Antibiotic resistance: a matter of time

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It’s 1928 and a Petri dish left next to an open window is about to revolutionise modern medicine. Scottish scientist Alexander Fleming finds that something in the mould growing in the dish is killing off bacteria. It’s penicillin, the first antibiotic. This wonder drug, and other antibiotics, will go on to treat the untreatable, saving millions of lives.

It’s 2050. The cupboard is bare. Antibiotics were our precious resource. We needed to use them. Of course we did. But we weren’t prudent. Because each time we used them, misused them, and overused them, we gave the bacteria a chance to evolve, to become resistant. And without global leadership scientists have been unable to bring new antibiotics to market. Now, even cuts have fatal consequences.

Has the clock really been ticking towards a post-antibiotic future, where drug-resistant infections kill 10m people a year? Where chemotherapy is unsafe? Where simple surgeries are too risky to perform? Where the world’s biggest child-killer, pneumonia, is now unstoppable? Is this just a projection?

2020. Climate change is headline news. Forests burn. Scientists predict rising sea levels. There is a sense that time for action is running out. And then comes Covid. It’s a fast-moving pandemic. A million dead and counting. But the world mobilises with urgency. Individuals, doctors, scientists, yes, governments and policymakers, too. The unthinkable becomes the norm. Cities, countries under lockdown. Economies radically reshaped. Vaccines developed in record time.

And against this backdrop, a chance to change the narrative on that other looming global catastrophe, the one we already know about – antibiotic resistance. Because everyone sees now, we can mobilise. We can take individual and collective responsibility, and we must be prepared.

It’s 1945. The Allied victory. That was a collective effort, too. During World War Two penicillin has been mass produced, used to treat soldiers’ septic wounds. Hailed as a victory of science over death. But as he collects his Nobel Prize, Fleming is already issuing a warning. Misusing antibiotics can hasten the evolution of drug-resistant bacteria and render them useless for future generations.

Here’s how it works with E coli in a giant Petri dish. The E coli bacteria hits a line of antibiotic and pause, until a random mutation enables the bacteria to overcome the drug. At each line, the antibiotic is 10 times more concentrated, but there are also more mutations. It’s evolution by natural selection, only very, very fast.

We live in a Petri dish, too. The bacteria are a part of our ecosystem – around us, within us. Trillions upon trillions, helpful as well as harmful. And resistance is natural, to be expected. But by increased misuse we only encouraged the mutations. We overprescribed. Of course we did. Medicine is not an exact science. Diagnosis is difficult, and people expect to be cured. In some parts of the world antibiotics don’t even need a prescription at all. They’re over the counter or at the back of the drawer. But against viral coughs, colds, and sore throats, they’re useless – worse than useless. We give them to our farm animals, too. We want to prevent infection. We want to plump our food. We want cheap meat.

It’s the 1980s. This is the start of the discovery void. For more than 30 years no new classes of antibiotics will be launched. Why? Follow the money, and it runs out. Big Pharma has no incentive to invest in the development of antibiotics. There’s no profit. It’s expensive, time consuming, and complex, and single use. While antidepressants and heart drugs – they make money on repeat Meanwhile, controls designed to limit the inappropriate use of antibiotics also limit financial incentives for making them.

It’s 2020, the here and now, and we have some of the answers. Preventing infections with better hygiene and vaccines. We can repackage existing antibiotics to make them resistance-proof. Or use phage therapy to attack the bacteria with viruses. And in the future AI could lead to more accurate diagnoses. Surely new antibiotics must be part of the answer, too. Funding agreements can give the bigger companies the financial incentive. Partnerships can give smaller companies access to resources. And what about de-linking volume from profit? Concentrating not on the number of pills but their value. Paying companies not for how much antibiotic they provide, but its potential worth to the health system. Something like a subscription. Something like insurance.

The building is catching fire. The edifice is crumbling. The cupboard is running bare. Already, antibiotic resistance is killing 700,000 people a year. In some ways Covid has made the problem worse. Fears about secondary infections mean large quantities of antibiotics have been prescribed to patients. But Covid could help make things better, too. If it motivates us, if the world mobilises – individuals, doctors, scientists, yes, governments and policy makers, too. The solutions are scientific, but they’re also economic, and they’re societal. It’s a collective effort.

It’s not a projection. It’s not a sort of an imaginary projection that it’s going to get worse. We know that’s going to happen. And because we know that it’s going to happen, we actually also know how we can slow it down. You realise that actually all those things that you prepare for – it’s so that you’ve got it there when you need it. Everyone has their part to play. The point is we do have the opportunity to do something about it.

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