“Many other developed countries with established pharmaceutical industries such as Japan, Canada, and the UK have implemented or are working to roll out their own incentives to spur antibiotic development. The Pasteur Act dwarfs these. This could potentially drive pharmaceutical companies to flock to the US market to make drugs deemed important there and not in other places.
“The size of the Pasteur Act is going to be so large that it ultimately draws developers to only focusing on the United States, only developing the drug so that it can be used appropriately in the United States, and only registering the drug in the United States, because that’s ultimately going to be sufficient revenue and incentive for what otherwise is not a very profitable market,” explained Rohit Malpani, a senior policy advisor at the Global Antibiotic Research and Development Partnership, or GARDP.
Cirz added that with a steady influx of Pasteur Act funds, pharmaceutical companies may be less interested in investing additional funds to figure out ways to manufacture their antibiotics more cheaply. Usually companies would continue investing so they can increase their profit margins by lowering manufacturing costs, but if profit margins are set by the US government, then there’s less incentive to make an approved drug cheaper, when it can divert attention to making even more drugs. Without that innovation for affordable production, the act may unintentionally prohibit developing countries such as India from being able to independently manufacture the drug.
Finally, while Americans with federal health insurance plans are guaranteed access to antimicrobials that receive support from the act, the proposed legislation does not provide any stipulations or guidance for ensuring global access to these drugs. Pharmaceutical companies are left to make decisions regarding pricing, manufacturing, and distribution of whatever antibiotics might be funded by the program, argued Ava Alkon, global health advocacy and policy adviser at Doctors Without Borders.
“What the act doesn’t do is attach any meaningful conditions to facilitate affordable access to people outside of those federal programs, and certainly not outside of the US,” said Alkon.
“From our years of work on access issues around the world, this generally results in products being sold to the highest bidder and being inaccessible in many contexts where they’re needed,” she said.”
https://www.vox.com/future-perfect/367247/antibiotic-resistance-bacteria-pasteur-act-big-pharma
“For decades, evidence had amassed that the widespread use of antibiotics to help chickens, pigs, and cattle grow faster — and survive the crowded conditions of factory farms — was causing bacteria to mutate and develop resistance to antibiotics. By 2009, US agriculture companies were buying up two-thirds of what are termed medically important antibiotics — those used in human medicine. This in turn has made those precious, lifesaving drugs less effective for people.
Over time, once easily treatable human infections, like sepsis, urinary tract infections, and tuberculosis, became harder or sometimes impossible to treat. A foundational component of modern medicine was starting to crumble. But it wasn’t until the mid-2010s that the FDA finally took the basic steps of requiring farmers to get veterinary prescriptions for antibiotics and banning the use of antibiotics to make animals grow faster — steps that some European regulators had taken a decade or more prior.”
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“according to Matthew Wellington of the Public Interest Research Group, the FDA’s reforms went after the low-hanging fruit, and they didn’t go nearly far enough. Now, in a concerning course reversal, antibiotic sales for use in livestock ticked back up 7 percent from 2017 to 2021, per a new FDA report. The chicken industry, which had led the pack in reducing antibiotic use on farms, bought 12 percent more antibiotics in 2021 than in 2020.”
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“In 2019, antibiotic-resistant bacteria directly killed over 1.2 million people, including 35,000 Americans, and more than 3 million others died from diseases where antibiotic resistance played a role — far more than the global toll of HIV/AIDS or malaria, leading the World Health Organization to call antibiotic resistance “one of the biggest threats to global health, food security, and development today.””
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“The FDA and the US food industry have proven that they can make progress on the issue — but to keep antibiotics working, they need to do a lot more. That will require them to tackle beef and pork, two of the more stubborn and complex sectors of America’s meat system that just can’t seem to quit antibiotics, since doing so could demand substantive changes to how animals are farmed for food.”
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“In the early 2000s, the nation’s fourth-largest chicken producer Perdue Farms began efforts to wean its birds off antibiotics, which it achieved in 2016 by changing chickens’ diets and replacing antibiotics with vaccines and probiotics. At first, chicken raised without antibiotics cost 50 percent more, but the company says it has since been able to all but close the cost differential.
In the mid-2010s, while Perdue was making progress, activists leveraged the momentum and successfully convinced McDonald’s to source chicken raised without medically important antibiotics. Tyson Foods, the nation’s largest poultry producer, then committed to reducing antibiotic use, contributing to a “domino effect” in which producers and restaurants made further pledges to reduce antibiotics in poultry, said Wellington.
By 2020, a little over half of America’s 9 billion chickens farmed for meat were raised without antibiotics, according to an industry survey.
The sea change in chicken production demonstrated it was possible to quickly scale down antibiotics in farming, but it didn’t do much to reduce overall use, as the chicken industry only used 6 percent of antibiotics in agriculture in 2016. And the momentum didn’t spread to other parts of the meat business, like beef and pork, which together account for over 80 percent of medically important antibiotics fed to farmed animals.”
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“Chickens are slaughtered at just six or seven weeks old, so the chance they’ll get sick is lower than pigs, who are slaughtered at six months old, or cattle, slaughtered at around three years of age.
The chicken industry is also vertically integrated, meaning a company like Tyson or Perdue controls virtually every link in the supply chain, so making big changes like cutting out antibiotics is easier than in the more decentralized supply chain of beef. For example, the typical steer will change hands several times before slaughter, going from a breeder to pasture grazing to a feedlot, all of which make it harder to coordinate an antibiotic-free regimen. In the last few months of their life cattle are also fed a high-grain diet that they aren’t adapted to digest, which increases the chance they’ll develop a liver abscess, a condition that’s prevented with — you guessed it — antibiotics.”
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“The pork sector, like poultry, is also vertically integrated, but the industry has largely opposed animal welfare, environmental, and antibiotic reforms. Antibiotics in pig production shot up 25 percent from 2017 to 2021.
There’s also no pork or beef giant that’s taken the antibiotic-free leap like Perdue did for chicken.”
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“Aside from outright banning the routine use of medically important antibiotics to prevent disease, Wellington said he’d like to see the FDA take three actions: set a target of reducing antibiotic use by 50 percent by the end of 2025 (based on 2010 levels); publish data on antibiotic use, not just sales; and limit the duration of antibiotic courses for farmed animals.
An FDA spokesperson said specific reduction targets weren’t possible because the agency doesn’t know how many antibiotics farmers are using: “We cannot effectively monitor antimicrobial use without first putting a system in place for determining [a] baseline and assessing trends over time.” The agency right now only collects sales data, and it’s been exploring a voluntary public-private approach to collect and report real-world use data.”
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“here’s a lot to learn from the Europeans: Denmark, the continent’s second-largest pork producer, has become the de facto case study in how to wean Big Meat off antibiotics. In the early 1990s, it started phasing out antibiotics in pigs with little impact on the industry. From 1992 to 2008, antibiotic use per pig fell by over 50 percent, and while pig mortality went up in the short term, by 2008 it had dropped back to near-1992 levels.”
“if we’re not very careful now, humanity may backslide into a world where our antibiotics become useless — and the common infections they used to treat cut our lives short.
The Covid-19 pandemic has made that danger worse. According to a new report from the Centers for Disease Control and Prevention (CDC), during the first year of the pandemic, the problem of drug resistance only intensified.
Drug resistance is what happens when we overuse antibiotics in the treatment of humans, animals, or crops. When a new antibiotic is introduced, it can have great, lifesaving results — for a while. But then the bacteria adapt. Gradually, the antibiotic becomes less effective, and we’re left with diseases we’re less able to treat.
Even before Covid-19, experts had been warning that we’re approaching a post-antibiotic era — a time when our antibiotics would become largely useless against health problems ranging from tuberculosis to STIs to urinary tract infections. They noted that routine hospital procedures like C-sections and joint replacements could become more dangerous, too, as the risk associated with infection — especially infections acquired in hospitals — increases.
Some professionals, especially in hospitals, had heeded the experts’ warnings, and we’d seen some progress as a result. Take staph infections, for example. A 2019 CDC report noted that rates of methicillin-resistant Staphylococcus aureus (MRSA) had dropped. And overall, deaths caused by drug resistance had decreased by 18 percent since 2013.
But the Covid-19 pandemic has reversed years of hard-won progress. Drug-resistant hospital-related deaths and infections from seven pathogens grew 15 percent from 2019 to 2020, including a 13 percent increase for MRSA infections, which can be deadly.
One reason for that is that hospitals overprescribed antibiotics, according to the CDC. From March through October 2020, almost 80 percent of Covid-19 patients who were hospitalized were given antibiotics. As a viral illness, Covid-19 isn’t affected by antibiotics, but doctors may have been keen to prescribe them to cure or protect against secondary infections, especially given that hospital stays for Covid-19 can be long and intensive.
“This setback can and must be temporary,” Michael Craig, the director of the CDC’s Antibiotic Resistance Coordination and Strategy Unit, said in a statement. “The best way to avert a pandemic caused by an antimicrobial-resistant pathogen is to identify gaps and invest in prevention to keep our nation safe.”
Obviously, the last thing we want is for the Covid-19 pandemic to pave the way for a new pandemic caused by some drug-resistant pathogen.”
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“The good news is that we can absolutely address the problem of drug resistance. In its new report, the CDC calls for doubling down on strategies we know work, like preventing hospital-acquired infections in the first place and training medical professionals on when it is and isn’t appropriate to dole out antibiotics.”
“the overuse of antibiotics, whether in human patients or in livestock, results in bacteria adapting to the drugs, leading them to become less effective over time. If the pace of resistance isn’t halted — whether through more judicious use of the drugs or through the development of new classes of antibiotics — it will likely lead to soaring deaths from common infections and surgical complications, sending us back to a world where a minor cut could potentially once again be lethal.
We can avoid this fate, but it will require coordinating a global response before it’s too late.”