If discovery of new antibiotics continue to falter while resistance to those currently in clinical use spread, society will soon lack effective remedies to cure infections.
But it doesn't have to be that way. Collaboration between academia, drug companies and the U.S. federal government can stop that trajectory right in its tracks.
That's the assessment from Dr. Carl Nathan, chairman of the Department of Microbiology and Immunology, professor of Microbiology and Immunology, the R.A. Rees Pritchett Professor of Microbiology and professor of Medicine at Weill Cornell.
In a new State of the Art article, "Fresh Approaches to Anti-Infective Therapies," published in the June 27 issue of Science Translational Medicine, Dr. Nathan explained the linked challenges of antibiotic resistance and discovery and recommended new federal policies and collaborative efforts that can rejuvenate antibiotic discovery — the likes of which are vital to the health and safety of people around the world.
"Our shrinking ability to cure bacterial infections threatens to impair much of our modern medical practice, undermines global economic growth, compromises national security and drives up mortality rates for individuals in all stages and stations of life," Dr. Nathan wrote.
Infectious diseases have been a leading cause of human death for much of history, but one that was greatly diminished in the latter part of the 20th century in America due to improvements to sanitation, nutrition, immunization and antibiotics. But as pharmaceutical companies withdrew from antibiotic discovery — in large part due to revenue — and the food industry began to use antibiotics to enhance animal and plant growth —thereby hastening the spread of resistance — the protection antibiotics afforded diminished.
But it's not enough to go back to the "golden age" when antibiotics were believed to be the most effective line of defense against infections, as that perception, Dr. Nathan said, was just a mirage.
"To regain, maintain and extend substantial control over bacterial infections will require continuous development and application of fresh approaches based on new knowledge, practices and policies," he said. "We need to learn more about how antibiotics work, how bacteria resist them and how to discover, test, approve and conserve them."
To that end, Dr. Nathan recommends that researchers from academic institutions, pharmaceutical companies and government team up in collaborative laboratories to investigate innovative approaches, share best practices and share the rights in resulting intellectual property. Such a model is in practice with the Bill & Melinda Gates Foundation's TB Drug Accelerator, an innovative partnership with seven pharmaceutical companies and four research institutions — including Weill Cornell — recently launched to speed the discovery of new treatments for tuberculosis.
Dr. Nathan also suggests that the government create a national interagency Infectious Disease Policy Board that reports to the president of the United States. This board would establish guidelines on antibiotics — including priorities for antibiotic research, recommended legislation on reducing the administration of antibiotics to healthy food animals and plants, directives for new U.S. Food and Drug Administration regulations for clinical trials and education of the public and physicians on appropriate antibiotic use — and create an efficient monitoring system for antibiotic resistance and infectious disease outbreaks.
"We need efforts that are organized, multidisciplinary, multiple and parallel," he said, "and that bring the private and public sectors together in precompetitive space to address them in accord with a new set of national policies."