With very few antibiotics in development at major pharmaceutical companies, the Pentagon is stepping in to support research to combat the growing threat of "superbugs" — bacteria that can't be stopped with current medications.
Speaking at the 2014 Military Health Research Symposium on Aug. 21, DoD infectious disease experts said the rise of drug-resistant bacteria and fungi pose a global threat that can't be ignored.
More than a third of U.S. service members injured in Iraq and Afghanistan developed a bacterial or fungal infection as potentially life-threatening as their wounds.
And about one in 10 recruits gets a skin infection — often caused by an antibiotic-resistant germ like methicillin-resistant Staphylococcus aureus, or MRSA — that can delay training or lead to separation, according to Pentagon data.
The threat to readiness and emerging issues worldwide with drug-resistant microbes are leading DoD to spend more than $40 million a year to support research and development of vaccines or medications to treat the germs.
The hope is that Pentagon-funded research will seed future work on antibiotics that can attack these superbugs.
Pipeline is bare
"There are no new antibiotics in the pipeline — none expected that have novel mechanisms of action," Army Col. Emil Lesho with the Walter Reed Army Institute of Research said during a telephone call with reporters.
Lesho said "Big Pharma" has no incentives to study and pursue this issue because it lacks the potential to create high profit margins.
One recent research initiative jump-started with Pentagon funding is a vaccine for the norovirus, the hard-to-kill germ that afflicts cruise ships and can send entire units running to the latrines.
The National Institutes of Health and DoD supported the vaccine's development by LygoCyte of Bozeman, Montana. The company later was bought by Japanese pharmaceutical giant Takeda, which plans to manufacture it.
"We try to take the risk out of this early research. We try to identify these technologies, new products ... and be able to provide some funding for investigators so they can flesh out whether it's going to be successful," said Army Col. Michael Kozar, director of the military infectious disease research program at the U.S. Army Medical Research and Materiel Command.
The White House is starting to pay close attention to the global threat posed by such microbes. The President's Council of Advisors on Science and Technology is set to publish a report that likely will create a task force on antibiotic resistance and call for germ genome sequencing as well as incentives for drug firms to invest in research.
Meanwhile, WRAIR has received funding to study experimental therapeutics such as small molecules that have potential to act as antibiotics and bacteriophages — viruses that kill bacteria.
"The jury is still out whether these can become viable treatments, but we are asking those questions and funding that type of research," Kozar said.
Battling fungal infections
The Pentagon also is taking a close look at anti-fungal treatments. In 2010, the rate of fungal infections in trauma cases among U.S. troops reached 3.5 percent.
Since severe fungal infections rarely occur in civilian settings, there's scant interest in developing treatments for them, Kozar said.
"But we were seeing them in some war fighters coming back from Afghanistan," Kozar said. "And if you look here in the U.S., you do have similar situations. One that comes to mind is the tornado in Joplin, Missouri — 80 percent of the folks who had infections had fungal infections."
Infections have been more prevalent among wounded troops in Iraq and Afghanistan because many have survived injuries that would have been fatal in previous conflicts. In addition, drug-resistant bacteria have taken hold in places where troops are treated and housed.
The Trauma and Infectious Disease Outcomes Study, underway at the Uniformed Services University of the Health Sciences, is following service members who were injured or sickened during the recent wars.
Its findings are expected to drive future drug research programs and treatments as well as prevention efforts, experts said.
"We're not doing this research for the previous war. We're trying go get ahead of what happens in the next conflict. ... What we're trying to do is be prepared, do the research, get the countermeasures," Kozar said.
He said developing a new antibiotic or vaccine takes eight to 12 years and between $500 million to $800 million.
"If it were easy to solve these problems, they would have been solved already," Kozar said. "The good news is it's getting a lot of attention. ... The role we are playing is to focus on things that have military relevance."