The CRE Threat, Healthcare System Challenges, and the Urgent Call for Policy Reform
Antibiotic resistance is fast emerging as a public health emergency in Taiwan, with top infectious disease experts warning that the country is running out of effective drugs to treat severe infections. The crisis, they say, is compounded by global pharmaceutical disinterest in Taiwan’s market due to suppressed pricing policies, and by local pharmaceutical firms lacking capacity for new antibiotic development.
During a press conference held on Saturday in Taipei, Dr. Wang Fu-der (王復德), president of the Infection Control Society of Taiwan, and Dr. Chang Feng-yee (張峰義), head of the Infectious Diseases Society of Taiwan, painted a concerning picture of Taiwan’s antibiotic future — particularly with the rise of carbapenem-resistant enterobacteriaceae (CRE), a group of multidrug-resistant bacteria posing a growing risk in hospitals.
CRE and the Alarming Numbers in Taiwan
CRE, which renders one of the most powerful classes of antibiotics (carbapenems) ineffective, has been included in the World Health Organization’s (WHO) Bacterial Pathogen Priority List for global threat monitoring. In Taiwan, CRE prevalence has more than doubled over the past decade in intensive care units (ICUs), according to Taiwan’s Centers for Disease Control (CDC).
- In 2015, about 15% of ICU patients in Taiwan’s medical centers were infected with CRE.
- By Q3 of 2024, that figure had surged to 30.3%, indicating a critical rise in hard-to-treat infections.
This doubling is more than just a statistical trend; it highlights the systemic vulnerability of Taiwan’s healthcare infrastructure, especially during post-surgical recovery or ventilator use in ICU settings, where patients are most susceptible to opportunistic bacterial infections.
The Economic and Human Cost of Resistance
Wang cited international projections that by 2050, antibiotic resistance could lead to 33,000 deaths annually in Taiwan alone, along with economic losses exceeding NT$300 billion (US$10 billion). These projections mirror global studies from the World Bank and the United Nations that predict antimicrobial resistance (AMR) could cost the global economy US$100 trillion by mid-century if unaddressed.
Despite this, Taiwan’s pharmaceutical landscape lacks incentives to develop or import the advanced antibiotics necessary to combat CRE and similar bacteria.
Why Taiwan Lags Behind in Advanced Antibiotics
Dr. Chang explained that while newer antibiotics have been introduced in the West, Taiwan is falling behind because:
- Local drug manufacturers focus on generic medications, lacking the R&D capacity to develop next-gen antibiotics.
- Taiwan’s National Health Insurance (NHI) pricing policies force pharmaceutical companies to offer drugs at low prices, discouraging them from introducing new, costly antibiotics into the market.
- Taiwan’s small market size means global firms often prioritize China and larger economies where higher profit margins are possible.
International pharmaceutical companies are wary of Taiwan because offering a lower price here could set a global precedent, putting pressure on them in larger markets that use Taiwan’s pricing as a benchmark.
The Clinical Crisis in Hospitals
Multidrug-resistant bacteria — including methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) producing strains, and CRE — are already creating treatment dilemmas. The limited number of remaining antibiotics means:
- Doctors are forced to rely on outdated or less effective treatments.
- Patients must wait longer for correct treatment, increasing mortality rates.
- Hospitals see longer stays, higher costs, and a greater risk of outbreaks among vulnerable patients.
Dr. Chang emphasized that “delayed treatment beyond 72 hours” for resistant infections significantly raises mortality, highlighting the need for rapid diagnostics and a wider arsenal of antibiotics.
What Can Be Done? Policy Recommendations
Both experts urged a multi-pronged approach:
- Government subsidies or funding to support original antibiotic development by local firms.
- Flexible drug pricing policies under the NHI that don’t discourage foreign pharma investment.
- Establishing public-private partnerships (PPPs) to fast-track antibiotic approvals.
- Encouraging the use of antimicrobial stewardship programs (ASPs) in all major hospitals.
- Investment in national surveillance and diagnostic labs to rapidly detect resistance trends.
If Taiwan cannot incentivize both innovation and global engagement, the nation may soon find itself without viable options for routine infections, potentially reversing decades of medical progress.
🔍 FAQs
What is CRE and why is it dangerous?
CRE (carbapenem-resistant enterobacteriaceae) is a type of bacteria that has evolved to resist carbapenem antibiotics, often considered last-resort drugs. It’s highly prevalent in ICUs and extremely difficult to treat.
Why are foreign pharmaceutical companies avoiding Taiwan?
Because of low NHI-regulated drug prices and Taiwan’s small market size, many pharma companies don’t see it as financially viable to introduce costly new antibiotics.
How can Taiwan solve the antibiotic resistance issue?
By adjusting its drug pricing structure, investing in local R&D, and building incentives for global pharmaceutical companies to introduce their latest medications to Taiwan.
What role does the NHI system play in this problem?
While NHI ensures low-cost healthcare for citizens, its aggressive pricing strategies discourage pharmaceutical innovation and limit access to newer drugs.
Are there any global parallels to Taiwan’s situation?
Yes. Several mid-sized markets globally face similar challenges — balancing public healthcare affordability with the need to encourage pharma innovation and investment.
