Emily Spivak: Superbugs are real and we are not ready for them

Bacteria that develop a resistance to antibiotics are a public health challenge to the world.

The next health care crisis is already here. The United States is not ready for it. And as a result, the entire world is vulnerable.

Those are the stark facts of mankind’s fight against antibiotic-resistant diseases or “superbugs.” I serve on the CDC’s Board of Scientific Counselors and co-lead Antimicrobial Stewardship Programs at University of Utah Health and the Salt Lake City Veterans Affairs Healthcare System. In my opinion, the war on superbugs is one of the most pressing public health challenges of our generation.

Superbugs are bacteria that used to be treatable by antibiotics but aren’t anymore.

Unlike most diseases, these infections are not static targets. They do not simply present themselves and wait passively for medical science to develop a cure.

Over time, antibiotic-resistant diseases adapt. The very medicines that defeat them today cause them to reemerge stronger tomorrow.

According to the latest estimate, superbugs killed nearly 1.3 million people globally in 2019. Older Americans are disproportionately impacted. New research from the University of Utah, Pew Charitable Trusts, and Infectious Diseases Society of America found that seniors — just 15% of the U.S. population — make up 40% of deaths from antibiotic-resistant bacterial infections.

Superbugs come in many forms, including variants of common bacteria like streptococcus. The CDC has a “watch list” of more which could soon evolve beyond the reach of medical science.

The fight against AMR infections — a fight, frankly, we are losing — faces two huge obstacles.

The scientific problem is that antibiotics, even when they work, can strengthen the pathogens they fight. Unlike treating other maladies, treating bacterial infections with antibiotics makes everyone in the world more vulnerable to them.

This problem is more acute every day because one in three U.S. antibiotic prescriptions is medically unnecessary. In many cases, doctors operate out of an abundance of caution or in the face of few treatment options. Early in the pandemic, doctors prescribed antibiotics for hospitalized Covid-19 patients for these exact reasons. But as superbugs grow stronger, it’s ever more critical to prescribe antibiotics prudently.

Utahns can be proud that our state keeps a close watch on antibiotic usage. Both the University of Utah and Intermountain Healthcare lead stewardship projects so that we wisely utilize our existing antibiotics.

But we’re in dire need of more resources. Amid the pandemic, we’ve had to shift already-limited resources to focus on COVID-19 therapeutics.

Stewardship alone won’t solve the problem. This leads us to the economic problem.

Because bacteria develop resistance, antibiotics have a shorter lifespan than other medicines. New ones need to be used judiciously, so they can treat infections when older products lose their effectiveness. The pharmaceutical business cycle relies on high-volume sales of new medicines to provide returns on investments in research. That model doesn’t apply to antibiotics because they’re made in the hopes that they will be used sparingly — but must be on the shelf when needed in an emergency.

As a result, many drug companies can’t financially continue in the antibiotics business -- even as superbugs grow more dangerous.

Two things need to change, as soon as possible.

First, the American people need to make the fight against antibiotic resistance a public health priority. That means investing in stewardship programs to educate patients and providers about the harms of overusing antibiotics and to ensure we use antibiotics only when appropriate. That also means developing an arsenal of new medicines.

Second, to accomplish that, we need to address the economic problem through public policy. If drug companies have little chance of earning back their investment producing new therapies, then the answer may lie in additional government support for novel antibiotics — and for the stewardship programs that ensure they’re used wisely.

Under a “subscription-style” model, proposed in the PASTEUR Act introduced this year, the government would pay regular payments for the availability of novel antibiotics rather than paying based upon the volume of product used. The bill would realign market incentives with public health and increase resources for antibiotic stewardship programs.

We cannot wait for someone else to solve this problem. These diseases will never stop working against us. The United States has the resources, medical research infrastructure, and expertise needed to take the leadership role in this crisis.

Emily Spivak

Emily Spivak, M.D., is an associate professor of medicine in the Division of Infectious Diseases at the University of Utah School of Medicine. The views expressed are her own and do not necessarily represent the views of University of Utah Health or the Veterans Health Administration.