This article was originally published in The Conversation, an independent and non-profit source of news, analysis and commentary from academic experts. The disclosure information is available on the original website.
Author: Gerry Wright, Professor of Biochemistry and Biomedical Sciences, McMaster University
I grew up believing in the advanced trajectory of progress in science and medicine – that human health would continue to improve as it had hundreds of years ago. As I progressed in my own career in health sciences, I remained optimistic.
Now I have serious doubts.
Science is still working well, but deadly obstacles are blocking the path between research and progress in the field where I work: Antibiotics.
The threat to humanity is serious and worsens every day, but for reasons beyond me and my colleagues, there seems to be little collective will to do much about it.
This week (12-18 November) is the World Antibiotic Awareness Week. We need to talk about this threat. We need to develop models of public-private cooperation – to encourage, finance and invest in the discovery and development of antibiotic drugs.
Penicillin led to complacency
Here's the problem: 75 years ago, science took penicillin to public use, opening a new era in infectious disease control, just as sanitation had done before. Infectious diseases, such as pneumonia and streptococcus, which were commonly fatal until my grandparents day, were tamed-at least for a while.
In later generations, life expectancy increased by 25 years, and infectious diseases plummeted from their prime among all causes of human death, where they consistently stood above bullets and bombs – even during the World Wars.
With cheap, plentiful and effective antibiotics, people in the developed world have become complacent about controlling the infection.
But all this time, as we live our better and longer lives, infectious diseases are coming back and today they are knocking on the door. In fact, they are already breaking into the door.
Market will not meet demand
In a quick example of Darwinian adaptation through natural selection, bacteria and other microbes are evolving to survive antibiotics. They will continue to adapt and succeed unless mankind builds new layers of defense in the form of new antibiotics and other creative approaches.
Governments around the world recognize the crisis, as they said at a special high-level meeting of the United Nations General Assembly in 2016 and the G20 in 2017.
The troubling part is that we know what we have to do to create new therapies with antibiotics, and although the work is undeniably difficult, there are already some promising new alternatives for the older drugs, and more are in the pipeline.
Unfortunately, they are not yet available in the commercial market, and they can never get there unless something changes to make them viable – not as drugs but as commodities.
The critical impediment to the production of new antibiotics turns out to be our own economic model, which relies on the market to meet demand. The invisible hand, as the philosopher and economist Adam Smith called it, is not working here, and what is at stake is all the progress that antibiotics have made possible.
Public model is risky
Last summer in the United States, two pharmaceutical companies received FDA approval for new antibiotic compounds. As markets discovered that these companies had created drugs that could literally save the world, their stocks fell.
It seems counterintuitive, 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 recoup the investment in the 20 years prior to the expiration of its patent.
It's hard to do this when you're trying to recover the cost of a recipe 10 days at a time. And when you prescribe the new drug only for infections that can not be resolved with traditional and cheap antibiotics, they still work in many cases.
The only way it would make sense to create new antibiotics would be to make them astronomically expensive in the range of rare cancer drugs, and who would pay for it?
Many argue that we should look at antibiotics the same way we look at firefighters. 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 make sense, but who will take the political risk?
Hospitals under threat
No intervention – where the public, through its governments around the world, cooperates with the private sector to help encourage, finance and invest in the discovery and development of antibiotic medicines – the end of effective antibiotics will be scary.
This will happen gradually, but it will certainly happen. Early stages are already here in the form of antibiotic-resistant infections that threaten the basic function of hospitals.
Next, we will see common procedures, such as oral hygiene consultations and joint replacement surgeries, permanently canceled due to the risk of infection.
People of all ages will start dying again from diseases we get used to dealing with $ 10 or $ 20 pills. Those who do not die will get sick more often and for much longer, raising the cost of care.
Life expectancy could go back to where it was in the early 1900s, and the golden era of antibiotics would prove to have been only a brief and happy story in history.
It does not have to be this way. Let's turn our consciousness into action.
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