Antibiotics - drugs that can prevent and treat infections - are becoming less effective as a result of drug resistance. Anthony McDonnell gives an overview of the current situation and its causes, and outlines some of the actions that can be taken to prevent the rise of resistance and its catastrophic consequences

Mcdonnell, Anthony

LSE Research Online

Superbugs:	are	we	returning	to	an	era	where	bacteriaare	a	major	killer	without	a	cure?Antibiotics	–	drugs	that	can	prevent	and	treat	infections	–	are	becoming	less	effective	as	a	result	ofdrug	resistance.	Anthony	McDonnell	gives	an	overview	of	the	current	situation	and	its	causes,	andoutlines	some	of	the	actions	that	can	be	taken	to	prevent	the	rise	of	resistance	and	its	catastrophicconsequences.There	have	been	bacteria	on	this	planet	for	at	least	the	last	3.5	billion	years.	For	the	entirety	of	ourspecies’	existence	we	have	relied	on	bacteria	to	aid	us	in	breaking	down	food,	whilst	being	helpless	to	guard	againsttheir	wrath	whenever	we	had	a	bacterial	infection.	It	wasn’t	until	the	late	19th	century	that	more	powerful	microscopeslead	us	to	understand	what	bacteria	were	and	how	the	infections	spread,	in	what	was	known	at	the	time	as	‘germtheory.’Understanding	how	bacteria	made	people	unwell	led	us	to	greatly	improve	hygiene;	with	large	governmentprogrammes	to	build	sanitation	systems,	doctors	started	to	wash	their	hands	and	utensils,	and	people	started	to	drinkclean	water.	These	changes,	along	with	other	medical	innovation,	lead	to	dramatic	improvements	in	people’s	health:in	1900	one	in	every	125	Americans	were	killed	every	year	by	infection	and	life	expectancy	was	just	46;	by	1941,	ithad	risen	to	65	and	the	number	of	people	dying	annually	from	infections	had	fallen	to	just	one	in	500.	It	was	in	thisyear	that	humans	finally	took	the	upper	hand	in	our	battle	to	stave	of	infection,	when	a	research	team	in	Oxforddemonstrated	how	penicillin	can	cure	bacterial	infections.	By	1955	just	one	in	every	1670	Americans	were	killed	byinfections	annually	(the	rate	has	plateaued	since	then).Over	the	next	few	decades,	antibiotics	transformed	modern	medicine,	not	only	allowing	us	to	treat	people	who	hadbacterial	infections,	but	also	creating	a	safety	net	for	other	areas	of	medicine.	Doctors	can	now	treat	other	illnessesthrough	surgery	or	by	using	drugs	that	have	the	unfortunate	side	effect	of	greatly	lower	immune	systems	(such	aschemotherapy),	with	the	knowledge	that	if	someone	picks	up	a	bacterial	infection,	it	can	be	treated.Sadly,	however,	this	was	not	the	end	of	the	story.	Every	time	bacteria	come	into	contact	withantibiotics	there	is	the	possibility	that	through	a	process	of	natural	selection,	they	may	evolve	toevade	the	drugs,	creating	what	is	referred	to	as	‘superbugs’.	These	superbugs	can	often	not	bekilled	by	antibiotics.	They	have	altered	their	membranes	so	the	antibiotic	cannot	get	into	theircell,	developed	efflux	pumps	to	remove	the	antibiotic	from	their	system	or	learned	to	makeenzymes	that	break	down	the	antibiotic.	In	the	early	years	of	antibiotic	development	researcherswere	able	to	come	up	with	enough	new	antibiotics	to	replace	the	ones	that	we	had	lost	toresistance,	but	this	is	no	longer	the	case.	There	has	not	been	a	new	class	of	antibiotic	able	totreat	gram-negative	bacteria	since	the	1980s.	This	has	led	to	a	slowly-building	crisis	that	kills58,000	neonates	in	India	every	year	and	about	1.5	million	people	globally.	If	we	do	not	start	totake	robust	action	against	superbugs,	then	we	are	looking	at	returning	to	an	era	where	bacteriaare	once	again	a	major	killer	for	which	there	is	no	cure.In	our	recent	book	‘Superbugs:	An	Arms	Race	Against	Bacteria,’	Will	Hall,	Jim	O’Neill,	and	I	look	at	the	scientific,economic,	and	political	failures	that	have	led	us	to	the	point	where	antibiotics	are	ceasing	to	work,	examine	what	willhappen	if	we	fail	to	act,	before	outlining	the	policy	interventions	that	we	think	are	required	to	keep	us	ahead	in	thisvital	arms	race.	In	short,	we	need	to	new	antibiotics	to	replace	those	lost	to	resistance;	but	more	importantly	we	needto	slow	down	the	rise	of	resistance	by	preventing	people	from	becoming	sick,	having	better	prescription	practiceswhen	people	become	ill,	and	stop	the	environmental	pollution	from	agriculture	and	manufacturing	that	seesantibiotics	pumped	into	the	environment.All	of	these	problems	are	held	back	by	market	failures.	In	order	to	prevent	the	rise	of	resistance,	public	health	officialsoften	rightly	try	to	limit	the	sales	of	new	antibiotics	–	the	more	valuable	a	drug	the	stronger	the	impulse	to	protect	it	islikely	to	be.	This	is	problematic	because	innovators	make	greater	returns	the	more	of	their	product	they	sell	thoughtheir	patent	system,	which	uses	price	and	volume	as	a	proxy	for	societal	value.	We	need	a	new	system	for	rewardingantibiotic	producers	that	incentivise	new	drugs	without	encouraging	companies	to	oversell.British Politics and Policy at LSE: Superbugs: are we returning to an era where bacteria are a major killer without a cure? Page 1 of 2		Date originally posted: 2018-05-07Permalink: http://blogs.lse.ac.uk/politicsandpolicy/superbugs/Blog homepage: http://blogs.lse.ac.uk/politicsandpolicy/Sanitation	systems	need	to	be	improved	in	almost	all	low	and	many	middle-income	countries,	so	that	people	stopbecoming	sick.	When	we	prevent	illness	then	people	will	not	need	antibiotics.	For	example,	at	the	moment,	1.7million	children	die	annually	from	diarrhoea	or	pneumonia,	and	research	indicates	that	simply	by	getting	peopleaccess	to	soap	we	could	more	than	half	this	number.	This	is	not	just	a	problem	in	resource-constrainedenvironments:	in	the	US,	research	suggests	that	while	68%	of	people	wash	their	hands	after	going	to	the	toilet,	only5%	did	so	thoroughly	enough	to	remove	all	the	bacteria	on	their	hands.Finally,	with	diagnostics	and	pollution	we	need	to	find	ways	of	getting	decision	makers	to	internalise	the	societalbenefits	that	accrue	from	good	antibiotic	stewardship.	Regulation	or	taxation	should	be	used	to	stop	theenvironmental	pollution	of	antibiotics.	Rapid	diagnostics	can	greatly	improve	prescriber	practices,	but	there	is	a	lackof	investment	into	this	area,	and	often	when	these	diagnostics	exist	they	end	up	costing	more	than	the	antibiotics,and	so	people	do	not	use	them.	This	means	we	are	ignoring	the	societal	benefit	of	using	diagnostics	to	keepresistance	at	bay.______Note:	the	above	draws	on	the	author’s	co-authored	book,	Superbugs:	An	Arms	Race	against	Bacteria.About	the	AuthorAnthony	McDonnell	was	the	Head	of	Economic	Research	on	the	AMR	Review.	Since	then,	hehas	led	a	project	for	the	Wellcome	Trust	examining	areas	in	health	research	that	would	benefitfrom	a	greater	use	of	economics.	He	now	works	as	a	Senior	Health	Economist	at	the	NuffieldDepartment	of	Medicine,	University	of	Oxford,	researching	the	most	cost-effective	way	oferadicating	malaria	in	Africa	and	Southeast	Asia.	All	articles	posted	on	this	blog	give	the	views	of	the	author(s),	and	not	the	position	of	LSE	British	Politics	and	Policy,nor	of	the	London	School	of	Economics	and	Political	Science.	Featured	image	credit:	Pixabay	(Public	Domain).British Politics and Policy at LSE: Superbugs: are we returning to an era where bacteria are a major killer without a cure? Page 2 of 2		Date originally posted: 2018-05-07Permalink: http://blogs.lse.ac.uk/politicsandpolicy/superbugs/Blog homepage: http://blogs.lse.ac.uk/politicsandpolicy/

Superbugs: are we returning to an era where bacteria are a major killer without a cure?

http://eprints.lse.ac.uk/89967/1/politicsandpolicy-superbugs.pdf

Superbugs: are we returning to an era where bacteria are a major killer without a cure?

Abstract

Similar works

Full text

Available Versions

LSE Research Online