According to Ezekiel J. Emanuel MD, an oncologist, a vice provost at the University of Pennsylvania and Obamacare architect, the bacteria are winning. His article in the New York Times points out that every year at least two million people are infected with bacteria that can’t be wiped out with antibiotics, and as a result, 23,000 people die. Direct health care costs from these illnesses are estimated to be as high as $20 billion annually. Should a health care worker or any injured worker become infected while undergoing treatment for an industrial injury, the claim cost would exponentially increase.
Just last week, the U.C.L.A. Health System announced that nearly 180 patients may have been exposed to the CRE superbug that was linked to two deaths in one of its hospitals. Today, 30 percent of severe strep pneumonia infections are resistant to multiple drugs and 30 percent of gonorrhea infections are resistant to all antibiotics. And drug-resistant enterobacteriaceae, enterococcus, acinetobacter and a slew of other unpronounceable bacteria pose serious threats.
Dr. Emanuel says “The development of antibiotics has been glacial. We need a completely new approach.”
The number of F.D.A.-approved antibiotics has decreased steadily in the past two decades. The big pharmaceutical companies have largely stopped work on these drugs. Pfizer, long the leader in developing antibiotics, closed its antibiotic research operations in 2011. Smaller biotech companies now account for 80 percent of antibiotic development. There are now about 40 new antibiotics in development. That might sound promising – but not when compared with the 771 new drugs and vaccines in clinical trials or awaiting F.D.A. review for cancer. And most of these antibiotics are unlikely to come out of the testing process as F.D.A.-approved drugs.
There are ways, apart from developing new drugs, to combat the problem of superbugs and drug resistance. One is hand-washing, especially in hospitals. Another is reversing the overprescribing of antibiotics. It’s estimated that half of all antibiotics used are unnecessary. Animal feed accounts for 80 percent of the antibiotics used in the United States and contributes to antibiotic resistance. We could also fix our antiquated system for tracking drug-resistant bacteria.
But just as important, we need to develop new treatments. Bacteria figure out a way to become resistant to every new drug. We are in an endless life-or-death struggle with bacteria.
The big problem is profitability. Unlike drugs for cholesterol or high blood pressure, or insulin for diabetes, which are taken every day for life, antibiotics tend to be given for a short time, a week or at most a few months. So profits have to be made on brief usage. Furthermore, any new antibiotics that might be developed to fight these drug-resistant bacteria are likely to be used very sparingly under highly controlled circumstances, to slow the development of resistant bacteria and extend their usefulness. This also limits the amount that can be sold.
Even though antibiotics are lifesaving, they do not command a premium price in the marketplace. As a society we seem willing to pay $100,000 or more for cancer drugs that cure no one and at best add weeks or a few months to life. We are willing to pay tens of thousands of dollars for knee surgery that, at best, improves function but is not lifesaving. So why won’t we pay $10,000 for a lifesaving antibiotic?
Congress has tried to address the problem. In 2012, it passed an act that expedited F.D.A. review and gave drug companies five more years of market exclusivity without generic competition. That has increased drug company interest in developing antibiotics, but not enough. Because it costs at least $1 billion to develop a new drug.