BAD BUGS, NO DRUGS 2002-2020: PROGRESS, CHALLENGES, AND CALL TO ACTION.

Antimicrobial resistance (AMR) requires a multifaceted response via a One Health approach. Antibiotics make procedures including joint replacement, transplantation, cancer chemotherapy, and premature newborn care possible. The U.S. Centers for Disease Control and Prevention (CDC) estimates that 2 million Americans are infected and >35,900 die from AMR, costing over $20 billion/year. Projections are that this will increase to 350 million cumulative AMR deaths by 2050. In its 2004 report entitled "Bad Bugs, No Drugs: As Antibiotic R&D Stagnates, A Public Health Crisis Brews," the Infectious Diseases Society of America (IDSA) raised alarm and proposed solutions. In the face of decreasing Food and Drug Administration (FDA) approvals and several program failures, scientific collaboration and regulatory innovation led to updated guidance for common, life-threatening infections. The IDSA and others worked to advance policies for discovery and development of drugs for the most resistant infections. Successes include legislation and public-private partnerships that provide push incentives. Need exists for pull incentives; several models are currently being explored.