Americans combat more than 2.8 million antibiotic-resistant infections each year—a battle Gunnar Esiason, son of former NFL quarterback “Boomer” Esiason, knows all too well. Esiason lives with cystic fibrosis, a life-threatening genetic disease that affects the lungs and cells that produce mucus, puts him at an increased risk for bacterial infections, and makes him especially vulnerable to antibiotic-resistant bacteria. “I very much attribute my survival thus far to antibiotics,” he says.
Esiason is the director of patient outreach at the Boomer Esiason Foundation, a nonprofit cystic fibrosis organization, and is pursuing graduate studies at Dartmouth. In this talk with Pew, he discusses what keeps him motivated in the fight against antibiotic resistance and why the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act is so important. This interview has been edited for length and clarity.
I am living with cystic fibrosis, and many of us with the condition rely on antibiotics every day. In the CF world, antibiotic resistance is commonplace. It is one of the leading complications that contribute to patient death. In a way, people living with CF are at the tip of the spear when it comes to the antibiotic-resistance crisis. Our very existence is like a microcosm of the larger drug resistance problem. I consider antibiotic resistance to be one of the greatest threats facing humanity.
I have been living with a chronic Pseudomonas aeruginosa infection in my lungs since I was a child. Multidrug-resistant Pseudomonas aeruginosa is a Gram-negative bacteria and considered a serious threat by the CDC. I first discussed antibiotic resistance with my doctor when I was in my early 20s. At the time I was dealing with recurrent pulmonary exacerbations, or periods where my symptoms became noticeably more severe, stemming from my increasingly stubborn Pseudomonas infection. First- and second-line antibiotics that I had used for years, both inhaled and intravenous, started to fail me. Between 2013 and 2018, when things were at their worst, I underwent nearly two dozen procedures while spending a cumulative year on intravenous antibiotics to control the infection and prevent my body from slipping into end-stage illness. Beyond my own experience, one of my best friends living with cystic fibrosis passed away in December 2018 when “the antibiotics stopped working.”
Living with chronic illness has value. We are the end users in the health care industry, and our experiences should be driving policy and innovation decisions. To be blunt, living with a chronic multidrug resistant infection isn’t exactly fun. Sporadic fevers, aches, deep coughs, occasionally coughing up blood, and the lingering fear of losing another antibiotic option are all constants in my life. Infection, more than anything, contributes to my declining lung function. Our voices are powerful because we live this crisis every single day. It’s up to us to speak up about antimicrobial resistance because I think people don’t want to believe it’s a real problem.
We are primarily concerned with developing new options, and our organization, the Boomer Esiason Foundation, provides grants to researchers. Within the context of CF, I encourage patients to provide sputum cultures whenever researchers come calling or if universities are building culture libraries. Finally, we also strive to minimize patient-to-patient contact in cystic fibrosis and strengthen medical center infection control to reduce the risk of hospital-acquired infection or infections spread between those living with cystic fibrosis.
The pipeline for new antimicrobial options has largely stagnated because the economic incentive to create new options is waning. How can we convince industry to take up new antibacterial projects while we are telling consumers to limit antibiotic use until absolutely necessary? Antibiotic stewardship is simultaneously proving to be one of our best allies in the fight against antibiotic resistance, but also a significant barrier to future options. We are seeing really amazing technologies get stuck in academia without moving into the biopharmaceutical world. Industry is the catalyst necessary to mass produce effective treatments for patients. Within the context of CF, for example, researchers at Yale University are working on a bacteriophage project that has successfully treated a handful of people with cystic fibrosis that are living with multidrug resistant infections but has yet to reach full-scale multisite clinical trials because of limited external support. Our government needs to help incentivize innovation, encourage clinical trials, ensure expedited regulatory reviews, and then foster a sustainable business model. If new antibiotic manufacturers continue to go bust, then we’re right back to square one. Passage of the DISARM Act could be a very valuable first step to paving the way to stabilizing the antibiotic market.
Within CF, antibiotic-resistant infections are a critical problem that do not garner enough attention. We’ve had some amazing drug breakthroughs in CF, but they will all be for naught if we cannot control the infectious disease side of CF. I fear future medical breakthroughs across the board could be undermined if antibiotic resistance continues to run out of control. I think people can learn a lot from the cystic fibrosis community, notably the success we’ve had in drug development, but also what a post-antibiotic era would look like. The latter especially, because as many of us grow older with CF and troublesome respiratory infections, that’s exactly what we live in—a post-antibiotic era.