Researchers at the Walter Reed Army Institute of Research recently identified the gene that made a strain of E. coli resistant to colistin

Credit: Courtesy of United States Army | Wikimedia Commons

Last month, a Pennsylvania woman was diagnosed with the first American case of an infection resistant to colistin — a treatment known as the antibiotic of last resort. Although she has recovered, the case has heightened concern about the dangers of antibiotic resistance.

In response to this crisis, Vice Provost for Global Initiatives and Chair of the Department of Medical Ethics and Health Policy Ezekiel Emanuel published an op-ed in the Washington Post in late May, proposing a $2 billion prize to anyone who secures FDA approval for a new antibiotic.

Emanuel wrote that the Pennsylvania case “signals that a superbug is inevitable.”

Superbugs could cost the global economy as much as $100 trillion between 2014 and 2050, according to a 2014 report published by British economist Jim O’Neill.

The report also projected an extra 10 million deaths from drug-resistant infections each year by 2050 — more than the number of worldwide cancer deaths in 2014 — if action is not taken to combat antibiotic resistance.

Emanuel proposed four steps to combatting this problem.

He suggested hospitals should implement programs to reduce the overuse of antibiotics. Next, an electronic system should review the necessity of antibiotic prescriptions in order to minimize the number of unnecessary prescriptions. He also proposed government funding for pre-clinical research on antibiotics. Finally, he proposed large financial prizes.

Pharmaceutical companies currently have a greater financial incentive to develop other types of drugs, Emmanuel said. Chemotherapy drugs, for example, can be much more profitable. There are currently only 37 antibiotics in clinical development, while nearly 836 drugs or vaccines are being developed for cancer.

“We have to shift the incentive structure for researchers and drug companies,” Emmanuel told NPR. “Otherwise we’re just not going to have enough development.”

The Pennsylvania woman’s infection was found to be from a strain of E. coli. Although the infection could not be treated with colistin, doctors were able to treat it with other antibiotics.

Researchers at the Walter Reed Army Institute of Research in Maryland identified the gene, called mcr-1, that made this strain of E. coli resistant to colistin.

The Centers for Disease Control and Prevention official Beth Bell stated that this strain currently poses a minimal risk to the general public.

Emmanuel proposed this prize as a collective effort by developed countries to encourage the development of new antibiotics. The United States would be one of several contributing to the fund and creating rules for their use in order to decrease the chances of resistance.

As for the source of the prize money, Emanuel suggested a small tax on hospitals. He wrote that even a tax of two cents for every $10 in revenue would generate $2 billion a year.

Emmanuel also stated that action is urgently needed to encourage antibiotic development and to slow the development of antibiotic-resistant infections.

“Unless we shift course, superbugs will become a fact of life,” Emmanuel said.

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