Merck’s Dr. Julie Gerberding on the threat of antimicrobial resistance and COVID-19

As America’s biopharmaceutical companies work around the clock to combat COVID-19, a disease caused by a novel strain of coronavirus, now is an important time to consider how we can prepare for the next public health emergency: Antimicrobial resistance (AMR). AMR occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that make the medications used to cure the infections they cause ineffective. According to the Centers for Disease Control and Prevention (CDC), more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. A key facet to fighting AMR is to ensure prescriber education to support appropriate prescribing of antibiotics.

We recently spoke with Dr. Julie Gerberding, executive vice president and chief patient officer at Merck, about AMR and the biopharmaceutical industry’s efforts to combat the COVID-19 pandemic. Prior to joining Merck, Dr. Gerberding served as director for the CDC where she led the response for public health emergencies and disease outbreaks. The following interview has been edited and condensed for clarity and length.

How has past experience combatting SARS, MERS and other infectious diseases informed the biopharmaceutical industry’s work to combat the novel coronavirus today?

From a scientific perspective, there are many lessons learned from past experience with SARS, avian influenza, Zika, Ebola and the 2009 influenza pandemic.

1. Fast detection and transparency about reporting is critical. We have been able to do better recognizing the initial outbreak of COVID-19 in China and being transparent about reporting, which is good news. But detection is still a focus for improvement, not just in the United States but in many countries around the world.
   
   
2. Efforts to contain the virus at its source are worth trying, but you can’t count on them to work. China made efforts to contain the virus, but eventually it spilled over and was transmitted to the rest of the world. There’s a tendency to hope that we can still contain COVID-19 at the local level, but this is an extremely transmissible virus, and those efforts are not likely to be successful in the short run.
   
   
3. Trustworthy communication is incredibly important. We need people to believe in their federal, state and local leaders and their own doctors, because the kind of advice we are offering is difficult to understand and very challenging to implement. We have to rely on the goodwill and compliance of the community to help us slow down the spread, and that is very challenging to accomplish.

A major difference between SARS and COVID-19 is that our science has advanced so much further that we can do things today in the biopharmaceutical industry that we couldn’t have dreamt of in 2003. This includes the platforms that are being developed to more rapidly produce effective vaccines, clinical trials to effectively prove value and manufacturing innovations that we can introduce into this emergency situation. 

What is antimicrobial resistance and why we should be concerned about it with COVID-19?

The patients who are the most ill with the novel coronavirus are often on ventilators and in critical care units at the hospital for relatively prolonged periods of time. They are at risk for acquiring pneumonia and developing bloodstream infections, because they have many intravenous lines and other interventions that increase the risk for infections. This is also the environment where multi drug-resistant infections caused by bacteria, or so called “superbugs,” emerge and are spread, so we need to be prepared for the emergence of drug resistant infections complicating coronavirus pneumonia.  

We should have antibiotics that are available in every hospital setting to combat these superbugs, but unfortunately Mother Nature has been faster at creating new superbugs than we as a scientific community have been at creating new antibiotics to combat them. So, there’s a gap between the bugs and the medicines.

It is widely believed there has been a market failure in the development of new antibiotics. Why is it important to fix this issue?

I’m afraid that in the coronavirus situation, we are at risk not because of the virus per se, but because we don’t have the right treatment for patients’ complicating infections. We need to make sure our hospitals at least have the best available innovative medicines, and right now in America, there’s a challenge in that. The newer “super-antibiotics” are more expensive than most generic antibiotics and it’s very difficult for hospitals to pay for them, given our current reimbursement system that pays hospitals a bundled amount for inpatient services.

Many manufacturers have given up and have stopped working on innovative antibiotics because they cannot earn back the investment that is required to get these products developed. That’s why we see some small biotechnology companies focused on antibiotics going bankrupt. Merck is still trying to develop new antibiotics because we have always viewed this a core part of our mission since the beginning of our company, but at the broader industry level it is hard for some to make an investment with no guarantee that they will ever recover what they have to spend to develop these antibiotics. The irony is that there is no volume to offset the investment, because these innovative antibiotics should not be used unless we absolutely have to, so the market has to be corrected another way. 

Is there anything else you think we should know about the relation between COVID-19 and AMR?

While we cannot predict when the next pandemic will occur or what will cause it, we can predict that infectious diseases and their treatment are usually complicated by secondary bacterial infections among sick people at hospitals. We need to be prepared in the future to have antibacterial medicines available, as it is just as important as having available vaccines and countermeasures for the pandemic pathogen.

To learn more about PhRMA member company efforts to combat COVID-19, visit PhRMA.org/Coronavirus