How can we solve the antibiotic resistance crisis Gerry Wright
Antibiotics: behind the scenes,
they enable much of modern medicine.
We use them to cure infectious diseases,
but also to safely facilitate everything
from surgery to chemotherapy
to organ transplants.
Without antibiotics,
even routine medical procedures
can lead to life-threatening infections.
And we’re at risk of losing them.
Antibiotics are chemicals
that prevent the growth of bacteria.
Unfortunately, some bacteria
have become resistant
to all currently available antibiotics.
At the same time,
we’ve stopped discovering new ones.
Still, there’s hope that we can get ahead
of the problem.
But first, how did we
get into this situation?
The first widely used antibiotic
was penicillin,
discovered in 1928 by Alexander Fleming.
In his 1945 Nobel Prize
acceptance speech,
Fleming warned that bacterial resistance
had the potential to ruin
the miracle of antibiotics.
He was right: in the 1940s and 50s,
resistant bacteria
already began to appear.
From then until the 1980s,
pharmaceutical companies
countered the problem of resistance
by discovering many new antibiotics.
At first this was a highly successful—
and highly profitable— enterprise.
Over time, a couple things changed.
Newly discovered antibiotics
were often only effective
for a narrow spectrum of infections,
whereas the first ones
had been broadly applicable.
This isn’t a problem in itself,
but it does mean that fewer doses
of these drugs could be sold—
making them less profitable.
In the early days,
antibiotics were heavily overprescribed,
including for viral infections
they had no effect on.
Scrutiny around prescriptions increased,
which is good, but also lowered sales.
At the same time,
companies began to develop more drugs
that are taken over a patient’s lifetime,
like blood pressure
and cholesterol medications,
and later anti-depressants
and anti-anxiety medications.
Because they are taken indefinitely,
these drugs more profitable.
By the mid-1980s, no new chemical classes
of antibiotics were discovered.
But bacteria continued to acquire
resistance and pass it along
by sharing genetic information
between individual bacteria
and even across species.
Now bacteria that are resistant
to many antibiotics are common,
and increasingly some strains
are resistant to all our current drugs.
So, what can we do about this?
We need to control the use
of existing antibiotics, create new ones,
combat resistance to new
and existing drugs,
and find new ways to fight
bacterial infections.
The largest consumer
of antibiotics is agriculture,
which uses antibiotics not only
to treat infections
but to promote the growth of food animals.
Using large volumes of antibiotics
increases the bacteria’s exposure
to the antibiotics
and therefore their opportunity
to develop resistance.
Many bacteria that are common in animals,
like salmonella, can also infect humans,
and drug-resistant versions can pass
to us through the food chain
and spread through international trade
and travel networks.
In terms of finding new antibiotics,
nature offers the most promising
new compounds.
Organisms like other microbes and fungi
have evolved over millions of years
to live in competitive environments—
meaning they often contain
antibiotic compounds
to give them a survival advantage
over certain bacteria.
We can also package antibiotics
with molecules that inhibit resistance.
One way bacteria develop resistance
is through proteins of their own
that degrade the drug.
By packaging the antibiotic with molecules
that block the degraders,
the antibiotic can do its job.
Phages, viruses that attack bacteria
but don’t affect humans,
are one promising new avenue
to combat bacterial infections.
Developing vaccines for common infections,
meanwhile,
can help prevent disease
in the first place.
The biggest challenge to all
these approaches is funding,
which is woefully inadequate
across the globe.
Antibiotics are so unprofitable
that many large pharmaceutical companies
have stopped trying to develop them.
Meanwhile, smaller companies
that successfully bring new antibiotics
to market often still go bankrupt,
like the American start up Achaogen.
New therapeutic techniques
like phages and vaccines
face the same fundamental problem
as traditional antibiotics:
if they’re working well,
they’re used just once,
which makes it difficult to make money.
And to successfully counteract resistance
in the long term,
we’ll need to use
new antibiotics sparingly—
lowering the profits
for their creators even further.
One possible solution is to shift profits
away from the volume of antibiotics sold.
For example, the United Kingdom
is testing a model
where healthcare providers
purchase antibiotic subscriptions.
While governments are looking for ways
to incentivize antibiotic development,
these programs are still
in the early stages.
Countries around the world
will need to do much more—
but with enough investment
in antibiotic development
and controlled use of our current drugs,
we can still get ahead of resistance.