Complacency Is the Biggest Public Health Threat

Complacency Is the Biggest Public Health Threat
By Wolfgang Klietmann

This year, roughly a dozen Americans will contract melioidosis, an infection caused by a tropical bacteria with a fatality rate as high as 50%. Two of the four patients in one recent outbreak died -- and none of them had recently traveled abroad, which suggests the bacteria is incubating on U.S. soil.

The toll could climb far, far higher.

The antibiotic-resistant bacteria is classified as a potential bioterrorism agent, since it's easily transported in air and water. It's known as the "great mimicker" because it can infect multiple organs and imitate different illnesses. Many clinicians find it difficult to detect and diagnose. Few hospitals are prepared to contain it. One of the main treatments is among the more than 250 therapies on the FDA's drug shortage list.

Our leaders shouldn't wait for adversaries to exploit this lack of preparedness. We need policy changes that spur the creation of new and better treatments for infectious diseases -- and ensure those medicines are accessible for future emergencies.

Despite the toll of the pandemic, the United States is already sliding back into complacency. Our vaccine industry remains fragile. Our public health infrastructure is understaffed and underfunded. Perhaps most concerningly, our antibiotic development pipeline is broken.

Drug-resistant infections kill 1 million people globally each year. Between 2025 and 2050, antibiotic resistance is expected to contribute to 170 million deaths worldwide.

Yet pharmaceutical companies have largely been forced out of antibiotic development. Unlike cholesterol or cancer drugs, physicians administer antibiotics sparingly to preserve effectiveness. This medically necessary approach means that companies can rarely recoup what they've spent to research and develop antibiotics, making these types of drugs commercially unattractive.

The stakes are enormous. Antimicrobial resistance could undo a century of medical progress. Surgery, chemotherapy, and even childbirth can be fatal without effective antibiotics. The World Health Organization lists antimicrobial resistance among the top 10 global public health threats. We must treat it with that level of urgency.

Pull incentives like the PASTEUR Act offer a fix. This bipartisan legislation would support antimicrobial therapies through a subscription-style model, where the government pays companies upfront for availability of new, critically needed antimicrobials. This approach ensures that antibiotic makers can continue providing new treatments regardless of the sales volume.

However, we can't strengthen our defenses against outbreaks and bioterrorism without a robust public health infrastructure. This means ensuring stable funding and staffing at every level, from federal agencies to local health departments. Nearly half of the staff at state and local public health agencies left their jobs between 2017 and 2021. Recent budget cuts and layoffs at federal agencies undermine our ability to detect, track, and respond to deadly outbreaks.

America's scientists are among the best in the world. But without the right incentives, those scientists won't save lives from the infectious disease threats of today -- and tomorrow.

Dr. Wolfgang Klietmann is a former clinical pathologist and medical microbiologist at Harvard Medical School. This piece originally ran in The Hill.

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