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The economics of antibiotics are broken and superbugs are on the rise–but a solution inspired by the subscription economy could save millions of lives


One day, you’re fine. But then you get a cut or bruise, or undergo a common medical procedure, maybe a root canal or surgery for a torn ligament. You develop an infection–and everything changes. Try though they might, the doctors can’t get it under control. They prescribe one antibiotic after another, including in combination–until they simply run out of options. When that moment arrives, it can be a death sentence.


In the medical world, this is known as antimicrobial resistance. Today, superbugs could be the greatest public health threat we face. These viruses, bacteria, parasites, and fungi have evolved to resist our available varieties of antimicrobial drugs. We need urgent congressional action to address this nationwide problem.


Every year, some 3 million Americans develop drug-resistant infections, leading to roughly 50,000 deaths. After heart disease and cancer, AMR is the leading cause of death from disease in the United States. Unless we can get this problem under control, it’s estimated that by 2050, superbugs will kill 10 million people per year worldwide.


That’s the medical side of the problem. We also have an economic and political problem.

Our country’s pharmaceutical pipeline for antimicrobials is a classic case of market failure in urgent need of government correction. As currently configured, the incentive structure for new drug development doesn’t work for antimicrobials as it does for other drugs.

As of this writing, there are only 50 antibiotics in clinical development. Of these, most will never see the light of day, either because the drugs won’t make it through trials or the small companies that develop them will run out of funds.


Since the 1980s, the number of new antibiotics approved by the U.S. Food and Drug Administration has dropped from an average of three per year to fewer than one, and the number of pharmaceutical companies pursuing antibiotic research has dwindled to just five. There have been no new classes of antibiotics brought to patients since 1984.


Most of the large pharmaceutical manufacturers have quit the antibiotics business altogether, and it’s easy to see why. By some estimates, it costs $1.5 billion to develop an antibiotic, but annual sales average around $46 million. That’s because doctors must prescribe new antibiotics as sparingly as possible to slow the spread of superbugs. The low sales volume makes for prohibitive financial math. Our supply can’t keep up with demand.

Fortunately, Washington has the power to step in and repair the pharmaceutical pipeline.

Some 65 members of Congress from both parties have come together to propose a common-sense fix. It’s called the Pasteur Act, named after the great French chemist and microbiologist Louis Pasteur.


The Pasteur Act uses a business model we all know well–subscriptions. Think of a streaming video service: You pay a flat fee, then get unlimited access to the content, of which you can watch as much or as little as you like.


Under the Pasteur Act, Washington would pay the developers of successful new antibiotics a fixed, annual subscription fee for a specified time period. In exchange, drug makers would supply as much of their product as the government needs. This model would give researchers the incentive to develop novel antibiotics no matter how many units they expect to sell.


Best of all, it’s without risk for the government. Drug makers don’t collect any revenue from Washington until they have an approved product.


For just $6 billion over 10 years, the Pasteur Act promises to be an incredible public investment. According to a policy paper published by the Center for Global Development, in that first decade, “every dollar spent would yield $6 of value, saving 20,000 American lives in all. After three decades, the value jumps to $28 per dollar invested and 383,000 American lives saved.”


Americans wouldn’t be the only ones to benefit. Internationally, the Pasteur Act is projected to save 518,00 lives in the first 10 years alone–and close to 10 million by 2053.


Though we are staring in the face of a historic public health threat, a solution is well within reach. Congress must act now.



Howard Dean is the former chair of the Democratic National Committee and former governor of Vermont.



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