By Tracey Guise and Laura Piddock, Special to CNN
Editor’s note: Tracey Guise is CEO of the British Society for Antimicrobial Chemotherapy. Laura J.V. Piddock is Director of Antibiotic Action and Professor of Microbiology at the University of Birmingham. The views expressed are their own.
It’s not surprising that international attention has been focused on the ongoing outbreak of Ebola that has struck West Africa. After all, there are few treatment options for the disease, which has a case fatality rate of up to 90 percent, and the current outbreak has been described as the deadliest outbreak in history. Indeed, Britain’s government recently held an emergency meeting to discuss the possible threat to the country, although the foreign secretary said he believes Britain has the expertise to deal with the threat.
But while Ebola is getting the headlines, another health threat has been growing across the globe, one with implications every bit as serious: the rapid rise of antibiotic resistant bacteria.
There are few of us alive in developed countries that can remember living without the unprecedented health benefits that antibiotics bring. Within a few decades of Alexander Fleming’s discovery of the antibacterial powers of Penicillium, back in 1928, healthcare had progressed more than it had in the two millennia prior to their discovery. Fast forward to today, and antibiotics are a mainstay of human health – lifesaving, life enhancing, life extending and enabling agents without which medicine as most of us know it would not exist.
As consumers, we have high expectations for our well-being, including life extending treatments for those with chronic conditions such as cystic fibrosis, successful cancer chemotherapy regimens, and organ transplant and joint replacement surgeries – we expect to receive these treatments when required and without exception. But imagine a world in which a simple scratch could prove fatal? Or even minor surgery became risky to perform? One recent study, reviewing 43,000 patients undergoing abdominal surgeries, showed that about 40 percent of patients having operations on the large intestine suffered an abdominal wound infection if they were not given antibiotics.
Sadly, these once inconceivable scenarios are edging closer to reality as health professionals across the globe grapple with a dual crisis of antibiotic resistance and a depleted antibiotic discovery and development pipeline. Together, they pose a global crisis to human health as critical as the AIDS pandemic in the 1980s and 1990s. This is not a crisis pending – it is already here.
Yet none of this should come as a surprise. Physicians and scientists have been warning of the relentless rise in the numbers of antibiotic resistant bacteria for half a century. But while dozens of reports and recommendations, including by the World Health Organization, have been published on the issue, there has been a noticeable absence of political will, which in turn has meant the public has remained largely unaware of the problem.
Meanwhile, an increasingly complex, and in turn expensive, regulatory environment for the pharmaceutical industry has meant that the development of antibiotics has become a high-risk activity with diminished returns for shareholders. As the number of pharmaceutical companies producing new antibiotics have declined, so have the number of new antibiotics reaching the market – only two systemic antibacterial agents were approved for use in humans from 2008-2012, compared to the 16 discovered from 1983-1987.
It is difficult to imagine how loud the outcry would be if there were so few new cancer treatments in the pipeline, yet the potential size of the antibiotic arsenal available to defeat a growing number of multidrug-resistant bacterial infections is troublingly small despite the efforts of organizations such as the Alliance for Prudent Antibiotic Use, CDDEP and the Pew Trust in the United States, and ReAct and Antibiotic Action in Europe. All are aware of the enormity of the task ahead, and hope that their collective messages will be received.
And their voices might finally be being heard.
The Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) was established by U.S. presidential declaration in 2009 and issued its first report in September 2012, identifying the need for intensified cooperation between the United States and Europe. In the European Union, the European Medicines Agency has been reviewing the requirements for clinical trials of antibacterial treatments. In India, meanwhile, the publication of the Chennai Declaration led to changes in Indian law aimed at ending the sale of over the counter antibiotics. And here in the U.K., the government last year published a five-year strategy on antimicrobial resistance, while in July, Prime Minister David Cameron declared the need for urgent and global action as he announced the launch of a commission on antibiotic resistance.
But while this increased interest is welcome, policymakers must match words with the kind of action that has been seen on challenges such as Alzheimer’s and obesity by ensuring similar levels of funding is in place to further our scientific base for understanding the biology, clinical and social impact of antibiotic resistance.
Governments must also do more to encourage drug development. One way of underpinning such efforts would be to assist academic and small and medium-sized enterprises (SMEs) to work together and with “big pharma” to accelerate the discovery of new ways to prevent and treat bacterial infections.
Finally, it is imperative that everyone has a clear understanding of the importance of ensuring antibiotics are used appropriately, especially as they are so commonplace – discouraging their use other than to treat bacterial infection is essential. With this in mind, education on appropriate use must include placing restrictions on the purchase of antibiotics by the general public, a widespread problem in some countries.
Former U.S. Secretary of State Henry Kissinger once famously said, “The absence of alternatives clears the mind marvellously.” This perfectly encapsulates the importance of antibiotics to health today, and we must now be bold enough to invest in the infrastructure and innovation needed to protect and replenish the antibiotic treasure trove.
We are at a crossroads, and inaction is not an option – a reality that must be acknowledged by politicians, scientists, healthcare professionals and the public alike. If we can ensure that it is, then we will give ourselves a fighting chance to make the future of global health a brighter one.