To prevent the next pandemic, we need new antibiotics

The end of the COVID-19 pandemic is finally in sight.

Both Pfizer and Moderna have received emergency FDA authorization to distribute tens of millions of doses of their vaccines across the country.

This is fantastic news. Unfortunately, the scientific community can’t rest on its laurels. An even worse pandemic is already looming. And this time, developing treatments will prove much more challenging.

This coming pandemic may not stem from a virus, but from drug-resistant bacteria and fungi known as “superbugs.” These microbes already kill 700,000 people worldwide each year and infect millions more. And unless scientists invent new, more potent drugs, superbugs could kill 10 million people annually by 2050.

Antibiotics normally kill the vast majority of bacteria they encounter. But sometimes, a few microbes survive, reproduce, and pass on their immunity to future generations. Over time, certain strains of bacteria can become largely or completely impervious to even the strongest drugs.

Drug resistance could spell the end of modern medicine. Without effective antibiotics, common operations like Caesarian sections and hip replacements may become too risky, since patients could contract lethal drug-resistant infections in the hospital.

Public health experts almost universally agree that superbugs pose an enormous threat. But relatively few drug companies are investigating new antibiotics.

It’s not hard to see why: the antibiotics market is fundamentally broken.

Doctors liberally prescribe cutting-edge treatments for diseases like cancer, multiple sclerosis, and diabetes. By contrast, doctors only use new antibiotics in emergencies. They worry about overprescribing new antibiotics, lest bacteria evolve to resist them.

Consequently, manufacturers sell relatively few doses of advanced antibiotics — and generate comparatively little revenue. In fact, many have abandoned antibiotics R&D. Just four major pharmaceutical companies still have antibiotics programs, down from 18 in the 1980s.

Small biotech firms have taken up that research burden but haven’t fared well in recent years. Startup Achaogen, for example, released a groundbreaking superbug treatment two years ago, but didn’t generate enough sales and ultimately filed for bankruptcy in 2019. At least three other startups have similarly gone belly up.

Simply put, the traditional biotech business model — invest heavily in R&D, and turn a profit by selling any successful drugs in heavy volume — doesn’t work for antibiotics. For the sake of patients worldwide, policymakers need to find an alternative.

Consider the potential of a Netflix-style subscription model, in which insurers — whether public or private — pay recurring fees for unlimited access to new antibiotics. A modified version of this model already proved successful with Pfizer’s COVID-19 vaccine. The U.S. government pre-purchased 100 million doses, with the option to buy an additional 500 million, which gave the company the confidence and funding necessary to develop the drug.

Governments could take a similar approach with antibiotics. Senators just proposed a bipartisan bill, the PASTEUR Act, which would allow the federal government to pay companies up to $3 billion to provide new antibiotics to doctors and hospitals. Experts think G20 countries will have to provide $4 billion in subscription-like payments to sufficiently spur the development of lifesaving antibiotics.

Right now, the antibiotics market is fundamentally broken. And unless policymakers fix it, the death toll from superbugs could make COVID-19 look tame by comparison.

Kenneth E. Thorpe is a professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease.