The world is in crisis: climate change has triggered once-in-a-millennium catastrophic weather events and we are all enduring the second year of a worldwide pandemic. 

There is, unfortunately, another public health crisis that is emerging: the growing inability of antibiotics to kill off infections.  Unless the world responds intelligently to this growing threat, these antibiotic-resistant infections, also known as “superbugs,” could kill more people worldwide than cancer by the middle of this century.

You heard that right:  Experts now predict that unless the threat posed by “superbugs” is curbed, in the not too distant future more will die from currently treatable infections than will die of cancer.

An appropriate response has a two-pronged approach: curb the overuse and misuse of current antibiotics and invest in new therapies that will kill “superbugs.”

How did the world find itself under this new threat? 

The more antibiotics are used, the faster bacteria evolve and develop resistance to them.  The U.S. Centers for Disease Control and Prevention (CDC) estimates that more than 2.8 million people develop resistant infections each year in the United States, and more than 35,000 die.

The pandemic may have made the situation worse.  The early treatment for COVID patients was to use antibiotics as a way to help fend off secondary infections – antibiotics attack bacteria, they do not kill viruses.  Yet, the regular use of antibiotics on COVID patients may have helped accelerate microbial resistance. 

All this to say that the nation – and the world – need to act before it is too late and the current antibiotics lose their effectiveness.  Some steps have been taken.  New York State now requires all hospitals and nursing homes to develop infection stewardship programs to better regulate the use of antibiotics.

There also is a growing recognition of the dangers posed by the overuse and misuse of human-important antibiotics on farm animals – but outside of the states of California and Maryland, little has been done in the U.S.  More on this in a moment.

And despite the obvious urgency, global research and development for new antibiotics is running dry.

Unlike cancer drugs or medicines that people take for years to control chronic illnesses, antibiotics must be used as conservatively as possible to preserve their effectiveness.  Using a product sparingly undermines its profitability.  Given that the antibiotics-making-business is unprofitable, drug companies spend their investment dollars on other therapies with big payoffs. 

Additionally, as mentioned earlier, hospitals and health systems have begun to implement much-needed antibiotic stewardship programs to reduce inappropriate antibiotic use and preserve the drugs’ efficacy.   While those actions are appropriate, a collateral effect is that it reduces the sales of new antibiotics.  Few drug companies find it feasible to spend big bucks to create an affordable drug that is meant to sit on the shelf for as long as possible.

These market factors have led almost every large pharmaceutical company to leave the field in recent years.  In 2014, eight big drug makers had a new antibiotic in the clinical pipeline; last year only two did.

The Biden Administration has advanced in its budget plan funding increases for key agencies, including the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health—which are deeply involved in the fight against antibiotic resistance.  Congress is considering legislation that would offer funding contracts to drug companies, providing them with a fair return on investment for the risk they incur to develop a new antibiotic based on the drug’s value to public health.  Hopefully, action will be taken.

Here in New York, the governor and state lawmakers should also consider measures to reduce overuse and misuse of antibiotics on farm animals.  Nearly one-quarter of all antibiotic-resistant infections emerge from agriculture, putting workers and communities at risk.  The superbug problem needs to be attacked at every level, including in agricultural settings.

There is no time to waste.