Spring was just arriving in 1942 when a woman in her early 30s came down with a bad infection with a common type of bacteria: Strep. She was admitted to a hospital in Connecticut, but her illness grew worse and her shot at surviving eventually appeared hopeless. Her temperature hit nearly 107 degrees Fahrenheit as she became distraught and slipped in and out of consciousness.
Growing desperate, her doctors tried everything – commonly used medications, blood transfusions, even surgery – but nothing helped her, according to a Centers for Disease Control and Prevention description of the patient.
There was, however, one last hope: an experimental drug known as penicillin.
Discovered by accident by a Scottish microbiologist named Sir Alexander Fleming years earlier, the drug was all the doctors had to offer. They injected the woman with the unproven medicine, and it worked. Within hours her fever disappeared, and then her other symptoms improved. The woman, Anne Miller, became the first American civilian to use the antibiotic treatment and went on to live to age 90.
While it’s hard to appreciate today the role of such a seemingly simple drug, penicillin and its development helped spur the creation of more and more life-saving antibiotics. The world saw a boom in the drugs spanning from the 1950s to the 1970s, and it changed the course of health care dramatically. The drugs diminished the dangers once posed by common bacterial infections that had plagued the U.S. and the rest of the world before the mid-1900s, when people were lucky to make it past their late 40s. Illnesses such as bacterial pneumonia and diarrhea that were previously the main causes of death in developed nations were suddenly cured within days of taking the new medicines.
“Before antibiotics, a simple skin infection had a 10% chance of killing you. People never think about that today, because we have antibiotics that cure all bacterial skin infections. We don’t think about skin infections as being a problem at all,” says Dr. Helen W. Boucher of the Levy Center for Integrated Management of Antimicrobial Resistance at Tufts University School of Medicine in Boston.
But now, warns Boucher and other experts, time for many of these drugs is running out. Antimicrobial resistance is turning back nearly a century of work to prevent deaths from bacterial and fungal infections. In the U.S. alone, nearly 3 million people annually are believed to fall ill to antibiotic-resistant bacterial infections, and more than 35,000 of the patients perish from the germs.
Boucher and others who are advocating for national initiatives, legislation and global efforts to stave off the threat of resistance, say the world is now facing a “silent pandemic” that could make many routine surgeries too risky, transform common and curable illnesses into the fatal ones they once were, and turn back the clock of health care by many decades.
As part of an occasional series on how to prevent the next pandemic, TheStreet spoke with Boucher by phone recently about this emerging disease threat. In addition to her other roles, Boucher is the interim Dean of Tufts University School of Medicine, Chief Academic Officer at Wellforce, and an infectious disease physician at Tufts Medical Center. The following has been edited for clarity and brevity.
TheStreet: Everyone has had COVID on their minds for the past year and a half, and everyone has been surprised at the ways in which the disease can affect our bodies. But a common bacterium – Staphylococcus aureus – that you have studied can also affect the heart, lungs, even joints. Could you talk a little bit about that in the context of antibacterial resistance?
Boucher: Before COVID and today, we have been faced with patients who have infections caused by resistant bacteria – everyday. It limits our ability more and more to care for people. We are seeing people who have infections caused by bacteria that are so resistant that we can’t treat them. I’ve had to put people on hospice, because we couldn’t treat their infection. The threat that this poses is really limiting health care, including limiting our ability to perform surgeries, to give people chemotherapy to treat their cancer, to give them organ transplants. The problem of antibiotic resistance is steadily getting worse, despite the efforts that we’re making. That’s why sometimes people call it the “silent pandemic.”
People like me, and our professional society, the Infectious Diseases Society of America, and others, are working hard to get buy-in from a lot of stakeholders, including the government, to make investments that will allow us to slow down, or stop, antibiotic resistance.
TheStreet: Tell me if I’m overstating the threat – but it sounds as if these drugs that we now depend on lose their effectiveness to resistant bacteria, that we will eventually increase the risk of any type of basic surgery, or even getting a cut, or even a respiratory infection….
Boucher: That’s exactly the concern – that we could undermine medical care as we know it. If you think about our aging population and how cancer is tremendously common – you can’t treat cancer if you don’t have antibiotics, full stop. You can’t do it. This could be a very serious – well it is a very serious problem – but it could become worse.
TheStreet: It seems like a big part of the this problem is … the lack of financial incentive for creating new antibiotic drugs, right? Most antibiotics are used over a few days and are expected to be affordable and some call the business model “broken.”
Boucher: One of the problems is the broken antibiotic market. So, one of the tools, one of the ways to address resistance, is to develop more antibiotics. But there are a number of other ways – antibiotic stewardship, having better diagnostics, and infection prevention in our hospitals. But new antibiotics are a very important part of combating the problem of resistance, and our market is broken. Even longer than 10 years ago, big pharma kind of left the space and then these little companies tried to move in and pick that up, and unfortunately the market has only gotten worse. We’ve seen the bankruptcy of several companies. A number of measures have been taken to try to fix this: so-called push incentives – things that would help the process before Food and Drug Administration approvals. Carb-X, for example, is a public-private partnership that gives money to these small companies. Those have been pretty successful.
But the bad news is that the post-FDA-approval world is still quite broken. Companies have been going bankrupt, because they’re not selling enough to stay afloat. Now, there’s movement for so-called pull-incentives to come into play at or after FDA approval. One is (legislation called) the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (Pasteur) Act, which is a subscription model that is a contract with the government that would provide a guaranteed return on investment to a company that would produce a much-needed antibiotic that meets certain criteria for up to 10 years. It’s linked to rigorous antibiotic stewardship and reporting use to the CDC and some other things that are measures that would provide the best chance for that antibiotic to last as long as possible.
Over 40 big stakeholder groups have signed on in support of the Pasteur Act, and we are very hopeful that will move forward as one step toward reinvigorating the pipeline.
TheStreet: A lot of people when they go to the doctor, they don’t always get a test to diagnose a particular viral or bacterial or other infection (especially before the pandemic). … Does more diagnostic testing make sense, so that doctors can accurately determine what’s causing symptoms? Patients have no idea whether the antibiotics they are taking are appropriate.
Boucher: The whole area of diagnostics is a big focus here. It’s clear that if we could diagnose whether a person has a virus -- or bacterial infection -- upfront, we would save a lot of inappropriate antibiotic use. There is a lot of focus on diagnostic testing and a lot of work going into that. This is a so-called wicked problem and it requires a really multifaceted approach and solutions. There are several international prizes being awarded for innovative strategies for testing, and the COVID epidemic has really shown us – again – the importance of having good diagnostic testing. I know that this fall we’re all going to be very focused on the importance of diagnostic testing. When people come in with respiratory symptoms – we'll be asking, Is it COVID? Is it the flu? Is it bacterial? That is a big, big issue.
TheStreet: How much should we be looking at vaccines for bacterial infections?
Boucher: Vaccines are very important. You perhaps think of vaccines as treating viral infections, but many bacterial infections are so-called super infections. So a person comes in with influenza, and they get a bacterial pneumonia because of Staph – Staphylococcus aureus – if you prevent the flu in the first place, they will never get the staph pneumonia. So, vaccination is vitally important. Not just the flu vaccine and COVID vaccine, but there are pneumonia vaccines – very, very effective. They are hugely important. But if we think the economic argument for antibiotics is difficult, the economic argument for vaccines is even more difficult… .
TheStreet: But you’re talking about the argument for producing and selling vaccines, and yet aren’t they highly cost-effective from a public health standpoint?
Boucher: Correct. But, someone still has to do the developing, somebody has to buy them and distribute them and all that. Investment is still required.
TheStreet: Is there a disconnect ... between global warming and emergence of these diseases?
Boucher: We know that it fits into this picture. This is a one-health problem. Antibiotic resistance involves humans, animals and the environment and all the interactions among them. With global warming, we’ve already seen a spread of resistance and changing resistance patterns, so we know that there is a relationship.
TheStreet: What about antifungal resistance?
Boucher: Antifungal resistance is very real. It’s definitely associated with global warming. There are some fungi that grow better in warmer climates, in warmer temperatures, and we are seeing that. You might have seen the outbreaks of mucormycosis in people with COVID in India. That’s related to the environment. The problem of resistance in antifungals is getting worse. We’re seeing a resistant Aspergillosis in this country, and things we hadn’t seen previously. There is a real need to address antifungal resistance. It’s a particular problem in immunocompromised people. So, those cancer patients, transplant patients – special groups. But then you see something like the horrible thing we see in India with the mucormycosis, and that’s happening not in immunocompromised patients, but in (all kinds of) patients. That is very disturbing and just a sign of what many people believe is to come.