Imagine a world without antimicrobial drugs.
Perhaps you envisioned the days before penicillin when ordinary cuts and infections were often deadly. This scenario may not stay in our past. It will be our future, too, if we don’t address the growing crisis of antimicrobial resistance.
First used in the 1940s, penicillin was revolutionary. But one of the discoverers, Alexander Fleming, warned in 1945 that the wonder drug might lead to resistance. Today, we have many drugs that treat bacterial and fungal infections, yet Fleming’s fear has come true: Pathogens can adapt and evolve into “superbugs,” infections resistant to the antimicrobials designed to kill them.
Antimicrobial resistance was linked to the deaths of nearly 173,000 people in the United States and almost 5 million people worldwide in 2019. Things worsened during the COVID-19 pandemic as drug-resistant hospital-acquired infections and deaths increased at least 15%.
We’re particularly vulnerable here in California.
Consider the fungal infection valley fever. In the five years between 2014 and 2019, cases of valley fever in California quadrupled. In August, the California Department of Public Health warned of an increased risk of valley fever this fall.
Meanwhile, California had the second highest number of cases of the deadly, drug-resistant fungus Candida auris in 2022. Cases of drug-resistant Shigella, which can cause severe diarrhea and fever, are increasing. And in February, Los Angeles County saw four cases of an unusual drug-resistant bacterial infection from contaminated eyedrops that can cause blindness and death.
We need a consistent stream of new antimicrobial treatments to catch and keep up with resistance. But the market for antimicrobial medicines is uniquely broken.
To preserve these drugs’ effectiveness, they must be used sparingly. Clinicians only prescribe them when appropriate and for short periods to not exacerbate antimicrobial resistance. That means antimicrobials — appropriately — have low sales, which don’t justify the huge financial risks companies take to invent new medicines.
As a result, many companies have left the business. In the 1980s, 18 large firms were inventing antimicrobials, but by 2019, there were just three. Small companies have picked up the mantle at their own risk. The FDA has approved nine antibiotics from small companies, including one in California, since 2010. But today, every company behind those antibiotics has gone bankrupt, is financially underwater, or was sold at a loss.
The number of new antimicrobials has shrunk commensurately. The FDA approved 63 new antibiotics between 1980 and 2000, but just 15 between 2000 and 2018.
This broken market directly threatens California, where the life sciences industry supports more than 1 million jobs and generates $472 billion in business output.
Thankfully, federal lawmakers are considering a promising solution. The bipartisan PASTEUR Act would revive the American — and Californian — antimicrobial industry by implementing subscription-style contracts for new treatments for the most threatening infections.
Instead of paying companies per sales volume, the government would contract with firms for a reliable supply of a new drug, regardless of how much of the medicine was required. This model would revitalize antimicrobial research and development, and ensure patients’ access to novel treatments while supporting their appropriate use.
Unless we change our current trajectory, superbugs are estimated to kill as many as 10 million people a year by 2050 — exceeding the COVID-19 pandemic and matching the death toll from cancer. Congress must act before it’s too late.
Mike Guerra is the president and chief executive officer of California Life Sciences, a membership organization representing the state’s life sciences industry.
