With the coronavirus pandemic taking a toll on the health and well-being of the public and the federal government rushing to respond, the Washington Examiner spoke with one of the foremost experts on infectious diseases, Dr. Greg Frank.
Frank is the director of infectious disease policy at the Biotechnology Innovation Organization, where he leads several infectious diseases policy issues, including antimicrobial resistance and vaccine policy. BIO is a trade organization and lobbying group that represents the interests of the biotechnology industry. Biotechnology is technology based on biology used most often to create medicines and cure diseases, to create fuels and help produce food products.
Dr. Frank received his doctorate in immunology at the University of Pittsburgh and pursued his postdoctoral training at the Laboratory of Viral Diseases at the National Institute of Allergy and Infectious Diseases. He has published multiple scientific articles in the field of infectious disease. The interview has been lightly edited for clarity.
Washington Examiner: Tell me a little bit about the biotechnology industry and the challenges those in the infectious disease world are facing.
Frank: In speaking with my colleagues who represent infectious disease doctors, you hear the stories abound of those consulting for a patient who is being treated for cancer, we cured them of cancer, and they died of an infection later — or a transplantation rejection or somebody having to have a joint replacement removed. These are happening now. But I think a lot of people feel like antibiotic-resistant infections are something we’ll worry about in 10, 20, 30, 40 years because it is relatively still low in frequency.
It’s difficult to give you percentages, but you know, it’s still probably in the low-digit percentage of cases. But when you apply that and how many people get infections — and the fact that it’s only going up. I think that puts it in a little more context. The other important detail there is if we were to solve those market challenges and the weird issues of antibiotics and antifungals and other medicines, then we would not see the products we need today to come to the market for another 10 to 15 years. So if we wait another 10 years before [we start], it gets really bad. That’s how long it’s gonna take us to really have the solutions we need. … I shudder to think of, sort of, how catastrophic consequences of resistance would be on modern medical care.
Washington Examiner: Is there any overlap between this antibiotic resistance phenomenon you describe that’s occurring and COVID-19?
Frank: It remains to be seen on the cures front. I think you’ve probably seen there are some combination therapies where antibiotics are being used, but I think the overlap that we see is that respiratory diseases, bowel diseases such as influenza — most people actually tend to succumb from secondary bacterial infections. The 1918 pandemic killed, I think, 100 million people. The majority of them, based off some retrospective analysis, was actually due to bacterial infections. This is before we had antibiotics. So we’re still learning a lot about the coronavirus outbreak right now. But I think we are seeing data that suggests that people, just like with other respiratory diseases that are very severe, are getting secondary bacterial infections.
And while we’re still trying to understand what impact that has, there was a study that was published a couple of weeks ago out of China where they looked at patients that went on to survive the disease, as well as those that succumbed. And the first data point that I think is important is everyone got antibiotics. I mentioned this is going to have an impact. It looks like [giving] antibiotic treatment just to be safe and stop the secondary infections is happening pretty widely. So when you think of a pandemic that may reach this magnitude of patients, that means a lot of antibiotics are going to be used.
Washington Examiner: For those who have survived or are recovering from the coronavirus disease?
Frank: Yeah, so everyone’s getting [antiobiotics] based off some of the studies we’re seeing — not everyone, that’s a bit of a bold statement. The majority of patients being treated for COVID-19 that we saw data from China are receiving antibiotics. So if this becomes a very widespread pandemic, we would likely see a lot of people getting antibiotics and further driving resistance. But the second point that is more important is that in that study I originally referenced, they looked at the people who died, and they found that 50% of those that had a secondary infection went on to die. So we don’t have the smoking gun yet that says that bacterial infections are killing people from coronavirus. But what we can say is it does tend to do this with other infections of the respiratory tract. We’re seeing people who have secondary infections die. So I think there’s a lot of smoke.
And we’re arguing that if we think about how many people could be getting “corona,” how many of those may be getting secondary infections? Let’s say just 5% or 10% — make it a low number. If you apply that to millions of people, a sizable amount of people may be actually getting resistant infections that we have no treatment for. So it’s going to compound the current response that we need to do precisely when we don’t really have the tools to do so. So I think that’s our link between what we think antibiotic resistance and the coronavirus pandemic is. I think it demonstrates a gap in our preparedness.
Washington Examiner: Which is what?
Frank: We need to do a better job with our stockpile and manufacturing distribution. We need to have vaccines available as quick as possible. We need to be developing treatments for disease. I think it’s demonstrating to us a gap that the mission for the U.S. government is to ensure people recover. And that includes actually making sure we have the armament of antimicrobials to do so. And frankly, we do not have that today.
Washington Examiner: So our mission is to do what exactly?
Frank: To ensure that everyone who is suffering from an outbreak or a pandemic fully recovers. So you know what we don’t want to happen, and this is something that we’ve seen. We don’t want to have a radiological attack or pandemic influenza outbreak where we saved people from the flu but then many of them may go on to die from secondary infections because they’ve been weakened. So that means we failed our mission. And I think that something we should bear in mind at this current outbreak is that we should also be considering what needs to be done to strengthen the antimicrobial pipeline. You know, I don’t think we can do anything to save us — or I should say help us — in this current pandemic. But I do think it’s something as we look forward and begin to plan we should be taking steps now to take action.
Washington Examiner: Any specific policies you suggest the federal government implement in the coming weeks?
Frank: The DISARM Act is a good first step. The bill would increase Medicare funding to hospitals that appropriately use innovative antibiotics. This would incentivize hospitals to use newer treatments safely, improving patient access to appropriate treatment and helping create a market for drug companies to fund antibiotic research and find new cures. This is only the part of the solution: To drive investment and create a robust, sustainable pipeline of medicines that stay ahead of resistance, we advocate policymakers consider implementing a market entry reward. This policy would reward the FDA approval of novel therapeutics that meet unmet medical needs of antimicrobial resistance, providing a certain return on investment for developers that is decoupled from volume of sales.
