JAMES HUGHES: Legislation vital in battle against ‘superbugs’

We’re losing the war on bugs. Superbugs, that is.

These drug-resistant microbes currently kill an estimated 700,000 people around the world each year — and they’re evolving faster than we can destroy them. If we don’t address this crisis, the global body count could grow to 10 million annually by 2050.

Luckily, in one of his final proposals in Congress, Senator Johnny Isakson, R-Ga., presented a battle plan. Together with Sen Bob Casey, he recently introduced the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms, or DISARM, Act. The reform will provide hospitals additional funding when they appropriately administer cutting-edge antibiotics.

Those higher payments will boost hospitals’ demand for these medicines. Hopefully, biotech companies will respond to that demand by developing new treatments for drug-resistant bacteria and fungi.

Antibiotics combat bacterial infections that, for most of recorded human history, were the leading causes of death. In the early years of the 20th century, diseases such as cholera, pneumonia, syphilis and typhoid fever claimed millions of lives around the world.

When doctors finally rolled out antibiotics in earnest in the 1940s, that began to change. Human life expectancy soared to unprecedented levels. In America, it rose from around 56 years in 1920 to more than 78 years in 2017.

It’s no exaggeration to say that antibiotics laid the foundation for all of modern medicine. They were some of the first truly mass-market treatments — and the profits their developers earned helped fund research into a wide range of illnesses, leading to many of the cures we take for granted today.

Unfortunately, this trend may soon reverse. Due to the rampant overuse of antibiotics, bacteria are increasingly evolving to resist drugs. Here in the United States, at least 2 million people develop drug-resistant infections each year. Of those, as many as 162,000 people don’t survive.

As existing antibiotics prove less and less effective, the need for new drugs becomes more urgent. But the pipeline for these drugs is running dry. Between 2008 and 2017, the FDA approved less than 10 new antibacterial drugs — down from 30 between 1983 and 1992. More than three decades have passed since researchers developed a new class of antibiotics.

Addressing this crisis will require strategies that both cut down on the over-prescription of antibiotics and spur the development of more effective drugs.

A recently released final rule from the Centers for Medicare and Medicaid Services hints at a solution. The reform would allow hospitals that use new antibiotics to qualify for a “new technology add-on payment” from Medicare. That’s a modest step in the right direction.

But the reform proposed by Sens. Isakson and Casey is more encouraging.

The DISARM Act would update Medicare’s antibiotics reimbursement policy. Currently, hospitals are often reimbursed for Medicare patients’ antibiotics as part of a flat-rate “bundled payment” for a given set of services, regardless of whether the patient is treated with a decades-old generic drug or a newly approved innovative antibiotic. As a result, hospitals often prefer using older, cheaper antibiotics.

In most cases, these older drugs are perfectly adequate. But sometimes, it would be more clinically appropriate to use newer antibiotics. Yet hospitals remain reluctant to administer these advanced drugs, which cost more to purchase.

The bill would fix this disincentive by increasing reimbursements for new antibiotics. This change would improve patient access to these innovative drugs — and help incentivize desperately needed investments in antibiotic research.

The DISARM Act also takes aim at the second driver of antibiotic resistance — the overuse of these drugs. To qualify for the reform’s more generous Medicare reimbursement, hospitals must implement antibiotic stewardship programs that follow recommendations from the Centers for Disease Control and Prevention. These organized efforts ensure patients get the appropriate drug at the correct dose for the right length of time.

Our state has been a national leader in enacting such initiatives — most notably through the Georgia Honor Roll for Antibiotic Stewardship. Implemented in 2014, the honor roll encourages hospitals and acute care centers to prescribe antibiotics appropriately.

As promising as the DISARM Act may be, it’s only a start. The growing crisis of antimicrobial resistance has the potential to undo one of the biggest public health triumphs in human history. To adequately combat this crisis, the government may ultimately need to offer additional financial incentives such as direct rewards to firms that bring new antibiotics to market.

In the meantime, however, passing the DISARM Act would bring us closer to the day when antibiotic resistance no longer poses a threat to millions of people.