Issue No. 18: The Intertwined Pandemics

The global response to COVID-19 is one of the great public health stories of our time. And that effort continues to this day. Right now, researchers are working furiously to stay ahead of the virus as it continues to mutate; health officials are devoting immense resources to help more people get vaccinated and boosted; and biopharmaceutical companies are investing heavily in new vaccines, therapeutics, and diagnostics.

Yet a different, related pandemic of antimicrobial resistance (AMR) has yet to inspire the same kind of energetic response. The alarming growth in drug-resistant “superbugs” in recent years poses a significant threat to global health and a serious cause for concern. In 2019 alone, these infections killed 1.2 million people, and were associated with a total of nearly 5 million deaths, according to a recent analysis in the British medical journal The Lancet. The annual death count from this crisis could reach 10 million as soon as 2050, according to an analysis from before the pandemic. And, according to the latest evidence, COVID-19 has only accelerated and exacerbated the AMR crisis.

Beating back COVID-19 deserves to be a prime global-health priority — as does the larger effort to prevent and prepare for future pandemics. But these goals are deeply intertwined with an AMR crisis that has been worsening for years, and that could make critical medical advances unviable in the near future. This makes it all the more essential that governments, non-profits, and private sector companies tackle the superbug crisis with the same urgency they are bringing to COVID-19.

The COVID Response Is Still Going Strong

While the world looks far different today than it did during the first wave of the pandemic, COVID-19 continues to put global health in serious danger. Two new subvariants of the virus’s Omicron strain, known as BA.4 and BA.5, are spreading across the United States, accounting for more than 70 percent of new infections, according to the latest figures from the Centers for Disease Control and Prevention (CDC).

Thankfully, the response from the global health community remains as aggressive as ever. In March, the CDC authorized additional boosters for certain high-risk individuals. The CDC also recently recommended that children as young as six months old get a COVID-19 vaccine.

The National Institutes of Health is devoting considerable funds to discovering new antiviral drugs for treating COVID-19, including a recent award of $577 million to establish nine Antiviral Drug Discovery Centers for Pathogens of Pandemic Concern. And the biopharmaceutical industry is making impressive progress in creating new vaccines, therapies, and diagnostics for fighting the pandemic.

All these developments are encouraging news. What’s troubling, however, is that no such large-scale effort has yet materialized for fighting the AMR threat — a global health emergency that is growing deadlier by the day. That needs to change — especially considering how the current pandemic has impacted the escalating crisis of drug-resistant infections.

The AMR-COVID Link

A new study presented at the latest European Congress of Clinical Microbiology & Infectious Diseases in Lisbon, Portugal finds yet more evidence of the close relationship between the COVID-19 pandemic and the AMR crisis. That study looked at 271 hospitals across the United States during the pandemic. And it found that antibiotic-resistant bacterial infections were more common among hospitalized patients with COVID-19, as well as among hospitalized patients who tested negative for the virus, as opposed to those hospitalized pre-pandemic.

In the case of hospital-onset AMR infections — that is, infections that emerged more than two days after a patient was admitted to the hospital — the increase was particularly stark. Whereas the overall rate of hospital-onset AMR infections was 0.77 per 100 patients before the pandemic, during the pandemic that figure rose to 0.86per 100 admissions. For patients testing positive for COVID-19, the rate was 2.19 per 100 admissions.

Additionally, a recent study published in Clinical Infectious Diseases found deaths due to fungal infections increased notably during 2020 and 2021, particularly as a result of cases associated with COVID-19. Fungal infection mortality rates only increased slightly from 2018 to 2019, totaling 4,746 and 4,833 deaths, respectively. However, in 2020, fungal deaths rose to 5,922 and to 7,199 in 2021. Of the 13,121 fungal deaths between the two years, 2,868 or 21.9% were associated with COVID-19 and COVID-19 was the leading underlying cause of death among 90.5% of those 2,868 cases.

These are not the only indications that AMR and COVID-19 are intertwined. As the CDC has noted, the pandemic created “a perfect storm” for drug-resistant infections in hospitals and other healthcare settings.

CDC researchers noted that unusually long hospital stays and heightened incidences of patients on intravenous lines, catheters, and ventilators contributed to an increase in bloodstream infections. The uncertainty of the early pandemic also played a role as clinicians sought to treat patients with any tools at their disposal, including antibiotics. Staffing shortages and patient surges pushed hospitals beyond their capacity, further straining infection control and prevention measures.

More alarming is that the full extent to which the pandemic inflamed the AMR crisis remains unclear even today. That’s all the more reason why the healthcare community, as well as governments and companies around the world, should be prepared to attack the superbug threat with the same intensity they showed in their response to COVID-19.

What’s At Stake in the Fight Against AMR

By now, the world knows all too well how an infectious disease crisis can upend our way of life. Not only did COVID-19 take the lives of millions of people, it shut down large parts of the economy and kept people all over the world from making a living, seeing their loved ones, and even going to school.

But the AMR crisis could take away something just as precious: modern medicine. In recent years, the most commonly-used antibiotics have grown less effective at fighting deadly infections. And if this trend continues, all kinds of medical procedures that rely on antibiotics — from routine surgeries like hip replacements to emergency procedures like heart transplants — may no longer be possible. This will leave all of humanity at a greater risk of death from nearly every conceivable injury and disease.

It’s not just COVID-19 that we need to worry about. AMR jeopardizes our response to any future pandemic or public health emergency. Any threat involving widescale hospitalizations inherently elevates the risk of secondary infections and furthers resistance. Without effective antimicrobials to ward off these infections, our ability to combat a future pandemic will be significantly reduced or even rendered futile. And unlike the viral nature of COVID-19, the next pandemic could also be bacterial or fungal.

Fortunately, there are ways to ward off this future, if we act quickly.

Tackling AMR Will Take a COVID-Level Effort

A crucial step in addressing the AMR crisis is developing new products capable of fighting superbugs. In the last 35 years, the Food and Drug Administration has only approved one new antibacterial drug with a novel target. Central to this challenge is a broken market which makes creating new antimicrobial medicines extremely difficult.

When new antimicrobials reach the market, they have to be used appropriately and judiciously to preserve their effectiveness. As a result, the biopharmaceutical firms that create new and innovative products have seriously limited opportunities to earn back their upfront costs via a traditional volume-based sales model. In many cases, biotech start-ups that develop new antibiotics go bankrupt, even after securing FDA approval of a new product. And, in recent years, large pharmaceutical firms have backed away from the antibiotic market.

But as the COVID-19 vaccine effort demonstrated, with the right incentives, life science innovation can respond quickly to address critical public health needs. What’s needed are reforms that sustain the development of new antimicrobials by modernizing how these medicines are sold and paid for. These include policies like the Pioneering Antimicrobial Subscriptions To End Upsurging Resistance (PASTEUR) Act — a bipartisan bill currently before Congress, which would create a subscription-like model for critically needed new antimicrobials, so that innovative companies can recoup their investments in research and development for these inventions even if they are used sparingly.

The global push to contain COVID-19 and prepare for the next pandemic continues to grow. These efforts need to work in concert with a response to the threat of AMR that is at least as aggressive. It’s time for governments, companies, and non-profits to address this reality, and invest the resources necessary to prevent a superbug pandemic while we still can.

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