We Will Miss Antibiotics When They’re Gone
By NICHOLAS BAGLEY and KEVIN OUTTERSON
Jan 18 2017
On Friday, the Centers for Disease Control and Prevention released a disturbing report about the death of an elderly woman in Washoe County, Nev. What killed her wasn’t heart disease, cancer or pneumonia. What killed her were bacteria that were resistant to every antibiotic doctors could throw at them.
This anonymous woman is only the latest casualty in a war against antibiotic-resistant bacteria — a war that we are losing. Although most bacteria die when they encounter an antibiotic, a few hardy bugs survive. Through repeated exposure, those tough bacteria proliferate, spreading resistance genes through the bacterial population. That’s the curse of antibiotics: The more they’re used, the worse they get, especially when they’re used carelessly.
Already, more than 23,000 people in the United States are estimated to die every year from resistant bacteria. That death toll will grow as microbes develop new mechanisms to defeat the drugs that, for decades, have kept infections at bay. We are on the cusp of what the World Health Organization calls a “post-antibiotic era.”
And we will miss antibiotics when they’re gone. Minor scrapes and routine infections could become life threatening. Common surgeries would start looking like Russian roulette. Gonorrhea and other sexually transmitted infections might become untreatable. Diseases that our parents defeated — like tuberculosis — could come roaring back. The economic costs would be staggering: In September, the World Bank estimated that between 1.1 and 3.8 percent of the global economy will be lost by 2050 if we fail to act.
Yet few new antibiotics are in development. Most large drug companies have fled the field. The reason is simple: To conserve their effectiveness, new antibiotics are put on the shelf to be used only when older antibiotics stop working. That makes perfect sense for public health, but companies can’t make a profit on what they can’t sell. This mismatch between the huge social value of new antibiotics and the relative indifference of drug manufacturers could spell disaster.
Aware of the problem, Congress has taken some initial steps to address it. In particular, the 2012 Generating Antibiotic Incentives Now Act grants to manufacturers an extended, exclusive period to sell newly approved antibiotics. By keeping generics off the market for longer, Congress hoped to sweeten the pot for manufacturers and encourage needed research.
But the law probably won’t stimulate much innovation. A couple more years of poor sales are a small incentive and may actually promote overuse of antibiotics. The law is also poorly targeted. Some “new” antibiotics are similar to existing compounds — so similar that bacteria are already resistant to them. We don’t need to reward manufacturers for tweaking antibiotics that we already have. We need them to develop entirely new antibiotics.