March 01, 2022
Real Clear Policy
By Kenneth E. Thorpe
While the pandemic is by no means over, Covid-19 isn't the only threat to public health we face. In fact, it might not even be our most serious challenge.
Despite the tragic loss of more than 2,000 American lives to the virus each day, case counts have dropped dramatically in recent weeks, and hospitalizations and deaths are falling too. Covid-19 remains nightmarish for many but is no longer an existential problem for the healthcare system as a whole.
By contrast, we're rapidly losing the ability to fight "superbugs," the bacteria and fungi that have evolved and developed resistance to almost all existing antimicrobial treatments. Antimicrobial resistance (AMR) already kills at least 35,000 Americans each year and about 700,000 people worldwide. A recent global report from The Lancet found that in 2019 there were an estimated 4.95 million deaths associated with bacterial AMR, including 1.27 million deaths directly attributable to it.
Because these superbugs may soon learn to evade even our strongest antibiotics, they're on track to kill 10 million people worldwide annually by 2050. A world without antibiotics would catapult us back into the medical dark ages, where simple cuts and scrapes could prove fatal, and routine procedures like joint replacements and C-sections become horrifically risky.
The only way to stop this increasing threat is to develop a new arsenal of antibiotic treatments, which will require government policies that encourage, rather than inhibit, innovation.
In recent years, many drug companies have scaled back, or even fully abandoned, their research into new antibiotics due to unfavorable economics. Drug development is expensive. Bringing a single medicine all the way from initial concept to FDA approval costs an average of $2.6 billion and typically requires 10 to 15 years. The overwhelming majority of projects fail, either in the lab or in clinical trials.
For antibiotics developers, those high up-front costs present a particularly thorny problem, because advanced antibiotics are only supposed to be used in emergencies. These types of medicines naturally have low sales volumes, making it tough for companies to recoup their initial investment, much less earn a return.
Some lawmakers have taken note of this market failure and proposed measures, such as the Pioneering Antimicrobial Subscriptions to End Up surging Resistance Act, or PASTEUR Act, that would increase reimbursements for new antibiotics and reward companies that bring them to market.
Those reforms are sorely needed to combat arguably the biggest threat to public health in the 21st century. But even those measures won't be enough if Congress proceeds with its plan to allow the government to set drug prices.
The Build Back Better Act, which is currently stalled in the Senate but by no means dead, would allow federal officials to fix the price of dozens of common medicines. That would slash biotech companies' revenues by hundreds of billions of dollars.
Such drastic cuts in funding would force companies to scale back their research, thereby hamstringing efforts to manufacture and distribute these therapies for Covid-19, superbugs, and all sorts of other diseases, from cancer and diabetes to cardiovascular diseases.
From the perspective of patients, lowering drug prices should focus on reducing what they spend out-of-pocket. While the Build Back Better Act caps out-of-pocket spending at $2,000, this is still too high for many patients, particularly those who are already living with one or more chronic conditions and were still well before the pandemic. Further reductions would improve medication adherence and improve patient outcomes, and for the very sickest patients, could reduce overall spending.
There will be no better opportunity for President Biden to speak some plain truths than during his State of the Union address on March 1. He must underscore to the nation both the gravity of our current public health challenges and what lies ahead so that we are better prepared for future pandemic threats.
There's a lot on the table as we still work to close the door on the Covid-19 pandemic, and perhaps even more importantly work to prevent and prepare for future ones. Making sure that we have a stable runway for innovations that will protect us into the future and make outcomes safer for patients across the globe should be a top priority.
Kenneth E. Thorpe is a professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease.