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Failing to plan, it’s been said, is planning to fail. By this standard, the United States and other countries are planning for failure when it comes to preparing for the next public health crises, one of which will certainly be antimicrobial resistance, the phenomenon in which bacteria and fungi evolve to resist even the strongest treatments.

Covid-19 has demonstrated the catastrophic result of a virus catching the world unprepared. But over human history, bacteria have been our most dangerous foe. So it doesn’t make sense to me that the Biden administration recently released a pandemic preparedness plan that mentions the threat of antimicrobial resistance just once, and then only in passing.

This omission is ominous. Drug-resistant “superbugs” sicken nearly 3 million Americans each year and kill 35,000. Some experts estimate the real toll is much higher, with up to 162,000 Americans dying each year from antimicrobial resistance. An influential report commissioned by the Prime Minister of the United Kingdom and the Wellcome Trust estimated this scourge could kill as many as 10 million people each year around the globe.

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Much like Covid-19, antibiotic-resistant pathogens disproportionately affect vulnerable populations, including seniors. A new study from The Pew Charitable Trusts, University of Utah, and Infectious Diseases Society of America found that Americans aged 65 and above account for an estimated 40% of deaths related to antimicrobial resistance despite constituting just 15% of the U.S. population.

Much of modern medicine relies on the safety net of effective antibiotics. Surgeries, outpatient procedures, cancer treatments, and much more would be more dangerous without antibiotics. Infection is already the second leading cause of death for people with cancer.

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Despite this grim news, we’re in the calm before the superbug storm. Because infections are evolving faster than scientists can invent new treatments, cases and deaths are expected to rise in the years ahead. The World Health Organization considers antimicrobial resistance to be a major global threat that will weaken, kill, and send millions of people into extreme poverty within this decade.

This storm is not a theoretical possibility. It will make landfall. How much damage it will do depends on whether our leaders recognize the danger and prepare for success.

With a new crisis emerging seemingly every day, political leaders have displayed little sense of urgency about this long-term threat. The number of new antibiotics being developed and brought to market has plummeted in recent decades. And among the 43 in development, none take aim at the “most dangerous bacteria,” according to a recent report from the World Health Organization. In fact, the last new class of antibiotics against the worst superbugs was discovered in 1962, when John F. Kennedy was in the White House.

Why so little progress against a demonstrable threat? The marketplace for antimicrobials is broken, even though they have transformed medicine and are valuable to society. That is because these drugs should be used sparingly to avoid the development of resistance. The prices of antimicrobials are surprisingly low. But low volumes and low prices make for bad business.

Companies are increasingly going bankrupt in the process of trying to square this circle. Sponsors of 41% of the new antibiotics approved by the FDA over the last decade have suffered a similar fate. Scientific breakthroughs are being ground to dust by terrible economics.

The economic incentives for developing new antimicrobial drugs must change if the world wants new weapons against superbugs.

There are solutions. A bipartisan bill, the PASTEUR Act (H.R. 3932 and S. 2076), has been introduced in Congress that would establish a Netflix-like subscription system under which the federal government would pay a flat fee to drug companies for pre-paid access to highly innovative antibiotics. This is similar to paying in advance to have the Federal Emergency Management Agency or local fire departments ready to respond to natural disasters and fires, investing in preparedness today for protection tomorrow. The PASTEUR Act smartly pays for preparedness, so the U.S. will be ready when the storm hits.

If we’ve learned nothing else from the Covid-19 pandemic, it’s become clear that although preparedness can seem expensive, it is actually wise investment. The cost of the PASTEUR Act is less than one latte per American each year. This money can be invested in preparedness today to save lives, and trillions of dollars, when the storm of antimicrobial resistance ultimately arrives in full force and targets the most vulnerable among us.

Kevin Outterson is the founder and executive director of CARB-X and a professor at Boston University School of Law. CARB-X is a global nonprofit partnership that focuses on supporting the developers of promising new antibiotics, diagnostics, and vaccines. It is funded by BARDA, the Wellcome Trust, the National Institute of Allergy and Infectious Diseases, the Bill & Melinda Gates Foundation, and the governments of the United Kingdom and Germany. These opinions are the author’s own and do not necessarily reflect the views of CARB-X or any CARB-X funder.

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