As an infectious diseases doctor at Rutgers Robert Wood Johnson Medical School, I’ve been watching the spread of Candida auris with great concern.

This fungus can cause serious infection, pain, suffering, and even death — and people with weak immune systems are at particularly high risk. It has caused outbreaks in health care facilities across the country. We saw 61 cases in New Jersey last year — more than in more populous states like Pennsylvania, Ohio and Texas. More than 1,000 cases were reported nationwide.

Considering the COVID-19 pandemic, that may not sound like much, but Candida auris is on the rise. There were no cases before 2009 and, in recent years, it has been noted to be highly resistant to antifungal drugs. In many instances, there are few therapies left that can successfully treat it, and some strains are resistant to all available treatments.

The emergence and spread of C. auris is part of a wider crisis known as antimicrobial resistance, or AMR. Like other organisms, disease-causing bacteria and fungi evolve to become increasingly resistant to available therapies. When exposed to an effective medication, most of the pathogens die, but some resist. These survivors can grow into drug-resistant “superbugs” and can pass their resistance on to their next-generation offspring.

Antimicrobial drugs are the foundations of modern medicine — but deep cracks are causing that foundation to crumble. Superbugs took at least 1.27 million lives worldwide in 2019, shattering previous estimates.    Don’t miss the best in editorials, opinion columns and commentary from writers. Add your email here:          

In some cases, we’re unable to provide critically needed organ transplants because we lack effective antibiotics. Since transplant patients must have their immune systems suppressed so they don’t reject the transplanted organs, their compromised immune systems often cannot fend off superbugs without effective antimicrobials.

If we don’t strengthen the development of new treatments, it will be increasingly difficult to safely provide many types of surgeries because the risk of untreatable antimicrobial-resistant infection will be too high. The pipeline for new antimicrobials is already inadequate to address current threats, let alone future superbugs that are bound to emerge.

Moreover, antimicrobial resistance and the pandemic have exacerbated one another. Amid the first surges of COVID-19, as intensive care units filled with critically ill patients on ventilators, I found myself treating multidrug-resistant infections more frequently than ever. Secondary bacterial infections led to serious illness and death in a significant share of COVID-19 patients.

How do we address this crisis?

Typically, the more an antimicrobial drug is used, the less effective it can become. These drugs must be used sparingly — especially the newest ones. As a result, it’s challenging for companies to invest billions of dollars into developing a new drug, only to find they can’t generate a viable return on investment.

That’s why most major biopharmaceutical firms have abandoned their antibiotic development programs. And several startups that successfully developed FDA-approved antibiotics have closed for lack of sales. For instance, Achaogen created a new drug to fight carbapenem-resistant Enterobacterales (CRE), superbugs considered urgent by the CDC — but went bankrupt in 2019.

We urgently need to turn this situation around to ensure we can successfully treat patients now and in the future.

One solution would be for lawmakers to improve the market dynamics for antimicrobials. Traditionally, medicines are paid for based on the volume of products purchased. Instead, we need a payment model that compensates developers for antimicrobials that treat the most threatening infections, regardless of how many doses are used.

Think of it as Netflix for antibiotics. For a set fee, there could be access to as much or as little as needed. The bipartisan PASTEUR Act, under consideration in Congress, would establish this model. By decoupling the return on investment from the drug’s sales, it would create a new incentive structure for antibiotics that better meets public health needs.

If we wait much longer to fix the broken market for new antimicrobials, we’re increasing the chance that more Americans will die unnecessarily from superbugs. Candida auris is not yet a household name like COVID-19. Let’s keep it that way.

Keith Kaye, MD, MPH, is an infectious diseases doctor, professor of medicine and chief of the Division of Allergy, Immunology and Infectious Diseases at Rutgers University’s Robert Wood Johnson Medical School.

Read the full op-ed in The Star-Ledger here.