Even as we confront a surging COVID-19 pandemic in advance of global vaccination — another looming pandemic threatens us.

This threat comes from rising numbers of drug-resistant bacteria and fungi. These “superbugs” are immune to most antibiotics. They already kill 700,000 people around the world each year. And they’re evolving faster than we are developing new treatments. One report warns that these infections could kill more than 10 million people worldwide each year by 2050, unless scientists invent more powerful antibiotics.

A superbug pandemic could prove even more devastating than COVID-19 — in terms of medical care interrupted and too many lives lost. The rise in treatment-resistant infections makes surgeries, as well as chemotherapy and immunotherapy, much riskier since superbugs abound in hospitals and prey on patients with weakened and suppressed immune systems.

Given the severity of the threat, it would seem that drug companies would spare no expense to find new treatments. After all, they have heroically moved heaven and earth to develop vaccines and therapeutics for COVID-19.

Yet, very few drug firms are investing in superbug treatments, largely because the antibiotics market is much different than the market for other drugs.

With most pharmaceuticals — such as cancer therapies — new treatments are available to patients once FDA approved. But with antibiotics, to avoid resistance developing, doctors typically refrain from using the newest ones to minimize the chances of superbugs growing resistant to those new treatments.

Every time an antibiotic is used, resistance can develop. So, holding back new antibiotics makes sense from a scientific perspective and clinical recommendations. But it creates an enormous economic challenge when it comes to encouraging companies to fund antibiotic research. If doctors aren’t using the newest antibiotics, companies can’t sell enough doses to recoup their development costs. On average, it takes 23 years for an antibiotic to recover the costs it took to discover and develop it. Simply put, the traditional pharmaceutical sales model — charging per prescription to recoup costs and make a profit — doesn’t work for antibiotics.

As a result, most major pharmaceutical companies have abandoned antibiotic research. And many smaller biotech firms have gone bankrupt or chosen to leave the field. Today, just four major pharmaceutical companies maintain antibiotic research programs.

A new piece of legislation aims to create a sustainable business model to encourage more private investment in much-needed antibiotics.

The bipartisan PASTEUR Act, introduced by Senators Michael Bennet (D-CO) and Todd Young (R-IN), would create a subscription model for new, innovative antibiotics that kill superbugs. Federal insurance programs would receive unlimited access to the drugs, regardless of how many doses doctors prescribe by paying companies in advance for innovative, new FDA-approved antibiotics that tackle priority areas of greatest need.

By not linking payments to usage but incentivizing research in priority areas, the legislation addresses the economic disincentives to antibiotic research and will spur innovation to meet the growing threat of drug-resistant infections.

The world will face a deadly new pandemic relatively soon, one that is fueled by a superbug that may already exist. Will we be prepared to fight and defeat it? That depends entirely on whether our leaders take the growing threat of superbugs seriously.

Randall Rutta is president and CEO of AARDA. He also serves as principal at ConnectHealth and as a board member of the Partnership to Fight Infectious Disease. This piece was originally published in the Boston Herald.

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