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New weapons needed for an old battle

Buried under the dirt in Iraq and Afghanistan, amid the rubble and improvised explosive devices, lurks an invisible enemy. It has struck hundreds of U.S. soldiers in the last decade. There are some weapons in our arsenal that we can use to fight this threat, yet in a growing number of instances we are completely unarmed.

The foe in question is a microscopic germ so commonly associated with wounded soldiers that it is nicknamed Iraqibacter. Its real name is Acinetobacter baumannii.

The story of this bug and the soldiers it has harmed illustrates what the Centers for Disease Control and Prevention and the World Health Organization have identified as one of the greatest public health threats: antibiotic resistance.

The emergence of nearly untreatable bacteria threatens everyone. The most notorious superbug is MRSA -- methicillin-resistant Staphylococcus aureus. It kills 19,000 Americans each year and is responsible for more than 360,000 hospitalizations. Other multidrug-resistant bacteria claim the lives of tens of thousands of Americans.

Unfortunately, soldiers face unique threats of multidrug-resistant infection. The CDCreported the first 102 cases of Acinetobacter infection among U.S. military servicemen and women between 2002 and 2004. More have occurred since; many have been marked by "widespread resistance to antimicrobial agents." Worse still, Acinetobacter is not the only, nor even the most deadly, superbug that afflicts our troops. These germs can infect the lungs, bloodstream, bones, heart and other vital organs and systems.

Bacteria inevitably develop resistance to antibiotics, but the process can be slowed by prescribing these drugs only when they are absolutely needed and taking them exactly as prescribed. Fortunately, health care practitioners and hospital administrators are making great strides both in controlling the spread of superbugs and in preserving the effectiveness of antibiotics.

Yet as effective as these measures have been, bacteria will always evolve and doctors will always need novel antibiotics.

Lately, these new drugs have been few and far between. In the 40 years after the discovery of penicillin, drug makers brought an astonishing 13 classes of antibiotics to market -- not just slight variations on a chemical theme but distinct categories that kill microbes in their own unique way. In the last 40 years, however, drug makers have added a paltry three new antibiotic classes.

Why are there so few new antibiotics? In short, their development costs are too high and their earning potential is too low.

Ultimately, it costs hundreds of millions of dollars to bring a new drug to market, whether that drug is a big-earning cholesterol drug that millions of people will take every day for years, or something like an antibiotic that gets prescribed for only a few days at a time.

Antibiotics are not the first drugs to fall through the cracks of the free market. Congress passed the Orphan Drug Act to incentivize drug makers to develop a range of life-saving medicines to treat conditions from which fewer than 200,000 people suffered. Since this law was enacted in 1983, the Food and Drug Administration has approved more than 350 orphan drugs to treat various forms of cancer, leukemia and AIDS-related diseases, among many other conditions, saving many thousands of lives.

Congress can take similar steps to spur the development of new antibiotics. The FDA also can give drug makers greater confidence to invest in these drugs by streamlining and clarifying the antibiotics approval process.

Our ability to treat wounded soldiers in the field of battle and rapidly evacuate them to medical facilities has dramatically improved over the past decade. More of our troops are surviving injury and making it home. That comes with a duty: We must now care for an increasing number of soldiers with a variety of difficult-to-treat conditions. Part of this responsibility entails ensuring we have the best drugs to treat them.


Joyce Johnson is vice president of health sciences for Battelle, which manages or co-manages research laboratories, including seven U.S. national laboratories and one international nuclear laboratory in the United Kingdom.