Climate change is playing an outsized role in the emergence and reemergence of fungal infections, most visibly with Candida auris and valley fever. This deeply concerning reality has come at a time when there is a critical lack of new antifungal medicines, developing into a major public health threat. Yet over the last ten years, just four new antifungal drugs were approved in the United States, Europe and China combined. Nine additional drugs are in various stages of development. Of those, only three have made it through the experimental period in humans.
Global industry leaders point out that the window for creating successful new antifungal therapies is closing fast. John Rex, chief medical officer of F2G Ltd., noted that significant progress in antifungal research should have begun decades ago. As refuges from violence and emerging climates markedly change their surroundings, the consequences to public health will be catastrophic.
The Rising Threat of Valley Fever
Valley fever is caused by inhaling the Coccidioides fungi. It infects 10,000 – 20,000 people annually in the United States, with the states of Arizona and California most heavily impacted. The disease is especially worrisome since it causes an average of 200 deaths annually. In Arizona alone, this doubling trend was evident, with dramatically escalating infections from 11,000 cases in 2023 to 14,770 cases in 2024.
There’s a public health crisis underfoot, as California is experiencing its largest and most dangerous outbreak of valley fever. They’ve increased from 9,200 in 2023 to 12,637 in 2024. As of March 31, more than 3,100 people had already been diagnosed with valley fever in California’s current reporting year.
The people most at risk are folks like construction workers and landscapers. This is largely because they often interact with the outdoor environment in settings with elevated spore exposure. Edward Robb called attention to a very cool detail. Area residents of the American Southwest may gain lifelong immunity to valley fever after repeated exposure.
“The individuals that are most susceptible would be people who have high exposure to spores, which could be somebody working in landscaping or construction, somebody going camping,” – Edward Robb
Development Challenges for Antifungal Treatments
As the need for novel antifungal medicines gets more urgent, the trend continues on at a glacial pace. Only four new antifungal drugs have been approved in the last decade. At present, only nine others are in advanced development, and only three of those have gotten as far as late-stage clinical trials. Broadly speaking, as Rex himself pointed out the other day on Pharmalot, “If you are waiting for a new antifungal, you should have started 25 years ago.”
This void of approved treatments is dangerous, there are currently no licensed therapies for some fungal infections. This critical shortage lays bare a key lack in medical research and public health preparedness.
“There are fungal infections you can get for which we have no current licensed therapy whatsoever.” – John Rex
F2G Ltd., a biotech company based in the U.K., is taking this gap on directly. Today, they’re working on a new antifungal drug, olorofim, which is currently in the final stages of clinical trials. Experts warn that very few new antifungal drugs will be approved over the next ten years.
Innovative Approaches to Fungal Infections
Alongside the conventional pharmaceutical pipeline, new avenues are being pursued to fight fungus. Anivive, a sustainable pet pharmaceutical company based in California, is developing vaccines to protect against valley fever and blastomycosis. Their vaccine is based on a live fungus. This fungus has been genetically engineered so that it can no longer change form and infect humans or animals.
The valley fever vaccine that’s currently being tested on dogs is making progress during early studies. Most promisingly, researchers are investigating its potential use in humans. This cross-species, preventive, and translational approach has the potential to provide a new way of addressing the growing threat posed by fungal infections.
While researchers are still working to better understand these strategies, they are already being hampered by the effects of climate change. Further, conditions are making it increasingly ideal for fungi to thrive. Consequently, public health experts have cautioned that we should expect a resurgence in infections.
“The only preventative is not to breathe, and so far that hasn’t worked out so well.” – Edward Robb
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