Superbugs threaten us all — it’s time for Congress to act

Up to 37 million Americans have chronic kidney disease — but nine in 10 of them don’t realize it. The illness typically causes no symptoms until it reaches advanced stages, which gives the condition its reputation as the “silent killer.” For around 800,000 Americans with end-stage kidney failure, kidney function is so impaired they must receive dialysis to survive — or a transplant.
Unfortunately, dialysis increasingly exposes patients to another killer: drug-resistant infections, or “superbugs.”

Antibacterial-resistant infections contributed to nearly 5 million deaths worldwide in 2019. In the United States, superbugs were the third leading cause of death from disease in 2019, behind heart disease and cancer, linked to nearly 173,000 deaths. The global death toll from this public health crisis is set to top 10 million annually by 2050 — exceeding the number of people who die from cancer.

We must act to combat superbugs — and fast. Thankfully, there’s a common-sense solution at hand. A bill known as the PASTEUR Act, which was recently reintroduced in Congress by a bipartisan group of lawmakers in both the House and the Senate, would jump-start the arsenal of new antimicrobial medicines we need to counteract the accelerating superbug pandemic.

Drug resistance, or antimicrobial resistance (AMR), occurs when disease-causing pathogens like bacteria and fungi evolve to fend off currently available antimicrobial medications. It’s hard to overstate how pervasive AMR is. A stunning 92 percent of urinary tract infections are resistant to at least one antibiotic. Nine in ten cases of the hospital-associated fungus Candida auris, or C. auris, are drug-resistant.

Nobody is immune to superbugs, but certain patient groups are at much higher risk of infection. People with chronic conditions, like kidney disease or weakened immune systems, are more likely to contract a drug-resistant infection than otherwise healthy people.

According to one CDC study, people on dialysis are 100 times more likely to contract a staph bloodstream infection than those who are not on dialysis. Frighteningly, 40 percent of these infections are caused by methicillin-resistant staph, better known as MRSA. In fact, infection is a leading cause of death among patients on dialysis.

We can’t sit idly by as a patient, who has been waiting years for a kidney transplant, contracts a drug-resistant infection that delays their eligibility to receive the organ. Or while a patient on dialysis battles a bloodstream infection that no available antibiotic can treat and succumbs, not to kidney disease, but to a superbug.

The good news is there is increased global attention on AMR. Earlier this year, four global health agencies issued a joint call to action to combat superbugs.

Fighting AMR is well within our scientific reach. The problem is that the market for the novel treatments we need to do so is broken. Consider the dearth of antimicrobials in the development pipeline. It has been nearly four decades since scientists discovered a new class of antibiotics. Between 2017 and 2021, just 12 new antibiotics of any kind became available.

This lack of antimicrobial production is due, in part, to properly limited antimicrobial consumption. To preserve the efficacy of antimicrobials, especially the newest, strongest ones, physicians must prescribe them only when they’re appropriate for the patient. This careful antimicrobial use — also known as stewardship — helps slow the rate of resistance and preserve the effectiveness of the drugs at our disposal. But it also limits their sales potential, making it nearly impossible for drug developers to sustain through their upfront investments.

Fortunately, the PASTEUR Act would correct this market contradiction by creating a new, alternative payment model for antimicrobials to treat serious and life-threatening infections — one fundamentally rooted in appropriate stewardship.

Under its provisions, the government would enter into contracts with antimicrobial innovators to ensure availability of novel products that meets patient needs. These contracts would not be based on volume, but rather access to novel treatments. Antimicrobial developers are assured the revenue they need to innovate new treatments, while clinicians can focus on using antimicrobials as responsibly and judiciously as possible.

For the sake of all patients — but especially those with chronic conditions like kidney disease — lawmakers should waste no time passing the PASTEUR Act and sending it to the president’s desk. It’s a smart idea that would jump-start new investment and put us on the path to outrunning the superbugs.

LaVarne A. Burton is the president and CEO of the American Kidney Fund.