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The writer is president of Resolve to Save Lives and a former US Centers for Disease Control and Prevention director. He is the author of ‘The Formula for Better Health: How to Save Millions of Lives — Including Your Own’ (2025)
We are losing the defences that protect us from microbes — our biological and institutional immune systems.
The biological loss is easy to see: microbes that once yielded to antibiotics now kill more than 1mn people a year. The institutional loss is more insidious: under-investment has weakened health departments. Recent wholesale destruction — closing programmes at the Centers for Disease Control and Prevention in the US, forcing out experienced leaders and staff, undermining vaccine guidance — has gutted systems needed to track resistant infections and stop outbreaks.
Drug resistance, resulting from overuse in clinical medicine and in agriculture, threatens to turn routine surgery into a high-risk procedure and to make transplant, chemotherapy and immunosuppressive therapies riskier.
Today we can see these threats more clearly. Genomic epidemiology reveals many distinct chains of transmission. We can track resistance in real time, spot new mutations and identify where infections spread. Artificial intelligence promises to accelerate drug discovery and improve disease tracking. But seeing microbes and patterns is not enough. We must also see why we often fail to act in our own best interest.
Short-term thinking blinds public and private sectors. Health systems are paid to provide services, not to protect and improve health. Companies have few incentives to create effective antibiotics: if their drug works well, it sells less. Hospitals under financial pressure neglect infection control. Agricultural producers overuse antibiotics because prevention seems costly. This is not inevitable; it results from a series of policy choices.
We have overcome similar crises before. In the 1990s, the US contained outbreaks of multi-drug resistant tuberculosis by combining better infection control in healthcare facilities with treatment, monitoring and accountability. Hospitals reduced infections resistant to carbapenems (antibiotics to treat serious bacterial infections) with rigorous protocols.
Optimism that we can reverse drug resistance is evidence-based. Progress is possible when we measure results, learn from failures and stay the course. The problem is not scientific complexity; it is political and economic barriers.
To make progress, we need new antibiotics, better infection prevention and control, improved antibiotic stewardship programmes and vaccines that prevent infections before they start. We must simplify what works and align financial incentives. Infection prevention succeeds only when the basics — clean facilities, reliable supplies, simple protocols — work everywhere. That requires steady funding, not crisis surges.
Antibiotic stewardship programmes need clear protocols and the authority to enforce them. New antibiotics need financing that rewards effectiveness, not volume. And vaccines need development and delivery systems that reach everyone who needs them.
Tom Frieden: ‘The same failures that have lowered our microbial defences drive epidemics of heart disease, drug deaths and illness from toxic exposures’ © Daphne Youree
One incentive shift would be to change the payment model for new antibiotics. When a new antibiotic that works against resistant infections costs 10 times more than an older, failing drug, insurers and patients choose the cheaper option, until it stops working. Netflix-like subscription models that pay fixed fees for unlimited access rather than volume can break this cycle. The UK and Sweden have tested this. It can work if government commits to long-term contracts. For fairness, development costs borne by governments should be factored into the price, or the public will pay twice.
Healthcare financing that rewards healthier outcomes — fewer hospitalisations, less disability — and punishes systems that do not prevent illness when they could have, can also improve incentives by aligning profit with public benefit and personal health. But incentives alone will not work; regulation is essential. The question is not whether to regulate, but how to regulate well. Three principles matter most.
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First, make the rules clear and simple. Second, enforce them consistently. Companies and hospitals that cut corners on infection control or antibiotic stewardship can undercut competitors that do the right thing. Fair enforcement creates a level playing field, with predictable, consistent rules and implementation, and no exceptions for any institution, individual or group.
Third, promote transparency. When companies hide safety data or governments conceal outbreak information, public confidence collapses. Open reporting of hospital infection rates, antibiotic prescribing patterns, and drug costs and pricing creates accountability. It also arms the public with information it can use. Transparency does not just prevent abuse, it enables the informed decisions that markets require.
Fair regulation protects companies and hospitals that act responsibly. It also protects their reputations and sustains their markets. When regulation fails, patients pay through lost lives, companies through backlash and societies through distrust.
The way to stop the superbug crisis illustrates a broader approach — a see/believe/create formula for health progress: see hidden threats clearly, believe that improvement is possible and create systems that work.
Countries that invest in tracking infections and resistance, prevention and stewardship not only save lives, but also strengthen their economies.”
The same failures that have lowered our microbial defences drive epidemics of heart disease, drug deaths and illness from toxic exposures. And the same approach — strengthen tracking, build confidence by making phased progress and overcome barriers to create a healthier system and society — can save even more lives, and increase productivity, by addressing the causes of these conditions.
The world is losing immunity to superbugs, but we can rebuild it. If we align economic incentives with public good, regulate transparently and invest in prevention, we can stop this epidemic. The microbes evolve relentlessly and outnumber us. We must create the systems to outsmart them.
