Thursday, August 13, 2020
Aug. 13, 2020

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Macario: COVID-19 underscores need to develop new antibiotics


As the world grapples with COVID-19, another pandemic has gone mostly unnoticed.

Each year, 700,000 people — including as many as 160,000 Americans — lose their lives to antibiotic-resistant bacteria. My 18-month-old son Simon was one of them. He woke up one morning screaming in agony. Within 24 hours, he died from a drug-resistant infection that doctors were powerless to stop. Had effective antibiotics been available, he would still be with us today.

Jump-starting research into these medicines — whether through government grants or private initiatives — needs to be a national priority. Without such efforts, millions of families will suffer the horrible loss ours did. Antimicrobial resistance, or AMR, the phenomenon by which bacteria and fungi evolve and become immune to drugs, could kill 10 million people annually by 2050.

Worryingly, the antibiotics needed to avoid this crisis aren’t being developed.

While progress in everything from cancer treatments to HIV medications has taken off in recent years, work on new antibiotics has essentially stalled. The FDA approved only nine new antibiotics between 2000 and 2018. That’s down from 63 between 1980 and 2000.

This lack of new antibiotics has allowed the kinds of drug-resistant bacteria that took Simon’s life to evolve and multiply, mostly unchecked. Years of antibiotic overuse have exacerbated this problem. Every time someone takes an antibiotic that they don’t need, it gives bacteria a chance to develop resistance. The Centers for Disease Control and Prevention estimates that a third of antibiotic prescriptions are unnecessary.

And now, the novel coronavirus is making matters worse. During the early days of the outbreak, antibiotic prescriptions spiked as doctors struggled to treat what was then a mysterious illness. Currently, secondary bacterial infections resulting from getting sick with COVID-19 are also on the rise. COVID-19 has added fuel to an AMR pandemic that has been raging for years.

Hope on the horizon

Without urgent action, we could soon live in a post-antibiotic society. So why isn’t the drug industry creating these vital medicines? Economics. The simple math of drug development makes it exceedingly difficult to create new antibiotics. New drugs are enormously expensive to develop.

For many medicines — a breakthrough arthritis treatment, for instance, or a new multiple sclerosis therapy — this investment is generally worth it, since companies can recoup that investment and turn a profit by selling the drugs in large volumes. Not so with antibiotics. In fact, since antibiotics are supposed to be used as infrequently as possible, firms that invest in antibiotics will sell relatively few doses and thus stand virtually no chance of even recouping development costs. As a result, many antibiotics research firms have either run out of money or have simply abandoned the research.

Last year, two promising antibiotic startups, Achaogen and Aradigm, declared bankruptcy. Just three major drug companies are currently investing in antibiotics, down from 18 in the 1980s.

But for the first time in years, there is real hope on the horizon. A new initiative from the world’s leading biotech and pharmaceutical firms — the “AMR Action Fund” — has committed $1 billion to accelerate the development of new antibiotics. The fund will directly invest in early and midstage experimental antibiotics, providing funding for the sorts of lifesaving treatments that could have saved my son. This is a phenomenal start. But $1 billion isn’t enough to defeat the AMR crisis. It only buys us a few years, at most.

Unless we change the foundational structure of antibiotic development — something that can only be done by our elected leaders in Washington with smarter government policies — firms will eventually abandon this field. That would be an understandable decision at the individual company level, but an unspeakable tragedy for society as a whole. The government, for example, can pass legislation that offers financial incentives to develop new antibiotics.

I am still coming to terms with the sudden death of my little boy. I don’t want any other mothers to endure this hellish experience. So long as we take bold action now to catalyze antibiotics research, they won’t have to.

Everly Macario supported the founding of the MRSA Research Center at The University of Chicago Medicine. She also served as a spokesperson for “Supermoms Against Superbugs.”