In the past and now, antibiotics have been crucial to the health and safety of the United States.
John Alter III
Head of External Affairs, AMR Action Fund
In the early months of 1944, the United States achieved a scientific feat that changed not only the course of World Word II (WWII) but human health as we know it. The government had tapped more than 20 companies to embark on a national effort aimed at mass producing penicillin, the then-experimental antibiotic that, while promising, had proven difficult to manufacture in large quantities. Battlefield infections were a lethal scourge that had claimed tens of thousands of lives during the conflict, and the Allies knew an effective treatment would be a strategic advantage.
The wartime partnership succeeded in spades. More than 2 million doses were ready by the time soldiers stormed the shores of Normandy on D-Day. By some estimates, penicillin saved more than 300,000 lives during WWII alone. A few months later, with the Nazi regime collapsing, the U.S. government released penicillin for commercial distribution.
Doctors embraced the newly minted miracle drug, and cash-flush pharmaceutical companies invested huge sums of money back into antibiotic research and development. The decades that followed are often referred to as the Golden Age of Antibiotics, a period marked by the discovery of dozens of antibiotics capable of treating an array of infections. The advent of these drugs benefitted every corner of medicine, from surgery to cancer care to labor and delivery, and extended the human lifespan like no other medication had before.
After the Golden Age
But by the 1990s, the sun had set on antibiotics’ Golden Age. Drug discovery had become difficult and expensive, and the profit margins of antibiotics paled in comparison to blockbuster cholesterol or inflammation drugs. Many companies closed their antibiotic programs, and the pipeline has since thinned to worrisome levels. All the while, bacteria were becoming resistant to our existing antibiotics, rendering the drugs increasingly ineffective.
This paucity of innovation coupled with the relentless rise of drug-resistant “superbugs” now poses one of the greatest health security threats of our time. In 2019, antibiotic-resistant infections directly killed 1.27 million people and that number is expected to swell to 10 million by 2050, costing the global economy somewhere in the range of $100 trillion. The challenge is huge and we are ill-prepared. The World Health Organization reports that there are only 45 traditional antibiotic candidates in the clinical pipeline — most of which will not make it through the rigors of regulatory approval.
Nobody is immune from this threat, especially our service members. While infection control has improved significantly since WWII, battlefields remain a bonanza of bacterial resistance. Severe wounds, unsanitary conditions, supply chain challenges, and laggard diagnostics help fuel drug-resistant infections in settings of conflict.
Consider the plight of thousands of American and European soldiers who were injured in Iraq and Afghanistan and became infected with Acinetobacter baumannii, a pernicious bacterium that can cause deadly infections. This bacteria was so pervasive among soldiers serving in the Middle East that it earned the unfortunate nickname “Iraqibacter.” Antibiotic-resistant strains of Acinetobacter baumannii are now a menace in hospitals across the country. The United States Centers for Disease Control and Prevention, which classifies the pathogen as an “urgent threat,” reported a 78% spike in hospital-acquired cases during the first year of the COVID-19 pandemic.
A robust pipeline of antibiotics is essential to taking on the threat of drug resistance and properly preparing for what’s coming, be it in barracks overseas or a surgical suite in Bethesda. To help jumpstart the necessary level of innovation, federal legislators should take steps to incentivize the development of novel antibiotics and reward companies that succeed in this difficult but critical field of medicine. With the right policies in place, they might just kick off the next Golden Age of antibiotics.