Good News: There's a Plan to Save Us From Antibiotic Resistant Superbugs

Antibiotic-resistant bacteria present a “perpetual challenge” in a war that won’t ever be won—but we're not necessarily doomed, according to one of the country’s top health officials.

Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, wrote a commentary in the Journal of the American Medical Association explaining that medicine needs new strategies to stay one step ahead of pathogenic microbes.

“The challenge of antimicrobial resistance is an enduring threat that likely will never be eliminated,” Fauci wrote. “The threat is due, in part, to the inherent ability of microbes to replicate rapidly and mutate, offering them an evolutionary advantage in fending off hazards to their survival.”

The news shouldn’t be shocking to anyone, but it does represent one of the strongest statements a US government official has said about the seriousness of antibiotic resistance.

Fauci takes a pragmatic view—he says that the threat is very real, we are running out of effective antibiotics, and we are increasingly seeing harder-to-treat versions of bacteria that were once easily treated with penicillin. Recent outbreaks of carbapenem-resistant Enterobacteriaceae in hospitals, resistant gonorrhea around the world, and resistant strains of tuberculosis are just early warnings of what could happen if new antibiotics aren’t developed. But he also says that humans are involved in a battle of “our wits” versus “their genes” that isn’t hopeless.

“A multifaceted, global solution to the problem of antimicrobial resistance is needed, one that combines effective prevention, appropriate use of therapeutics, passive surveillance and active case-finding, and a robust, multi sector research enterprise for development of drugs and diagnostics, including market-based incentives for industry,” he wrote.

Fauci notes that the pipeline of new antibiotics is finally starting to open back up again after years of stagnation and that we are developing new, non antibiotic-based strategies for fighting bacteria. He says that there are entire classes of bacteria that scientists think they can eventually create new antibiotics out of, and that “biomedical innovation combined with improved surveillance, prevention efforts, rapid diagnosis, market incentives to drive technology development, and curtailed misuse [of existing antibiotics] can meet the continual threat of antimicrobial resistance.

It’s an approach that the NIAID, one of the most important medical agencies in the United States, appears to be backing up. Earlier this month, the agency released a new “strategic plan” for fighting antibiotic resistance, a document that will help guide where the agency will be putting its money. That plan says the agency is working on—and funding others to—research new vaccines, create new antibiotics, and gain a basic understanding of how bacteria evolve resistance in the first place.

There's evidence it's starting to work. When I started writing about antibiotic resistance several years ago, every researcher told me the sky was falling, that there was nothing coming in the pipeline, and that we would eventually be completely screwed. We had used up all the antibiotics we knew how to make, and companies had no incentive to make new ones because development was expensive and profits were nonexistent. Today, the tone is still serious, but it's not so dire.

"We have actually been accelerating our efforts on antimicrobial resistance. It’s happening. The rhetoric is starting to work," Fauci told me. "What were once ideas and suggestions are now starting to get translated into reality. Not to lighten the complexity of the problem, but there are ways to address this."

As long as the agency, and others, like the FDA, make strong commitments to actually changing how we prescribe antibiotics and how we fight resistance, maybe we're not doomed. In fact, if we're successful, maybe the public at large won't ever know this crisis happened.