Bipartisan bill on antibiotics faces crucial stretch

Paige Kupas, The Hill, August 1, 2022

A health care bill is facing criticism from some experts who say it could lead to huge spending on new antibiotic drug development that may not improve patient outcomes in the long run.

The bipartisan legislation, with its $11 billion price tag, aims to establish a subscription model in which antibiotic developers are paid upfront for the use of their medicine, which could spur a flurry of new drugs to the market. To qualify, a new antibiotic must be checked against certain criteria in the bill — but physicians and experts worry how effective that could be in practice.

Lawmakers who back the measure say such a model would encourage innovation in drug development to combat what they say is a looming health crisis caused by antimicrobial resistance, which occurs when infections can no longer be treated with the drugs currently in circulation. The Centers for Disease Control and Prevention reports that 35,000 people in the U.S. die from such infections annually.

But some infectious disease experts said the bill does not explicitly outline certain conditions related to trials that improve patient outcomes. That includes running trials with patients who have resistance to the current generation of antibiotics.

“It shouldn’t be so much about more drugs but better drugs. We want drugs to come out that dominate the current [antibiotics], and we are very concerned that we are not going to get that out of this,” said Mark E. Miller, the executive vice president for health care for the philanthropy-funded Arnold Ventures, which develops evidence-based policy solutions to improve health care.

One of the biggest obstacles to passing the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act is the price tag, according to an aide to Sen. Michael Bennet (D-Colo.), one of the legislation’s four sponsors, who said leadership isn’t yet convinced that much money needs to be allocated to address the issue at this time.


The bill was first introduced in September 2020, before being reintroduced by Bennet, Doyle, Sen. Todd Young (R-Ind.), and Rep. Drew Ferguson (R-Ga.) in June 2021.

Democratic members say the White House backs the PASTEUR Act, though an administration official did not return a request for comment for this article.

One of the measure’s more vocal proponents is The Pew Charitable Trusts, which sees antimicrobial resistance and the over-prescription of antibiotics as an increasingly important issue in light of the COVID-19 pandemic. The Pew Charitable Trusts found that 52 percent of people admitted to the hospital with COVID-19 were prescribed at least one antibiotic.


However, research from the Mayo Clinic found that of 21 novel antibiotics examined, every Food and Drug Administration-approved label for such antibiotics contained at least one group of patients who were restricted from enrolling in the trials. This has raised concerns that antibiotics whose trials excluded certain groups — such as individuals who are resistant to current antibiotics — could be approved for the subscription contract under the bill.

Miller said the bill won’t necessarily lead to better treatment by offering patients and physicians more drugs to choose from.

“We’re going to spend this money, we’re going to get inferior drugs, and the doctors aren’t going to prescribe them then. If you’re going to spend this money, get dominant drugs,” Miller added.

Another issue is the notion of bringing more drugs into the market that are not vastly different from the current drugs, which poses a problem due to mutations of bacteria that could be resistant to new drugs, said Diana Zuckerman, president of the National Center for Health Research, a health policy think tank.

“Prescribing the new drug will make it more likely that there will be resistant bacteria because the new drug is so similar to other drugs on the market.” Zuckerman said.  

The PASTEUR Act does not specify which or how many characteristics an antibiotic must meet, raising concerns from physicians and antibiotic experts about how effective the legislation would be if it became law.

It also does not explicitly outline trials that infectious disease experts said should include patients who have resistance to the current generation of antibiotics that should be compared to current and new drugs.


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