Can we avoid an antibiotic apocalypse?
What are the biggest future dangers faced by the western world? If asked that question, most people might mumble “terrorism”, “climate change”, “debt crisis” or “cybercrime”. But if Professor Dame Sally Davies, Chief Medical Officer for England, is correct, there is another terrifying issue looming over all of us: the growth of antibiotic resistance.
In her recent book The Drugs Don’t Work, Davies explains that seven decades ago western doctors started using antimicrobials such as penicillin on a large scale to combat infections. Since then, we have all become accustomed to relying – unthinkingly – on these wonder drugs. But although they have transformed our lives, there is a catch. Since the drugs are so widely used – if not abused – the bacteria they fight are now mutating and becoming resistant.
The drugs companies, meanwhile, are not creating new antimicrobial medicines that could beat the bugs. As a result, we are moving towards a world where, within a generation, the drugs simply may not work any more. Modern medicine could lose the ability to combat many illnesses or infections. This sounds so horrifying it seems hard to imagine, and most people (myself included) rarely ponder this issue at all. But the problem is not merely theoretical. Davies calculates that about 25,000 people a year are already dying from drug-resistant bacteria in Europe – and the toll is similar in the US. “That is almost the same number as die in road traffic accidents,” she points out.
The only thing more startling than this is just how little response it has sparked among governments and voters. The figures that Davies is citing are hardly a dark secret: data are routinely being published on health websites. And Davies could hardly be described as a maverick – she has written her book while sitting in Whitehall, at the very heart of British government.
Even from that elevated position, the vivacious, no-nonsense Davies admits that she is finding it extraordinarily difficult to get people to care. She recently won one small victory, persuading the UK government to put the antimicrobial issue on the official “risk registry”. And next week, a host of bureaucrats and ministers will be holding international meetings to discuss the problem in places such as Doha and Rome.
There have also been some initiatives to change behaviour. British hospitals have recently cut reported incidences of MRSA – one drug-resistant bug – by improving hygiene on wards (for example, by insisting staff wash their hands).Countries such as France have reduced antibiotic usage through a public health campaign. The use of antibiotics in agriculture is being curbed in countries including Denmark and Norway. This area is critical, since overuse of these drugs is linked to the fact that western farmers routinely feed vast quantities of antibiotics to animals and fish in order to make them grow faster and more healthily. (Astonishingly, agriculture accounts for some 80 per cent of antibiotic usage in the US.) However, in Norway, fish-farmers have recently stopped tipping antibiotics into their tanks; apparently they are now immunising the fish individually instead.
While these moves are laudable – even if the idea of injecting individual fish boggles the mind – they remain slow. The problem that dogs the antimicrobial fight also overshadows finance and the climate change debate: namely the “agency” dilemma, or the fact that individual actors have little incentive to clean up their act if no one else is doing the same. Drugs companies don’t want to develop new antibiotics because these tend to lose their efficacy so fast. Or as Davies notes:
“No new class of anti-bacterial has been developed since 1987 . . . partly because companies can no longer make enough money out of antimicrobials to justify investing in the research needed.” Individual hospitals and doctors face pressure from patients to dole out the wonder drugs or, in some countries, lose business.
Separate governments seem reluctant to impose curbs without co-ordinated moves (after all, borders do not contain drug-resistant bugs). And voters are not demanding reforms now, since the issue is complex and considered “tomorrow’s problem”, as Davies says, with an “inherent tension between the generations”. Today’s adults want the drugs but it is future generations who will suffer most from overuse.
Everyone in medicine knows that there is a problem but many seem wearily resigned to the fact that change will not occur until there is a real crisis – that is, a drastically higher number of deaths. In that sense, it all seems horribly reminiscent of the way that problems built up in the financial system a few years ago. And that is a chilling point to ponder; particularly as we all brace ourselves to deal with this winter’s wave of cold and flu bugs.
‘The Drugs Don’t Work: A Global Threat’ by Professor Dame Sally Davies, Dr Jonathan Grant and Professor Mike Catchpole is published by Penguin (£3.99)