Technology

The $6 Billion Shot at Making New Antibiotics

Dustin Brown, a slight, dark-haired guy who lives in southwest Indiana, is 36, married, and a stay-at-home dad. He never expected to achieve any of those milestones: wife, toddler son, moving away from his family in Kentucky. Not even adulthood. Brown has cystic fibrosis, an inherited disorder that clogs major organs with sticky, sludgy mucus and makes them breeding grounds for infections. When he was born, newly diagnosed patients weren’t expected to survive past elementary school.

That the roughly 40,000 CF patients in the US have managed to beat that prediction is due to better treatments—just three years ago, the US Food and Drug Administration (FDA) fast-tracked a new drug combination to address the effects of the underlying genetic mutation—but also to hard work. Every day, Brown follows a tailored regimen of exercises, supplements, and pharmaceuticals to keep down the disease’s worst effects. That includes antibiotics: inhaled, in pills, and several times a year, through a catheter threaded up a vein into his heart. Brown calls taking care of his health “a full-time job.”

Still, he’s losing ground. The mucus in Brown’s lungs harbors Pseudomonas aeruginosa, bacteria that cause serious infections in people whose immune defenses are impaired. If that simmering occupation flares up into pneumonia, the results could be deadly, because tests by his doctors have shown that Brown’s strain of Pseudomonas is fully resistant to four antibiotics and partially resistant to two more. Brown has already tried the one remaining antibiotic the organism responds to. It triggered a life-threatening anemia.

“What are we going to do, if all these medicines run out?” he asks. “It’s scary, when you have a family and you’ve come this far. In the back of your mind, it can get you.”

The possible collapse of Brown’s treatment could be avoided, if there were another option. Right now, there are no new antibiotics that doctors can add to his regimen. In the US, antibiotic innovation has skidded to a halt. The last novel class approved by the FDA debuted in 1984.

A piece of legislation lined up for a vote in Congress, called the Pasteur Act (named both for the 19th-century microbiologist and to stand for Pioneering Antimicrobial Subscriptions to End Upsurging Resistance), could repopulate that empty landscape by guaranteeing government funds to help a small number of new antibiotics make it to market. The proposal has bipartisan support in both the House and Senate, is backed by the Department of Health and Human Services (HHS), was implicitly endorsed in the last White House budget, and resembles programs already implemented in other countries.

Independent analysts and drug-company personnel all say the measure is critically needed. But the Congress that reconvenes this week will be bruised from vituperative electioneering and distracted by races that remain unresolved. The body will also have to make decisions on a raft of legislative proposals that were delayed earlier in the year by hyperpartisan jostling, and will have to choose what they can accomplish before their session ends around Christmas Eve. If the Pasteur Act can’t get through by then, it will need to be reintroduced when the new Congress convenes in January. But that session will be focused on the 2024 election, and it could be hard for other issues to break through.

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