“The market is broken,” says Zachary Zimmerman, cofounder and director of the small antibiotic firm Forge Therapeutics, which currently has two new antibiotics under development. “So what we need to do is take the market out of the equation.”
This is what the Pasteur Act would do. In its current form, it commits $6 billion over several years to construct a sort of subscription plan for developing new antibiotics. That dollar amount is the result of numerous compromises—when first introduced in 2020, the bill called for $11 billion—and it wouldn’t all be spent on drugs. The program it would create in HHS would assemble panels of experts to evaluate whether any newly proposed antibiotic addresses an unmet need. Then they would estimate a societal value for the drug, anywhere from $750 million to $3 billion. The Treasury would disburse that money in tranches over several years. In return, the government would receive doses of the drug to dispense to federally insured patients, at no charge to them.
Compare the $6 billion in funding with the more than $1 billion cost of bringing out a single drug, and it’s clear the Pasteur Act won’t go far. It could support a couple of new drugs before it would need to be reauthorized. But experts who have been pressing for a program like this say that it won’t only guarantee the success of individual products, but will also signal to public markets and private capital that antibiotic development can be a reliable investment.
“We hear loud and clear, especially from smaller drug companies, that they view this funding mechanism as extremely valuable to the sustainability not only of the individual antibiotics that they will put forth as candidates, but to the viability of their entire company,” says David Hyun, a physician and director of the Pew Charitable Trusts’ antibiotic resistance project.
There are several hurdles in the way. The first is that the returning Congress doesn’t have much time left. The second is that, to succeed, the Pasteur Act will have to be attached to a larger piece of legislation, at a moment when lots of sponsors are trying to get their pet proposals through. One vehicle might be an omnibus spending bill that reauthorizes health programs on the verge of expiring. Another may be the annual, bipartisan, usually nonpolitical National Defense Authorization Act. With 66 cosponsors from both parties, Pasteur seems like a natural fit.
Yet last week, a coalition of six academics and 11 organizations—including the liberal-leaning groups Public Citizen and Doctors for America—asked the legislators who oversee military authorization to keep the measure out of that end-of-year act. In a letter to Senators Jack Reed of Rhode Island and James Imhofe of Oklahoma—the Democratic chair and Republican ranking member of the Senate Armed Services Committee—the group called the Pasteur Act “a blank check to pharmaceutical manufacturers.”
That objection offers a glimpse of what might spoil the Pasteur Act while it’s on the brink of success: its cost. So many large companies have been excoriated for extortionate pricing that the prospect of giving any money to any drugmaker is risky. Yet while the small biotechs holding up the field may be in pharma, they’re not Big Pharma: many have just a few employees, are working on their first-ever product, and aren’t earning anything yet, let alone extortionate returns. “We’re hearing: It’s just too much. We’re not prepared to spend this much,” says Mary Dwight, the chief policy and advocacy officer at the Cystic Fibrosis Foundation, which has taken on the Pasteur Act as a cause. “We would really like to flip that narrative, because it’s pretty clear to us that combating antimicrobial resistance is cost effective.”
According to research supported by the CDC, the US already spends $4.6 billion each year to respond to antibiotic-resistant infections. If that spending could be obviated, it would save in one year most of what the Pasteur Act would spend over several.
“If Pasteur passes, it would help not just CF patients, but the whole population,” Brown says. “We got through Covid, but if there are not more antibiotics to help treat bacterial infections, then Covid is going to look like the least of our worries. If a superbug gets out and nobody has anything to work with, then we’re all going to be in trouble.”