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← How can we solve the antibiotic resistance crisis? - Gerry Wright

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  1. Antibiotics: behind the scenes,
    they enable much of modern medicine.
  2. We use them to cure infectious diseases,
  3. but also to safely facilitate everything
    from surgery to chemotherapy
  4. to organ transplants.
  5. Without antibiotics,
  6. even routine medical procedures
    can lead to life-threatening infections.
  7. And we’re at risk of losing them.
  8. Antibiotics are chemicals
    that prevent the growth of bacteria.

  9. Unfortunately, some bacteria
    have become resistant
  10. to all currently available antibiotics.
  11. At the same time,
    we’ve stopped discovering new ones.
  12. Still, there’s hope that we can get ahead
    of the problem.
  13. But first, how did we
    get into this situation?

  14. The first widely used antibiotic
    was penicillin,
  15. discovered in 1928 by Alexander Fleming.
  16. In his 1945 Nobel Prize
    acceptance speech,
  17. Fleming warned that bacterial resistance
    had the potential to ruin
  18. the miracle of antibiotics.
  19. He was right: in the 1940s and 50s,
  20. resistant bacteria
    already began to appear.
  21. From then until the 1980s,

  22. pharmaceutical companies
    countered the problem of resistance
  23. by discovering many new antibiotics.
  24. At first this was a highly successful—
    and highly profitable— enterprise.
  25. Over time, a couple things changed.

  26. Newly discovered antibiotics
    were often only effective
  27. for a narrow spectrum of infections,
  28. whereas the first ones
    had been broadly applicable.
  29. This isn’t a problem in itself,
  30. but it does mean that fewer doses
    of these drugs could be sold—
  31. making them less profitable.
  32. In the early days,
    antibiotics were heavily overprescribed,
  33. including for viral infections
    they had no effect on.
  34. Scrutiny around prescriptions increased,
    which is good, but also lowered sales.
  35. At the same time,
    companies began to develop more drugs
  36. that are taken over a patient’s lifetime,
  37. like blood pressure
    and cholesterol medications,
  38. and later anti-depressants
    and anti-anxiety medications.
  39. Because they are taken indefinitely,
    these drugs more profitable.
  40. By the mid-1980s, no new chemical classes
    of antibiotics were discovered.

  41. But bacteria continued to acquire
    resistance and pass it along
  42. by sharing genetic information
    between individual bacteria
  43. and even across species.
  44. Now bacteria that are resistant
    to many antibiotics are common,
  45. and increasingly some strains
    are resistant to all our current drugs.
  46. So, what can we do about this?

  47. We need to control the use
    of existing antibiotics, create new ones,
  48. combat resistance to new
    and existing drugs,
  49. and find new ways to fight
    bacterial infections.
  50. The largest consumer
    of antibiotics is agriculture,
  51. which uses antibiotics not only
    to treat infections
  52. but to promote the growth of food animals.
  53. Using large volumes of antibiotics
  54. increases the bacteria’s exposure
    to the antibiotics
  55. and therefore their opportunity
    to develop resistance.
  56. Many bacteria that are common in animals,
    like salmonella, can also infect humans,
  57. and drug-resistant versions can pass
    to us through the food chain
  58. and spread through international trade
    and travel networks.
  59. In terms of finding new antibiotics,

  60. nature offers the most promising
    new compounds.
  61. Organisms like other microbes and fungi
    have evolved over millions of years
  62. to live in competitive environments—
  63. meaning they often contain
    antibiotic compounds
  64. to give them a survival advantage
    over certain bacteria.
  65. We can also package antibiotics
    with molecules that inhibit resistance.

  66. One way bacteria develop resistance
    is through proteins of their own
  67. that degrade the drug.
  68. By packaging the antibiotic with molecules
    that block the degraders,
  69. the antibiotic can do its job.
  70. Phages, viruses that attack bacteria
    but don’t affect humans,

  71. are one promising new avenue
    to combat bacterial infections.
  72. Developing vaccines for common infections,
    meanwhile,
  73. can help prevent disease
    in the first place.
  74. The biggest challenge to all
    these approaches is funding,

  75. which is woefully inadequate
    across the globe.
  76. Antibiotics are so unprofitable
    that many large pharmaceutical companies
  77. have stopped trying to develop them.
  78. Meanwhile, smaller companies
    that successfully bring new antibiotics
  79. to market often still go bankrupt,
    like the American start up Achaogen.
  80. New therapeutic techniques
    like phages and vaccines
  81. face the same fundamental problem
    as traditional antibiotics:
  82. if they’re working well,
    they’re used just once,
  83. which makes it difficult to make money.
  84. And to successfully counteract resistance
    in the long term,
  85. we’ll need to use
    new antibiotics sparingly—
  86. lowering the profits
    for their creators even further.
  87. One possible solution is to shift profits
    away from the volume of antibiotics sold.

  88. For example, the United Kingdom
    is testing a model
  89. where healthcare providers
    purchase antibiotic subscriptions.
  90. While governments are looking for ways
    to incentivize antibiotic development,
  91. these programs are still
    in the early stages.
  92. Countries around the world
    will need to do much more—
  93. but with enough investment
    in antibiotic development
  94. and controlled use of our current drugs,
  95. we can still get ahead of resistance.