| In the hit HBO series The Last of Us, a fungal pandemic devastates the world. A type of Cordyceps mushroom mutates to infect humans, turning them into zombie-like creatures. The scenario is unlikely to play out in real life for now. But the choice of fungus as a trigger does underscore a very real threat: The quiet rise of fungal infections and growing resistance to their treatments. Chances are, you’ve crossed paths with some form of fungal disease already. Common infections include oral and vaginal thrush, ringworm or athlete’s foot. Not really something you want to discuss with friends or colleagues over lunch, yet the medical community is starting to sound the alarm. The World Health Organization published its first report addressing the lack of medicines and diagnostics for invasive fungal diseases earlier this year, warning that these conditions are growing increasingly resistant to existing medicines. The agency cited Candida auris, a yeast first identified in 2009 that spreads in health-care facilities, and Cryptococcus neoformans, which can cause lung and brain infections through inhalation, as some of the organisms that pose the greatest threat. Fungi shouldn’t be underestimated. Resistant infections can be deadly, particularly for those with a weakened immune system, and climate change appears to make things worse. Research out of China last year shows that higher temperatures could help fungi to become resistant to drugs. Others argue these changing conditions allow for new pathogens to emerge and spread to new places. The big problem? The pharma industry hasn’t caught on, and the medicine cabinet is pretty bare when it comes to new antifungals. Only four have been approved by major regulators in the past decade, not nearly enough to ensure enough effective treatments, according to the WHO. And there are only three drug candidates in advanced clinical trials. The data on investments into new antifungals shows it has come in fits and starts. Commitments hit a high of almost $383 million in 2022, but they have ebbed since. This year has seen zero funding so far, according to data collated by financial research platform PitchBook for Bloomberg.
PitchBook's data also reveal how just a handful of firms like Pulmocide and F2G have dominated the investment in this space. The lack of broader interest is due to many factors, including the scientific challenge of finding new targets and the financial concern of insufficient return on investment. Sofinnova Partners, the venture-capital firm that backs F2G, says antifungals are one of the areas of highest need. “We need to have success stories in this field to bring back the interest,” says Kinam Hong, a physician and partner at the firm. Hopefully that happens soon, so the doomsday scenario remains the stuff of fiction. —Ashleigh Furlong | 
