccines and low cost-sharing burden among insured individuals, vaccination rates have declined across all age groups. Misinformation about vaccine safety and efficacy contributes to vaccine hesitancy, lowers vaccination rates, and prevents people from making informed decisions about vaccination for themselves and their families. Higher costs from avoidable illness result. Avoidable costs from vaccine-preventable illnesses among adults were estimated at $9 billion in 2015 alone.6
Within the first seven months of the first COVID-19 vaccine being administered in the US, the availability and adoption of COVID-19 vaccines helped to avert 1.38 million hospitalizations, prevented 213,000 deaths, and reduced costs by $354 billion. The public-private collaboration that dramatically reduced the toll of COVID-19 is a laudable example of unleashing the power of American biomedical innovation to save lives, reduce the burden of illness, and lower costs. Moving forward, policy efforts must also recognize and nurture the US biomedical ecosystem that develop and deliver vaccines and other critically important therapeutics and diagnostics for infectious illnesses.7
Despite the benefits of vaccination and low cost-sharing for insured individuals, adult vaccination rates remain below recommended levels and childhood vaccination rates are declining. Misinformation contributes to vaccine hesitancy adversely affecting vaccination rates and preventing people from making well-informed decisions about vaccination for themselves and their families. Policy efforts to not only provide recommended vaccines at no cost under Medicare, Medicaid, and other federal programs, but also to provide credible information about the risks and benefits of vaccination will help to boost vaccination rates and decrease the burden of vaccine-preventable illnesses.
We appreciate the opportunity to provide this information and commend your leadership on ways to reduce health care spending within the system and most importantly for individuals. We strongly encourage you to consider the significant human and cost burdens associated with the rise in AMR, vaccine-preventable illnesses, and need for the PASTEUR Act and other policy solutions to reduce the toll of infectious illness in America.
Candace DeMatteis, JD MPH
Vice President, Policy & Advocacy www.fightinfectiousdisease.org
 CDC. Guidelines for the Use of Doxycycline Post-Exposure Prophylaxis for Bacterial STI Prevention. Oct. 2. 2023. Available online at https://www.cdc.gov/std/treatment/guidelines-for-doxycycline.htm.
 CDC. COVID-19: U.S. Impact on Antibiotic Resistance. 2022 Special Report. Available online at https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf.
 PFID. Action to Fight Superbugs Needed Now to Save Lives and Lower Healthcare Costs. Available online at https://www.fightinfectiousdisease.org/_files/ugd/b11210_9c84ff00b68a4207894ca41a78ca4a90.pdf?index=true.
 PFID. Fact Sheets: Human and Economic Toll of Antibiotic Resistant Infections (In the State) https://www.fightinfectiousdisease.org/fact-sheet-states.
 S Ozawa, A Portnoy, et al. Modeling the Burden of Adult Vaccine-Preventable Diseases in the United States. Health Affairs. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.0462.
 See, PFID. COVID_19 Vaccines and Therapeutics Saved Millions of Lives, Enabled Faster Recovery Across the US. Available online at https://www.fightinfectiousdisease.org/_files/ugd/b11210_12ae881ea6a14b398e6fbe408f69b67c.pdf?index=tru.