Most of us assume that if we come down with a nasty throat infection, we will take a course of antibiotics and soon get better. Since the discovery of penicillin in 1928, bacteria-fighting drugs have cured many common ailments and consigned such terrors as deadly classroom measles infections to the past. However, evidence suggests that we may have grown dangerously complacent. Rising levels of antibiotic-resistant bacteria could thwart antibiotic wonder drugs and push over-strained health services to the brink.
As one of the featured case studies of the World Economic Forum’s Global Risks 2013 report, hubris can have a corrosive effect on human health. The data from the report, which analyses how 50 global risks will play out over the coming decade, puts antibiotic resistance within a web of connected threats that include a vulnerability to pandemics, failure of the international intellectual property regime and rising rates of chronic disease. Cushioned by the remarkable achievements of modern medicine, we often fail to appreciate how fragile our healthcare system can be, and the knock-on threat these risks in conjunction could pose to connected social and economic systems.
It might be hard for those of us with access to good healthcare to imagine, but a world without antibiotics is one in which, as Margaret Chan, Director-General of the World Health Organization, put it, “Things as common as strep throat or a child’s scratched knee could once kill again.” Routine surgery would become life-threatening because of the risk of untreatable infections, care for premature babies and certain cancer patients would falter, organ transplants would be unviable.
Alarming as all this sounds, it should not come as a surprise. When antibiotics enter the body, bacteria will inevitably mutate to become more resistant: the ones that survive the treatment to reproduce are the strongest. The more antibiotics are overused, the more the population of resistant bacteria swells – and antibiotics are overused in a number of ways. Patients demand inappropriate quick fixes in the false belief that antibiotics can cure viruses like the common cold; doctors are sometimes given financial incentives to prescribe them; and in some countries, antibiotics find their way into food and water after being used as growth promoters for livestock.
Until now, leaders have been able to turn a blind eye to this problem, as new antibiotics have always emerged to replace older, increasingly ineffective ones. This is changing; since 1987, we have fallen into a discovery void of any new antibiotics. Although several new drugs for fighting bacteria are in development, experts caution that we are decades behind in comparison with the historical rate at which we have discovered and developed new antibiotics. More worryingly, none of the drugs in the pipeline would be effective against certain killer bacteria.
There are a number of factors behind this paucity of innovation. To start with, it is simply very tough on a scientific level to discover a new kind of antibiotic. What’s more, pharmaceutical companies tend to prefer investing in new drugs to treat chronic illnesses like diabetes, because patients take them for a long time, making them much more lucrative than antibiotics. In addition, smaller companies struggle to clear the regulatory hurdles involved in meeting the expensive requirements for clinical trials.
The Global Risks report survey data showed a connection between antibiotic-resistant bacteria and the failure of the intellectual property system which helps to govern drug development, “as an effective mechanism for stimulating innovation and investment”. This link points to a broader market failure to provide the right kind of investment and incentives to create much-needed new antibiotics.
Antibiotic resistance already kills around 100,000 Americans, 80,000 Chinese and 25,000 Europeans a year, according to figures from the past four years, which are likely to be an underestimate. In the 10-year time period covered by the Global Risks report, it is far from unrealistic to project a significant spread of antibiotic-resistant bacteria with high mortality rates.
On top of destabilizing health systems, there are profound cost implications for economic and social systems. The annual cost to the US healthcare system of antibiotic-resistant infections is already estimated at between US$ 21 billion and US$ 34 billion. Elsewhere, losses to GDP have already been estimated at 0.4% to 1.6%. The consequences of a pandemic spread of antibiotic-resistant bacteria could also include shortages of food due to untreatable infections in livestock and, as leaders seek to slow the spread of pathogens, restrictions on trade in foodstuffs and even on travel and migration.
There are measures we can take to stop this grim scenario playing out – as long as we can shake off our hubris and implement them. To start with, the misuse of existing antibiotics must be curtailed. Licensing and regulatory barriers should not be stumbling blocks to life-saving discoveries. Furthermore, to encourage the development of new drugs, we need to rethink the way global markets and governance work in this area and encourage international collaboration. Incentives need to be in place that reflect the public interest and make it in pharma companies’ interests to invest in the appropriate research and development, with smaller companies nurtured to create new opportunities.
This process needs a swift shot in the arm if we are to make sure that some of the dazzling gains of modern medicine are not squandered by our own complacency, and that deadly throat infections remain largely a memory of the past.
This article was also published on CNN.
See also: Otto Cars – What if we lost the use of antibiotics?
Image: REUTERS/Eric Gaillard