Why antibiotic resistance could be deadlier than cancer
I have spent much of my career at St Mary’s Hospital, in London, a short walk from the laboratory where in 1928 Sir Alexander Fleming made his epoch-defining discovery of penicillin, the first antibiotic.
Millions of lives have been saved since and the drugs were once
thought to have put an end to infectious disease. But that dream has
died as bacteria resistant to antibiotics have grown and multiplied.
Today untreatable infections, for which there is no antibiotic, cause
more than 1m deaths a year worldwide, a toll projected to rise ten-fold
by 2050, surpassing all deaths from cancer.
Radical action is needed. For only the second time in its history, the
UN General Assembly will meet this week to address this global threat
and protect humanity from falling into a post-antimicrobial era in which
simple infections kill and routine surgery becomes too risky to
perform.
A key problem is that antibiotics are too casually prescribed to people, and too widely used in animal agriculture. This happens because they are cheap and have few immediately harmful effects.
I believe we must set a bold new target: by 2030 no antibiotic should be prescribed without a proper diagnosis that identifies the underlying cause as bacterial infection.
This is an ambitious goal which will require unprecedented co-operation, significant investment in diagnostic technologies and a fundamental shift in prescribing practices worldwide, including affordable diagnostics and support from richer countries for poorer ones. There will be exceptions, such as suspected sepsis which can be life-threatening, where treatment must begin immediately. But as the speed of testing improves, the list of exceptions will shrink.
Misuse of antibiotics occurs because doctors are making treatment decisions in an information vacuum. The drugs are only effective against bacterial infections, and in primary care at least 20% of prescriptions are inappropriate. In some parts of the world patients can get antibiotics without a prescription.
This goes against a fundamental principle of patient safety: that we provide patients with the right drugs, in the right doses, at the right time, via the right route. And it sets the wrong expectations among patients that antibiotics will be readily administered regardless of the root cause.
Imagine that we had a covid-like test that could be self-administered and swiftly tell patients and clinicians what they were treating? It would be transformative.
Such tests are becoming available. In June the £8m ($10.4m) Longitude Prize was awarded to a Swedish company, Sysmex Astrego, for developing a test that within 15 minutes can detect which urinary-tract infections are caused by bacteria, and within 45 minutes reveal which antibiotic they are sensitive to.
The challenge in getting the test more widely adopted is that it is currently much more expensive (£25 privately) than antibiotics (measured in pennies). This needs to change, through a combination of scale and innovation to reduce manufacturing and diagnostic costs. At the same time, antibiotic pricing must take into account the externalities of treating and controlling resistant infection.
Diagnostics have historically been undervalued, the poor partner of the health-care system. We saw this during covid, which exposed the world’s disgracefully underpowered testing capacity. We need to change the mindset of politicians and health-care commissioners and to realign incentives, through regulation if necessary.
Giving patients easier access to diagnostic tests will also transform disease surveillance. They will provide a real-time picture of the spread of infections and the evolution of transmission and resistance patterns. This will help to prevent outbreaks with results readily available for clinicians to act on.
There is an even bigger prize: the democratisation of diagnosis. For too long it has been dependent on health-care services, not the patient. This erects barriers of access and cost.
Anyone anywhere is at risk of contracting a life-threatening, drug-resistant infection. But the crisis is worst in poor and middle-income countries and among patients with multiple medical conditions. Being able to test without the need to access clinics or other traditional health-care settings is crucial to ensuring patients have the information they need to make decisions about their health.
Point-of-care testing transformed HIV care, enabling patients to halt transmission and pre-empt the onset of AIDS by initiating treatment with antiretroviral drugs. Just as HIV became a global responsibility, so too must antibiotic resistance.
It is a unique challenge, and it cannot be controlled by science alone. New, effective antibiotics are, of course, crucial. But innovative research will be futile unless accompanied by wide-scale changes in behaviour. Crucially, we must learn to wisely use the antibiotics we already have.
We need a global movement to protect humanity from the growing threat. Public engagement is critical for an issue that poses such huge challenges.
Engaging the public is central to the Fleming Initiative, a collaborative effort to tackle anti-microbial resistance, which I chair. It will raise awareness, foster cross-disciplinary innovation in research, technology and policy, and involve patients, doctors, farmers and others in developing measures that meet local needs. This work has already begun. In April we launched a media network, CHAIN, which, among other things, produces videos that make information on resistant infections more engaging and accessible.
It is eight years since the UN first agreed to stem the growth of drug-resistant infections, but there has been scant progress since. Antibiotics have underpinned medical progress for the past hundred years. We must keep them effective to underpin all that happens in medicine for the next hundred years.
Ara Darzi, Lord Darzi of Denham, is a surgeon, director of the Institute of Global Health Innovation at Imperial College London and chair of the Fleming Initiative. He led the recent report into the performance of the National Health Service in England.
Este artículo, publicado originalmente en The Economist, se reproduce al amparo de lo establecido en la legislación nacional e internacional (ver cobertura legal).
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