Alexander Pannett 12.15pm
Professor Dame Sally Davies, the Chief Medical Officer, has published an annual report that has made headlines by claiming that the rise in drug resistant infections is comparable to the threats of global warming and terrorism. She has called for the threat to be listed on the government’s National Register of Civil Emergencies.
The report highlights that, while a new infectious disease has been discovered nearly every year over the past 30 years, there have been very few new antibiotics developed to counter-act diseases that are evolving and becoming resistant to existing drugs.
This means that routine operations could soon cause infections that may prove fatal. Modern advances in health could be reversed as hospitals again resemble the mortality-stricken abattoirs of Victorian times.
We are already seeing this crisis unfolding throughout hospitals in the UK. The MRSA superbug made headlines with its prevalence amongst hospitals and resistance to antibiotics. MRSA has since been tackled by improved hygiene procedures at hospitals. But its presence heralds the threat of the worse that will come unless urgent action is taken now by world health authorities.
In evidence to the science select committee in late January, Professor Davies told MPs that the supply of new antibiotics had collapsed, and that the market model for delivering new antibiotics was broken.
New drugs are potentially a useful solution against resistance, but the drugs are often not available. Drug companies are not interested in developing a drug that, with widespread use, could be obsolete long before it has turned a profit; or a drug that is so effective that it is reserved as a final solution. New antibiotics that are developed are slight variations of existing drugs. Some classes of bacteria are not getting any new antibiotics at all.
An additional problem is that bacteria evolve at such a rate that any new antibiotic that is developed has only a short window in which it will work. In fact our very use of antibiotics encourages the development of resistant bacteria. Resistant bacteria may be rare, but rare mutations benefit the most when drugs kill off their competitors. Tests on mice with malaria have shown that the susceptible strains of bacteria win out over the resistant strains in the absence of antibiotics. However, after treatment the resistant strains re-develop at a faster rate and in greater numbers. The boost was biggest for mutant bacteria that were rare to begin with.
This, combined with the knowledge that governments are actively attempting to keep antibiotic prescriptions to a minimum, disincentivises pharmaceutical companies from investing in new drugs.
One answer is to develop new business models to encourage the development of new antibiotic drugs. Regulations can also be relaxed to allow pharmaceuticals to rush out antibiotics after targeted sample tests rather than the more lengthy current testing requirements.
However, for now the most immediate answer to alleviate the impending crisis is to restrict the use of antibiotics to only the most pressing of needs. The course of antibiotic treatment should be re-evaluated to limit the use of antibiotics to shorter durations where possible and eliminate antibiotic use where it is not necessary, such as viral infections and use in livestock. Better hygiene methods should also be used to prevent infections.
The growing resistance to antibiotics is a timely reminder that we must constantly review the tools we use to maintain a healthy society. Each of us has an obligation as members of a community to ensure that the advances we have made are bequeathed to future generations. The medical progress that has made life-saving operations a common feature of modern societies is a vital social imperative we must not surrender.
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