Will we have effective antibiotics in our future?
This article was written by Jamie Sullivan, MPH, and COPD Advocate.
At some point in life, nearly everyone will need antibiotics, yet for those with lung disease, antibiotics are often a vital component of treatment plans, whether it be for regular use to prevent and treat exacerbations or to treat nontuberculous mycobacterial (NTM) infections. Despite their essential nature, growing issues with antibiotic resistance and economic disincentives to develop new, innovative antibiotics could mean that soon, some individuals with previously treatable conditions will have nowhere else to turn.
Finding new ways to spur investment in novel antibiotics is the focus of the Pioneering Antimicrobial Subscriptions to End Up Surging Resistance Act of 2021, otherwise known as the PASTEUR Act. The bill, introduced in the Senate in June and included in legislation known as Cures 2.0 in the House, authorizes the Department of Health and Human Services (HHS) to carry out several new activities designed to change the model for antibiotic purchase and simultaneously fund new programs focused on combating antibiotic resistance.
Interest in carrying out the long and expensive processes required to develop novel antibiotic options is limited. One estimate showed there are a mere 43 antibiotics in development. In comparison, there are over 1,000 drugs in development for cancer. This lack of interest is due, in part, to the volume-based way we pay for treatments. Generally, when treating with an antibiotic, the goal is to use any novel therapy as a last resort, only if all the older treatments have proven not to work. While best for individual and public health, companies developing the treatments will do so anticipating that very few people will have to use their antibiotic.
This conundrum means the model for how we develop and pay for the treatments must change. Like how we think about the model for developing some vaccines in preparation to respond to a future pandemic, it's critical to the public's health that there be options if needed, with the hope they are never used.
The PASTEUR Act creates a new model for how we pay for critical-need antibiotics, and some are comparing to the “Netflix Model.” The proposal would allow Health and Human Services (HHS) to enter into contracts with pharmaceutical companies developing novel antibiotics to provide them with a payment that is not tied to the actual use of the new therapy, meaning they are guaranteed to have a predictable return on investment, and they can fully embrace the goal of developing novel antibiotic treatments.
While there is so much more to the issues of ensuring appropriate antibiotic use, decreasing resistance potential, and spurring the development of novel antibiotics, the PASTEUR Act will make a big impact and is widely supported by patient advocacy, medical professional, and pharmaceutical communities.
We encourage you to learn more about the PASTEUR Act and consider supporting the Foundation's advocacy efforts. The Cystic Fibrosis Foundation, one of the PASTEUR Act's leading champions, gave an overview and update on the bill during the EveryLife Foundation for Rare Disease's monthly Rare Disease Legislative Advocates (RDLA) webinar in November 2021. You can view the webinar recording here. The webinar also features updates on other policy issues like the Prescription Drug User Fee Reauthorization Act, which sets important policies for how the Food and Drug Administration will review new treatments. The webinar also highlighted the proposal to establish the Advanced Research Projects Agency for Health (ARPA-H) which would be a significant new investment in high-impact biomedical research. If you want to skip the PASTEUR Act, you can fast forward to minute 33:48 in the webinar.
We hope you will consider learning more about this vital issue and weighing in with this Action Alert. If this issue speaks to you and you want to get more involved, let us know, and we can connect you with advocacy leaders working diligently to get the PASTEUR Act across the finish line.