There's up to a 57% chance that another pandemic of COVID-19 proportions will occur in within the next 25 years, according to risk-modeling firm Metabiota.
In other words, it's likely not a matter of if, but rather when, we will face the next infectious-disease crisis. Experts even have rough ideas of how this future crisis will emerge—and it's increasingly possible that it could be a bacterium that resists all existing medicine.
Healthcare and policy leaders need to start preparing for that scenario now. And they can use their experiences from the pandemic to do it.
Antimicrobial resistance, or AMR, arises when a pathogen becomes resistant to medicines available to treat it. The World Health Organization considers it one of the top 10 public health threats.
The toll is alarming. "Superbugs" already kill an estimated 1.2 million people every year. The Centers for Disease Control and Prevention predicts that without measures to address this crisis, that figure could jump to 10 million over the next 30 years.
While leadership in Washington is important, preparing for the next pandemic can't only rest with government. Hospital and health system leaders will play a critical role in shoring up our defenses against AMR—just as they stepped up to help address COVID-19.
It all starts with being mindful about when caregivers prescribe antibiotics. Since bacteria have the chance to survive and grow resistant every time a patient takes an antibiotic, these drugs must be used only when necessary. Yet, according to the CDC, over half of antibiotic prescriptions for certain illnesses are "not consistent with recommended prescribing guidelines" and almost a third of antibiotic prescriptions are "unnecessary or suboptimal."
The problem only got worse during the pandemic. A Pew Charitable Trusts study found that between February and July 2020, over half of COVID hospitalizations resulted in a prescription for antibiotics, despite the fact that only 20% of patients had suspected bacterial lung infections. Another study found a significant increase in azithromycin (Z-Pak) prescriptions at New York and New Jersey hospitals early in the pandemic.
It's no coincidence that the number of drug-resistant infections surged during the pandemic.
But the AMR crisis predates COVID-19—and will continue affecting patients after the pandemic ends. To prevent AMR from worsening, it's imperative that both health leaders and policymakers learn from past mistakes and take action to prevent them from recurring.
That's where antibiotic stewardship programs come in. The Centers for Medicare and Medicaid Services requires that all acute-care hospitals to implement these programs to ensure doctors use antibiotics only when necessary. The rule helped double the number of hospitals implementing stewardship programs, but nearly 10% of facilities haven't done so.
Further closing that gap largely rests with health system leaders, who have the power to allocate money toward training staff, maintaining accountability and collaborating with other hospitals on stewardship priorities.
Addressing AMR is going to take all of us. Stewardship alone will not solve the problem. We also need better treatments and diagnostics. The PASTEUR Act, which was introduced in the House and Senate last summer, would allocate more government resources toward antibiotic stewardship in hospitals. The legislation represents an exciting opportunity to develop a public-private partnership, just like the ones that led to the development of lifesaving COVID-19 vaccines.
Preventing drug-resistant infections also means keeping vulnerable patients out of healthcare facilities—where a significant percentage of drug-resistant infections start—in the first place. Lawmakers and health system leaders also must continue to embrace telemedicine, which can improve health outcomes and eliminate unnecessary hospital visits down the road.
Consider just one study involving children with medically complex conditions, who are often in danger of getting sick when they come into contact with other ill patients in healthcare facilities. Researchers found that high-risk children who received a mix of in-person and virtual care were 99% less likely to need treatment for serious illness compared with those receiving only in-person care.
We have a lot of work to do before the U.S. is adequately prepared for the next public health crisis, starting with addressing the rising threat of AMR. If it does hit, we'll be better equipped to save lives because of the last two years plus.