In July 2014 the UK Government commissioned a comprehensive review of the antimicrobial resistance (AMR) crisis facing public health bodies throughout the world.
Simply put, antibiotics are failing and will no longer be able to protect us from infections within the next two or three decades.
This would mean a return to the medicine of the Victorian era when every operation, accident, cut or illness was potentially fatal.
Since the discovery of penicillin in 1928 the human race has benefited from the use of antibiotics to kill off or prevent bacterial infections. Consequently millions of people have had their lives safeguarded by the routine use of these drugs during operations or as prescribed to eliminate infections before they become serious.
But bacterium are fiendishly resilient and adaptable and a decades long race to stay ahead of their constant evolution into stronger, more resistant, strains by developing new and more effective antibiotics to keep them in check is more or less over; and the microbes won.
No new class of antibiotics has emerged from research since 1987. Meanwhile the growth of drug resistant bacterial strains has accelerated to the point where many of the antibiotics which were standard treatments only a few years ago are no longer viable against infections.
The situation has been made worse by years of over prescribing by doctors coupled with the misuse of the drugs by patients.
Bacterium effectively ‘learn’ how to resist the attacks of antibiotics by exposure to them; if a particular strain is not completely killed off by treatment it will transform itself into a more resistant strain and be on its merry way, more capable of dealing with the next antimicrobial intervention and so on, until it becomes a ‘superbug’; resistant to all known antibiotics.
Every time a patient starts to feel better and stops taking antibiotics before the full course of treatment is complete, they risk allowing a new form of the bacteria that infected them to escape and evolve before infecting the next host.
Add to this the use of antibiotics on an industrial scale in agriculture, mainly in animal feed, meaning that much of the food that appears on our plates already contains mild doses of antimicrobials which are not enough to destroy any bacteria inside us, but is sufficient to ‘teach’ a level of resistance.
All of this has been known within the medical community for many years, if not more widely publicised to the rest of us. There have been increasingly dire warnings from senior public health officials which seem to have gone largely unheeded since the most recent research suggests that the way we use antibiotics has not changed one jot in the past forty or fifty years.
This is the background to the publication of this first comprehensive review of the problem which has taken two years to compile.
It certainly pulls no punches in its prediction of a doom-laden future unless action is taken to radically change the way these drugs are used and how they are developed.
Left unchecked the report suggests that by the middle of the century (only 34 years away) more people will be dying from bacterial infections each year than currently die from all the cancers added together.
The good news is that the report committee by no means considers the problem to be unsolvable and suggests a ten-point plan:
None of these is particularly novel, most have been proposed or hinted at by public health experts in the past. It is not even the first time that a globally co-ordinated initiative has been suggested; AMR has already appeared on the discussion agenda at the UN and is on the list of future topics for consideration by both the G7 and the G20.
What the report does offer, under the chairmanship of British economist and current Commercial Secretary to the Treasury Lord Jim O’Neill, is a price tag for the enterprise.
The review suggests that the cost of taking global action on AMR would be $40 billion (around £27.5 billion) over a ten year period.
O’Neill’s plan includes massive incentives to pharmaceutical companies to concentrate their research on antibiotics including a billion dollar sweetener for every new antibiotic introduced to the market.
He points out that of the $40 billion annual global sales of antibiotics; only $4.7 billion are for patented drugs which is less than the annual return for a single cancer drug. So from a business perspective the pharmaceutical giants have no incentive to focus on antibiotics, yet.
Although the total bill for his initiative sounds expensive he also reminds us that this would represent only 0.05% of what the G20 countries will spend in total on healthcare over that ten year period.
I think everyone will welcome this thoughtful and commercially aware contribution to the discussion, particularly if it provides governments with a programme they can sign up to and ‘sell’ to their own constituents at home.
I see very little to disagree with in the fundamental principles of the plan.
I wonder, however, if we are seeing an economic market-driven focus because that’s the way the UK government (under David Cameron and George Osborne) chose to drive the argument by appointing a macro-economist (and government minister) to head the review.
What if the $16 billion that Lord Jim has earmarked for the pharmaceutical companies (anticipating the development of 15 new antibiotics over the ten year period) were to be distributed among, say, the top research and teaching hospitals and universities in the G20?
Would that not be a good way not only to address the issue at hand but to create a legacy and tradition of properly funded public research which might then be applied to other less commercially attractive but nonetheless vital programmes?
Maybe it is simply realistic to recognise profit as the only effective motivator in an industry which has repeatedly shown itself to be driven by greed above patient need and public safety, but if we are to rely upon Big Pharma as our guardian in these matters, I fully expect the final bill to far exceed anything that has been envisaged so far.
Who’s going to say no to them?
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