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Author: Gerry Wright, Professor of Biochemistry and Biomedical Sciences, McMaster University
I grew up believing in the forward trajectory of progress in science and medicine – that human health would continue to improve as it had for hundreds of years. As I progressed through my own career in health sciences, I continued to be optimistic.
Now I have serious doubts.
Science is still working well, but deadly obstacles blocking the way between research and progress in the field where I work: Antibiotics.
The Threat to Humanity is Worse and More Worse by the Day, but for reasons that Escape my colleagues and me, there seems to be shockingly little collective will to do much about it.
This week (Nov. 12-18) is World Antibiotic Awareness Week. We need to talk about this Threat. We need to develop models of public-private co-operation – to incentivize, fund and invest in antibiotic drug Discovery and development.
Penicillin led to complacency
Here's the problem: about 75 years ago, science brought penicillin into public use, opening a new era in infectious disease control, much as Sanitation had done before that. Infectious diseases such as pneumonia and strep, which had commonly been fatal even in my grandparents' day, were tamed – at least for a while.
In the generations that followed, life expectancy leapt by 25 years and infectious disease tumbled from its No. 1 one spot among all causes of human death, where it had consistently ranked higher than bullets and bombs – even during the World Wars.
With Cheap, Abundant and Effective Antibiotics at hand, people in the developed world became complacent about controlling infection.
But this whole time, while we have been living our better, longer lives, infectious diseases have been working on a comeback, and today they are pounding at the door. In fact, they're already breaking down the door.
Market will not meet demand
In a fast-forward example of Darwinian adaptation through natural selection, Bacteria and other microbes are evolving to Survive Antibiotics. They will continue to adapt and they will succeed unless Humanity builds new layers of defense in the form of new Antibiotics and other creative approaches.
Governments of the world recognize the crisis, as they affirmed at a special high-level meeting of the United Nations General Assembly in 2016 and at the G20 in 2017.
The worst part is that we know what we have to do to create new antibiotic Therapies, and although the work is undeniably difficult, there are already some promising new alternatives to older drugs, and more are in the pipeline.
Unfortunately, they are not yet available on the commercial market, and they may never get there unless something changes to make them viable – not as drugs, but as Commodities.
The critical impediment to producing new antibiotics turns out to be our own economic model, which trusts the market to meet the demand. The Invisible hand, as philosopher and economist Adam Smith called it, is not working here, and what's at risk is all the progress that Antibiotics has made possible.
Public model is risky
This past summer in the United States, two pharmaceutical companies earned FDA approval for new antibiotic compounds. As soon as the markets learned those companies had created drugs that could literally save the world, their stocks fell.
Sounds counter-intuitive, does not it? It turns out that spending hundreds of millions to create, test and market a new drug is a bad risk unless the drug can earn back the investment within the 20 years before its patent expires.
That's hard to do when you're trying to recover a 10-day prescription at a time. And when you're prescribing the new drug just for infections that can not be resolved with cheap, traditional Antibiotics, which still work in many cases.
The only way it would make sense of business to create new antibiotics would be to make them astronomically expensive, in the range of rare cancer drugs, and who would pay for that?
Many argue that we should look at Antibiotics the same way we look at fire departments. As individuals, we may never need them, but we are all willing to share the cost, because we expect them to be there.
A public model seems to have a sense, but who will take the political risk?
Hospitals under Threat
Without an intervention – where the public, through their governments around the world, cooperates with the private sector to help stimulate, fund and invest in antibiotic drug Discovery and development – the end of effective antibiotics will be frightening.
It will happen gradually, but it will certainly happen. The first stages are already in the form of multi-antibiotic-resistant infections that threaten the basic function of Hospitals.
Next, we will see common procedures such as dental hygiene appointments and joint replacement surgeries permanently canceled due to the risk of infection.
People of all ages will begin to die again from illnesses that we have become used to treating with $ 10 or $ 20 worth of pills. Those who do not die will be sick more often and for much longer, driving up the cost of care.
Life expectancy could fall back to where it was in the early 1900s, and the golden age of Antibiotics would prove to have been but a brief, happy blip in history.
It does not have to be this way. Let's turn our awareness into action.
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