Fungus-caused infections — real ones, not the ones sparking the zombie apocalypse on the popular show “The Last of Us” — pose a growing threat in the United States and around the world.
Mississippi has become the latest state to report residents infected with Candida auris, a highly contagious fungus that thrives in hospitals and nursing homes. It won’t be the last and, without dedicated effort, infections and deaths will continue to pile up.
The Mississippi Department of Public Health announced it has identified six people infected with C. auris. This pathogen can contaminate just about any surface imaginable, from intravenous lines and feeding tubes to bedsheets, doctors’ coats, and sinks. People who are elderly or immunocompromised are the most vulnerable to this pathogen, and it is often deadly: two of the six people infected in Mississippi have died.
Because the United States is ill-prepared to deal with this crisis, from both clinical and policy perspectives, the Mississippi scenario will continue to play out across the country in the coming months and years.
The rapid ascent of C. auris is unsettling. The fungus has carved a deadly path around the globe since Japanese researchers identified the first-known infection in 2009. The U.S. Centers for Disease Control and Prevention reported in 2016 that it had logged seven cases of C. auris across four states: New York, New Jersey, Maryland, and Illinois. By 2019, the pathogen had infected more than 700 people across 12 states, and the numbers continue to climb. In 2022, Louisiana, New Mexico, Tennessee, Wisconsin, Delaware, and Hawaii all confirmed their first C. auris cases, and nearly 5,000 people in the U.S. have now been infected with it.
C. auris can cause devastating infections that affect the blood, heart, and brain. It is often resistant to available treatments, and between 30% and 60% of people infected with it die. Once an infection is identified, it can upend an institution’s day-to-day operations, since it is a hardy pathogen that can survive on surfaces for prolonged periods and withstand common disinfectants. Stopping an outbreak and sterilizing facilities can be extremely costly and disruptive, preventing access to care for those who need it most. Last year, for example, a long-term care facility treating critically ill patients in Detroit had to stop admitting patients following a C. auris outbreak.
Public health experts have for years been warning that C. auris and other fungal infections are a growing threat. Numerous studies have detailed the ways in which climate change may aid and abet the spread of these pathogens as the world warms. C. auris is just one of dozens of fungal pathogens affecting humans, yet the U.S. — and the world — has continually failed to take action against this threat.
A quick assessment of the armamentarium of antifungal agents shows just how underprepared countries are. No new classes of antifungal drugs have become available during the last 20 years, according to a study in the journal Drugs, and only one new agent from a known antifungal class has been approved in the last decade. Investment in this area is sorely lacking: the World Health Organization reports that fungal infections receive less than 1.5% of all infectious disease research funding.
To draw attention to this crisis and help identify research and development gaps, the WHO recently identified 19 fungal pathogens that pose serious threats to human health and divided them into three priority categories: medium, high, and critical. C. auris is among the four deemed critical priorities. The WHO’s list is an important and welcome step forward, but the threat of C. auris needs to be recognized and dealt with by policymakers at the highest levels of government.
To mitigate the damage C. auris inflicts on Americans and the U.S. health care system, state and federal health officials need to strengthen their surveillance and reporting efforts. Academia and industry need to develop better diagnostics that can accurately distinguish C. auris from other candida species, some of which are less of a threat to health. And it is essential to get new antifungal agents through the drug development pipeline and to patients.
Progress will be halting until lawmakers get serious about the threat and enact essential policy solutions. In the U.S., the FORWARD Act would support much-needed research on endemic fungal diseases, including valley fever, cases of which have surged in the American southwest in recent years. There’s also the PASTEUR Act, a bipartisan piece of legislation designed to reward companies that successfully develop high-priority antimicrobials, including antifungals.
Congress came up short last year when it failed to vote on these bills. It’s likely that they will be reintroduced this year, but there are no guarantees they will move forward. What is guaranteed is that Mississippi won’t be the last state where people fall prey to the fast-emerging threat of C. auris and other fungal pathogens.
Henry Skinner is the CEO of the AMR Action Fund, the world’s largest public-private partnership investing in the development of new antimicrobial therapies.