Antibiotics have been a major driving force in the reduction of incidence of infectious diseases, and therefore in the development of living standards all over the world. However, bacteria are capable of adapting and developing resistance to antibiotics in a short time, which means that new drugs are constantly necessary to keep diseases from spreading. In the past few years, in large part due to misuse of antibiotics, the rate at which they become obsolete has greatly increased. This is aggravated by big pharmaceutical companies leaving or radically reducing attempts to discover new drugs to place in the market, and genomic research failing to deliver new products. This is a problem that needs to be tackled on a wide scale, involving cooperation between business, government and research institutions.
Consider for a moment how deep and wide-reaching the consequences of lacking antibiotics would be. Obviously, epidemics would rise and once again kill millions of people, severely impairing any chances of social or economic development. Tuberculosis would again spread (this is particularly worrying: the World Health Organisation estimates that, between 2000 and 2020, it will infect one billion people and kill 35 million). Pneumonia would once more become a common cause of death, particularly amongst older people. Sexually transmitted diseases would become much harder to cure, causing a number of serious health problems including ectopic pregnancies and a rise of infertility. Organ transplants - or even a surgery as commonplace as removing a burst appendix - would become virtually impossible. (Boseley, 2010, 1)
This apocalyptic scenario – returning to the situation we were in during the pre-antibiotics era, only with a much higher population concentrated in smaller spaces, (which facilitates the rise in epidemics) - might not be far away if nothing is done to avert it. In 2004, it was estimated that over 70% of pathogenic bacteria were resistant to at least one of the current available antibiotics. A number of ‘super bugs’ – resistant to most of the clinically used antibiotics – have also emerged. For instance, S.aureus, a bacteria which has developed resistance to methicillin, is estimated by the Infectious Disease Society of America to be responsible for half of the hospital-associated infections, killing 100 000 people a year in USA hospitals alone. (Demain, 2009)
How has this situation come to be? As bacteria evolve and adapt to changes in the environment, it is no surprise that new antibiotics are regularly needed. However, in the last few decades, the pace at which they adapt has become much faster, and ‘super-bugs’, resistant to most antibiotics, have become more common. This is related to misuse of antibiotics driven by economic reasons. Over half of the antibiotics used in the world are not used to cure disease, but in animal feed, because they work as growth promoters and make it possible to avoid the spread of diseases in conditions in which many animals are kept in a small space. (McVeigh, 2012) This means that we are daily being fed with antibiotics – and unaware of this fact.
To aggravate the issue, since the 90s, most of the big pharmaceutical companies have either completely abandoned antibiotic development (for instance, Roche, Merck and Abbott) or significantly cut down their investment in the area. Instead, they have invested in creating drugs for chronic diseases, which, as they need to be taken for extended periods of time, provide a much better revenue stream than antibiotics, used in short treatments. In addition, regulatory requirements for new antibiotics have become much stricter, greatly increasing the cost of their development. In particular, in the clinical trials phase, their patents last a relatively short time, and new drugs are often reserved for special cases. All this has increased the cost of inventing new antibiotics, making it less appealing than it once was from a business perspective. (Ragnar Norby et al., 2005)
It seems then that economic factors and the drive for profit are behind what may come to be a very serious problem worldwide. To avoid collapse in healthcare, we need to act on the causes of the problem.
First of all, it would be important to regulate the use of antibiotics which are medically important to cure human disease as growth promoters in animal feed (McVeigh, 2010), and also to enforce stricter guidelines on prescription. This could potentially slow down the appearance of ‘super-bugs’, but it doesn’t tackle the problem of lack of production of new antibiotics.
To do so, the main players in this problem – big pharmaceutical and small biotechnology companies, governments and hospitals, and research centres and universities - must be targeted. Better communication between them – for instance, cooperation between research groups and pharmaceutical companies to make the production of new antibiotics cheaper and faster – is an important factor. It may also be important to research if the legal requirements for putting new products in the market can be reduced in a way that makes that process cheaper for companies while keeping it safe for patients. (Ragnar Norby et al, 2005)
In the USA, the IDSA has suggested changes in legislation, such as patent extension, and measures such as tax incentives, to encourage the production of new antibiotics. (Ragnar Norby et al, 2005) Others (Boseley, 2010, 2) have suggested that the key step is to reward hospitals and drug companies for what they do to keep antibiotics effective, for instance by taxing drugs to reduce prescription and investing the revenue into the production of new antibiotics.
This is a very complicated issue, for it involves a large number of organisations and economic factors need to be considered in conjunction with human impact. It is clear, however, that this is an urgent problem whose solution will require a global plan involving investment, cooperation, and regulation. Further, it illustrates that the drive for profit found in business must be combined with a serious and responsible consideration of its human and social impact.
References:
BOSELEY; Sarah, 2010. Are You ready for a world without antibiotics? The Guardian (online), 12 August 2010 (28th February 2012) BOSELEY; Sarah, 2010 (2). A Radical Plan to Save Antibiotics. The Guardian (online). 7 September 2010. (28th February 2012) DEMAIN, A.L., SANCHEZ, S., 2009. Microbial Drug Discovery – 80 years of progress. The Journal of Antibiotics. 62, 5-16.(28th February 2012) McVEIGH, K. 2012. Scientists: Overuse of Antibiotics in Animal Agriculture Endangers Humans The Guardian (online), 19 September 2012 (28th February 2012) OVERBYE, K.M., BARRETT, J.F., 2005. Antibiotics: Where did we go wrong? Drug Discovery Today, Volume 10, Issue 1, 1 January 2005, Pages 45–52 (28th February 2012) RAGNAR NORBY, S., NORD, C.E., FINCH, R. for the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), 2005. Lack of Development of New Antimicrobial Drugs: a Potential Serious Threat to Public Health. The Lancet Infectious Diseases, Volume 5, Issue 2 February 2005, Pages 115–119 Available at: (28th February 2012)